It's Raining Doctors

Well, according to an analysis by Malaysian Medical Association (MMA), we should be expecting a glut of doctors soon based on current trends. The MMA annual report for 2004 states taht at the current rate of growth, there will be a surplus of about 4,000 doctors by 2020. The New Straits Times reported that Datuk Dr N. Athimulam, the chairman of MMA's committee on medical education

observed that 1,200 new doctors graduated annually from local institutions, with seven more institutions of higher learning going to offer medical courses in the next few years.

Dr Athimulam said universities in Ukraine and Russia were producing about 15 to 20 Malaysian doctors now, but several hundred students were in their third, fourth and fifth years of study.

According to Dr Athimulam, the doctor-population ratio will rise from 1:1,361 to 1:400 by 2020. This, in theory is an extremely "commendable" ratio, comparable to the developed countries. However, while Dr Athimulam's concern is understandably the fact as "competition gets tougher... [n]ew doctors entering the market [will find] it hard to stay in the business", my personal concern is the quality of doctors and health service we will receive in the near future.

Dr Chris Anthony from Butterworth wrote in his letter to NST today, that the number of medical schools in Malaysia (17) "exceeds the number of medical schools in Singapore (one), Canada (16), Ireland (five) and Australia (11)."

He went on to criticise the local medical schools on two key points:

In the enthusiasm for increasing the number of doctors quickly, we have overlooked the two important prerequisites for the training of doctors. They are, first, adequate numbers of experienced qualified teachers who themselves are practising clinicians and a well- equipped teaching hospital.

If one were to scrutinise our medical schools, both public and private, hardly any of them fulfil these two criteria.

As it is, we have already heard comments on the quality of some of the output from the private medical schools leaves plenty to be desired. Director-general of Health Datuk Dr Ismail Merican said that there are many doctors in hospitals "who did not have clinical skills such as patient care, familiarity with the signs and symptoms of diseases, diagnosing illnesses, and doctor-patient communication" and focused his criticisms on the insufficiency of clinical training by many private colleges. See blog post here.

To compound my concerns on the quality, it was highlighted above that we are expecting a drastic increase in medical graduates from Ukraine and Russia in the coming years from the usual 15-20 graduates per annum currently. Once again, with all due respect to the universities in Ukraine and Russia, their education system in general do not inspire too much confidence. In addition, I understand that the universities which most Malaysians attend over there are often not the top universities of those countries. From what I dare speculate, these universities are merely taking the opportunity arising from excessive demand for medical education to gain valuable foreign exchange. It does appear that sometime down the road, it will become necessary for me to sight the qualifications of the doctor first before allowing myself to be examined by him or her.

As highlighted in the previous posts, MMA has as far back as 2002 called for major reforms and improvements to our local medical education system.

The Malaysian Medical Association (MMA) has raised, as far back as 2002, concerns with regards to the rapid increase in private medical colleges in Malaysia. They have raised their concern on the lack of trained and qualified lecturers, the worrying lecturer-student ratios in excess of 1:25 compared against 1:5 in the National University of Singapore as well as the non-standardisation of medical curriculum and examinations resulting in uneven standards, among other issues.

More critically, the Ministry of Higher Education should play a larger role in setting the necessary entry requirements and standards for the selection of students in all private medical colleges to prevent these colleges from placing their commercial interests above that of producing quality doctors.

In an issue which I'll blog about in another post, I'm extremely concerned that the Ministry of Higher Education has to date leaned heavily towards the commercialisation and privatisation of higher education in Malaysia, to the extent that the interest of the students, the public and the country in general has not been properly taken into the account.

Hence, it's unsurprising that Dr Athimulam urged the Government to "go slow" on permits for institutions of higher learning to conduct medical courses before it comes to a stage whereby we have "unemployable" doctors as well.

See also other related posts "Medicine: A Calling" and "No Cure for Medical Schools".