A ploy to extend doctors’ service

I read in the Sun Newspaper Letter Section today this excellent letter by Dr Adrian Wong.

The announcement by Health Minister Datuk Seri Dr Chua Soi Lek that housemanship will be extended by one year is nothing more than a ploy to covertly extend the government service of doctors to five years.

The quality of our doctors has never been dictated by the length of training as housemen. There is no guarantee that doctors who have gone through two years of housemanship will be better trained than those who have gone through only one.

Medicine is a continuous process of learning, making mistakes and learning from them. It continues long after a doctor finishes his/her housemanship. The fact that a portion of that process is called the housemanship is really a matter of semantics. After a doctor finishes housemanship, he/she still has to complete another three years of government service. Their training does not stop the second their housemanship is over. It goes on as they serve in the government, and long after they finish that long mandatory public service.

Even if it’s convinced that a longer housemanship is required, the ministry should reduce the length of government service by a similar period. This is the practice at some hospitals which have implemented an extended housemanship where the doctors go through five specialties over 18 months. During the extra six months, the housemen are called junior MOs and the extra period counts towards their three-year government service.

The Health Ministry should apply this policy to all hospitals, instead of intentionally extending the total number of years doctors have to serve in the government?

If the ministry is really concerned about improving the quality of our doctors, there are so many other things it can look into. For example, why derecognise external specialist programmes in favour of our own Masters programme? Is our Masters programme truly superior, or is it merely a way to force our specialists to remain in Malaysia since it is not recognised anywhere in the world?

In a profession that deals with matters of life and death, it is also disconcerting to see the Health Ministry implement fast-track programmes like Skim Latihan Akademik Bumiputra. Those who qualify are trained as specialists right after their one-year housemanship and paid a much higher salary. Those who do not qualify have to complete the three years of government service (plus one year of housemanship) before they are allowed to apply for the same programme. Shouldn’t our specialist programmes be based on meritocracy?

Regarding housemanship; many people assume the danger lies in the young doctors’ inexperience. That cannot be further from the truth. Inexperience breeds caution. Housemen are inordinately careful because they know they are inexperienced. If any houseman is dangerous, it is because the system made him/her so. Housemen have been subjected to long hours of work, sometimes beyond 72 hours of continuous duty. If anything makes a young doctor dangerous, it is the lack of sleep and rest. In other professions that involve the lives of others (eg. commercial pilots), rest is mandatory and strictly enforced. Even in the US and UK, doctors must rest after working for a certain number of hours. Are the lives of our rakyat less valuable?

The ministry should just admit that it cannot attract enough doctors to stay on in public service. If the ministry must enslave doctors for another year, at least let them know you need them that badly. Don’t make it all about their "poor performance" when it is you who failed them and the rakyat.

Dr Adrian Wong
via e-mail

And just what is the Skim Latihan Akademik Bumiputra (SLAB)? An excerpt from Dr Cheah's Blog :

"... Masters training is usually offered to doctors who have completed 3 years of service after one's housemanship training. Or so it seems. Now a special programme called SLAB (Skim Latihan Akedemik Bumiputra) is offering Bumiputra doctors a chance of entering the Masters training even if one had just completed housemanship. Perhaps an excerpt from this article at this site titled "Unhappy Doctors" sums it all.

Who are these specialist trainess anyway? A small number of them are under the SLAB program - Skim Latihan Akademik Bumiputra - a 'backdoor' way to admit Malay doctors into the specialist training programme.

While other junior doctors serve in remote areas of Malaysia, completing their compulsory 'three year service as MO' before being qualified to apply for specialist training, Bumiputra doctors gain entry into UMMC right after their housemanship.

Once the Bumiputra doctors are admitted into this programme, they
are directly employed by UMMC at a salary scale higher than a fifth-year Health Ministry Medical Officer."