Calling all Malaysian doctors in the UK

Just as I was highlighting medical students as an 'at risk' occupational category, the dean of the UKM medicine faculty, Prof Dr Lokman Sain, hits back at the lack of opportunities for Malaysian doctors in Britain.

I have to give the dean credit for responding so quickly to the UKEC preliminary report. It was a proactive approach given that he would have been asked to comment on the specific situation of medical students studying overseas. Since perception or image is often as important (if not more so) than reality, it was good of him to come out and point out that Malaysian doctors who come back home can get better training opportunities compared to overseas doctors. It was also honest of him to come out and state that pay differentials was clearly one of the main reasons why Malaysian doctors who are overseas don't want to come back home. Even though most of us know this to be true, not many politicians have the guts to come out and say it straight out.

But we have to take his comments with a pinch of salt since journalists don't often report comments in full and sometimes take comments out of context. For example, the report stated that Prof Dr Lokman Sain was visiting students in Ireland and not Britain. This might have made a difference since Malaysian doctors praticising in the UK might have more opportunities open to them in London, Manchester and other major teaching hospitals given that there are more major cities and teaching hospitals in the UK compared to Ireland, which has a much smaller population.

We also have to weigh his following comments carefully:

“The information is misleading as some people will think that it is easier to become specialists in Britain but it is indisputable that we produce more specialists – about 400 specialists a year from UKM, Universiti Malaya and Universiti Sains Malaysia, compared to the 50 or so who come back from Britain every year,” he said.

Is he saying that of the Malaysian doctors who stay in the UK, only 50 or so manage to become specialists every year? Or is he saying that of only 50 or so who have managed to become specialists come back home to Malaysia every year? Both have different implications. The first is largely supportive of his argument. The second might not be. For example, there might be 50 or so specialists which come back to Malaysia every year but another 300 to 400 who become specialists and stay put in the UK. His statement seems a little unclear. (But if there are 50 specialists or so who come back from the UK to Malaysia, I think that's a good thing and worth investigating further e.g. by asking them why they came back instead of staying put in the UK)

I don't know the number of Malaysian doctors who are training to be specialists in the UK and Ireland at the moment but my sense is that the number of them becoming specialists in a year is probably closer to the 50 number rather than the 400 number for the 3 local varsities referred to by Prof Lokman Sain.

But is it the number of specialists or the proportion of specialists which is of greater importance here? For example, if only 400 out of 1000 (40%) of those intending to be specialists actually make it in the local varsities compared to 50 out of, let's say 100 (50%), in the UK, wouldn't it be more attractive to pursue a specialist career path in the UK? Or shouldn't we consider the total number of specialists that the UK produces each year versus the total number of specialists that the local varsities produce each year instead of comparing the total number of Malaysian specialists that the UK produces each year versus the total number of Malaysian specialists which Malaysia produces each year? If there are a larger number of specialists being produced in the UK, does it mean that a Malaysian doctor has a better chance of becoming a specialist in the UK?

I'm not a doctor but I would appreciate it greatly if someone who knows can enlighten me and the rest of our readers as to the thought process that an aspiring specialist goes through as he or she considers his or her options.

Another point not brought up directly by Prof Lokman Sain (or perhaps not reported) is that there might be certain facilities or resources or networks or faculty that a certain aspiring specialist has access to in the UK context which he or she would not have in the Malaysian context. For example, there might be a specific area of cancer that an oncologist might be interested in for which there are only a handful of people with the pre-requisite cutting edge knowledge, none of whom are in Malaysia. Of course, the opposite situation might also occur in that there might be expertise in the Malaysian context that are not available in the UK context, perhaps for certain diseases that are more prevalent in Malaysia compared to the UK. Again, I'm not a doctor so I wouldn't know. I'd just like to point out these possibilities.

I also want to question the following statement made by Prof Lokman Sain:

“Many of our doctors have been sent to the smaller peripheral hospitals as they couldn’t get into the major hospitals in Dublin and Cork,” he said.

Is there any way to guarantee that a doctor coming back to Malaysia won't be sent to a 'smaller peripheral' hospital in Kota Bahru or Kuala Terengganu or Raub? Is there some sort of guarantee that a Malaysian doctor who is trained overseas will be sent to a hospital in Penang or KL and that only locally trained doctors will be sent out to the more rural areas? I doubt it but perhaps someone more in the know would be able to enlighten us.

I gave the earlier example of a friend who graduated from the University of Melbourne, got sent to Kota Bahru and promptly quit after 2 weeks primarily because of poor working conditions. He's now a GP in Singapore. It sounded eerily simliar to the situation described at the end of the Star report by a houseman working in a local hospital.

“For example, yesterday I was forced to work for close to 36 consecutive hours, with only 15-minute breaks for meals,” he said.

Finally I want to address a possibility not touched by Prof Lokman Sain. He stated that many Malaysian doctors he met in Ireland were stuck there as junior housemen and denied promotions as priority was given to European Union doctors. Is it possible that some Malaysian doctors fear that they might face discimination of a similar kind if they come back to Malaysia? Again, I'm not sure of the promotion process in the local hospitals but if the promotion process in the local universities are anything to go by, then I think it's a relevant point to raise.

It's good marketing and a proactive approach on the part of Prof Lokman Sain. But we need to look deeper into the numbers and the issues if we are to understand the situation of non-returning doctors better and to try to find possible remedial solutions.