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THE NEED TO SPECIALISE, SPECIALISE AND SPECIALISE IN THIS MODERN ERA FOR MEDICAL GRADUATES
Prof Sachchithanantham Kanagasabai FRANZCOG, FRCOG, FACS, FICS DIMH MBBS & Dr.Devinaga Rasiah
A Senior Gynaecologist ,academician teacher, editor & author of multiple text books and clinical articles having spent 32 years training post graduate students locally and abroad tells his story of his fervent rhetoric as why the medical doctors of today need to specialize and is most qualified to do so.
The yesteryears
I suspect that when i go down memory lane back to the seventies when I joined the medical career that most current medical graduates are not aware that the medical practice in this country was managed by the medical officers and a few specialists. The Local specialists were few in number and the rest were mostly expatriates from India and Burma, perhaps one to a unit and none in fields like pediatrics and ENT, and their scarcity led to on many occasions for the less qualified to do the decisions on their behalf .However it cannot be denied that the medical officers of the era were well trained that they would duplicate the activities of their superiors and rise to the occasion to provide exemplary treatment
It was during the eighties when both critical medical education and health care reforms were developing throughout the country and abroad. The early post-graduation was done by doctors from this country obtaining their FRCS (general surgery /ophthalmology,orthopaedics was part of General Surgery), MRCOG and MRCP from the United Kingdom. These physicians who were formally trained were mostly educated in the schools of England and Scotland, and to a lesser extent in Europe. Many were graduates of the University of Edinburgh’s School of Medicine, which, during the 18th century, was considered to be one of the leading medical schools in Europe, if not the world. Hence, this school had great influence on medical practice throughout the world, and even into the early 19th century.
It was in the early eighties that the first postgraduate programme in orthopedics was drawn up the National University of Malaysia as its inception and hence examined the rise of specialization and the establishment of other specialties in the two premier Universities in Kuala Lumpur. Although initially the programmes were limited to a few candidates in view of the limited number of specialties, it paved the way for the development of residency programs throughout the Country during the period 1990 to the present. Today there are five Universities offering postgraduate studies
Current scenario
This article published: August 19, 2013 reiterates the country’s needs
Malaysia needs more medical specialist, says Health minister
Despite an increasing number of medical graduates, the country is facing a shortage of specialist doctors. Today’s statistics from Health Malaysia 2012 mentions that there are a total of 38,718 doctors practising, 27,478 in the public sector and 16,240 doctors in the private sector.
It cannot be denied that approximately 6% are specialists in the public sector and the numbers are dwindling as migration in large numbers to the private sector due to better remunerations by the private sector .The private hospitals are currently numbering 220 when compared to public hospitals which number 138.Ironically the private sector sees approximately 4 million patients compared to 49 million in the public sector.
To address this shortage of specialists currently, about 500 to 600 doctors are sent for training each year to become specialists every year. This has been an ongoing feature for the past twenty years .It is not the numbers that go for training which are of concern, but the dropouts from this programme is of concern, so the final numbers produced is not sufficient to address the pending crisis now and in the near future.
Apparently doctors who can specialise in cardiothoracic, hepatobiliary surgeries and other new infectious, lifestyle and chronic diseases are in dire need the most.
The country currently has 36, 607 doctors including specialists with a doctor population ratio of 1:791 based on the estimated population of 34 million.
The Ministry is hoping to have 85,000 doctors by 2020 to reach the standard ratio of 1:400 by 2020. It may be obvious why medical officers are reluctant to embark on a post-graduation, likewise the reasons for doing post-graduation too are pretty obvious. What is pertinent at this junction is to address the reasons for reluctance so that we can hope for a large cohort of specialists in the various discipline to man the needs of the country.
REASONS FOR RELUCTANCE TO SPECIALIZE.
1. The long trying hours at housemanship resulting in loss of passion for medicine. Eventually work becomes a chore and not relinquished, resulting in disappointment of having chosen the medical profession.
2. The perception that Specialisation requires long devoted time, unable to make time in this modern era when other priorities take precedence, like getting married and having children.
3. The current salaries being paid for housemanship and Medical officers are handsome and having achieved a sense of positioning in society with this economic satisfaction reached deprives one to further continue with further studies.
4. Lack of motivation by peers, seniors and Mentors. Apparently the mentors of today need motivation in view of the large numbers of litigation faced by them
5. Not a priority at this juncture inevitably resulting in postponement to make a decision
6. No guidance from established institution especially Universities to show ways and means of securing information to pursue postgraduate studies.
7. The Medical officer applicant need to be confirmed in service when applying and after submitting the application, he may not be selected.
8. Recurrent applications for post-graduation to universities which can be turned down further aggravating the situation.
9. A genuine reason being encouraged to take over the family practise
REASONS WHY ONE SHOULD SPECIALISE
1. Sense of being doyens of their respective discipline
2. The pride, grandeur and leadership of being a specialist should be a strong motivating factor
3. No senior medical officers in the respective unit should be left to idle, owness is on the senior consultant to motivate, provide study leave, monetary benefits for attending courses and admire their success.
4.From the perspective of return of investment, Specialist in public sector have easy access to promotions and a Superscale C ‘s take home with allowances can easily be in the region of 23K.The prospect in the private sector could range from 50k to100k.
5. If one does not qualify for the local postgraduate programme, it would be easy to start studying for the British Post graduate in MRCS, MRCP, MRCOG, MRCP (Paeds), Radiology in selected hospitals etc.
6. Those who want to migrate or work overseas would fear better if one has a foreign post graduate degree.
7 Ultimately the country needs a large number of specialists in view of the large number of patients who attend the public hospitals
CONCLUSION
The above recommendations are perhaps long term measures to get more specialists .However in order to fill the void, get the medical specialists trained overseas to return home .This may require the Government to have salary revisions to attract them. The second option would be to increase the number of post graduates admitted for training. This certainly would require the cooperation of the Universities .The third option would be for Government to approach the Private medical colleges to initiate their own post graduate programmes. Lastly collaboration with the Royal Colleges abroad to have local training programmes which can be accredited.
If one fails to embark on a postgraduate programme sooner or later there is a high probability of ending up as a glorified medical officer at the hospital. Subsequently anger, disappointment and frustration will get the better of one, forcing these officers to the private sector as a general practitioner where the challenges can be insurmountable.
