The dilemma of
doctors with no permanent job in Malaysia
https://scientificlogic.blogspot.com/2023/01/the-dilemma-of-medical-doctors-for.html
Here’s an article I read in today’s
paper about doctors trying to seek employment elsewhere especially in nearby
Singapore due to no scope for them in this country:
NST Leader:
Cry, my beloved doctors:
https://www.nst.com.my/opinion/leaders/2023/01/871220/nst-leader-cry-my-beloved-doctors
This problem is not about doctors
without permanent employment in government service, but it is about
having too many students wanting to study medicine, only to land up as contract
doctors. This has been going for over 60 years already. It is not just a job
problem they are now facing, but they chose a career after they left school.
I think this problem may also later
apply to all other graduates who opt to study only one popular field of study
such as computer science, and not just students choosing to study medicine.
During my time in the late 1960’s all
graduates including medical doctors were in great demand, and they all could
easily get a job with a common basic starting pay of RM 750 per month
irrespective what field they studied, whether medicine, dentistry, any branch
of science, engineering, arts, economics, etc. Their basic salary of RM
750 per month applies to all graduates as long as they are graduates with a
basic bachelor’s degree, and it does not matter in which field or profession.
In addition to the basic starting pay, they all got an allowance called COLA
(Cost of Living Allowances) depending on where they work, a higher COLA if they
are in the capital city in Kuala Lumpur.
My starting salary then, besides RM 120
as COLA, was RM 1,500 per month, twice as much as any other graduate because of
my higher MSc degree plus a Postgraduate Diploma in Nutrition. I have not
got my PhD yet. That was what was given to me. But prior to my appointment at
the Institute for Medical Research (IMR), I was working for the Massachusetts
Institute of Technology (MIT) in the United States. There my salary was US $
80,000 per year (US $ 6667 per month) or RM 20,000 per month at an exchanged
rate of US $ 1 = RM 3 during the 1960’s, but is now equivalent to RM 344,000
per year or RM 28,600 per month at present 2023 rate of US $ 1 = RM 4.2854988 Malaysian Ringgits
But despite
this very huge disparity in salary as well as academic-professional recognition
between the United States and Malaysia, I still prefer to return to my homeland
here in Malysia where I was born. In fact, prior to my job at MIT, I was
already offered a job in England, but I rejected it, and later WHO also offered
me another job to conduct cancer research in Lyon in France which I also
rejected. I was choosy then. So there was not much problem for me looking
for a job then. In fact, they voluntarily offered me jobs, I never sought
them. When I was still doing my postgraduate studies at the University of
London I wrote to the Ministry of Health Malaysia if I can get a job with them.
They immediately replied they already have a vacancy for me waiting, but I was
still studying in London.
But that was
in the 1960’s where there was not much competition, and far less graduates in
all fields including in medicine and in all professions. Even then doctors in
government service were very disgruntled and unhappy with their pay at only RM
750 per month which was tuppeny by today’s standard but was as big as a bullock
cart-wheel at that time. Cost of living then was incredibly cheap and very
low. Even though the cost of living was very low then, doctors in
government service were still very unhappy in the 1960s. They were constantly
complaining of low pay, overwork and sent to rural areas. Year after year doctors
were demanding better pay which took the government decades to give them a
‘drastic’ rise after countless fights and demands with only a few revisions of
salaries for all employees in government service, not just for doctors.
Many doctors
in the 1960’s left government service and went into private practice. They were
unhappy to be with the government due to poor pay, overwork and little chance
for promotion or for specialization. So, a lot left for private practice which
was then more lucrative, and higher in demand because patients could afford it
at just RM 5 - 15 with medicines for simple ailments like coughs and colds.
Cost of living then was very low, and everything from food to houses.
Everything was very, very cheap then.
For instance,
when I first came to KL to work at IMR I initially rented an unfurnished master
bedroom with an attached bathroom in Jalan Maroof in Bangsar in Kuala Lumpur
which is a very expensive area currently but was hardly developed then. My room
rent in a bungalow was just RM 80 per month. Then after the May 1969 incident,
I rented a whole single storey terrace house nearer my workplace.
Initially my rented house was in the middle of a row of linked single-storey
terrace houses, and later I shifted to a corner house with a garden at only RM
180 per month. Later, I again shifted to another single-storey house in Taman
Melewar, 1 km from where I am now staying, and the rent for the whole house was
also RM 180 per month. I then bought my first brand new car a Volkswagen
at only RM 7,000
Where can we
find a house with a rent of just RM 180 per month these days or a master
bedroom with an attached bathroom in a bungalow in posh areas like Bangsar with
a rent of just RM 80 per month, or a brand-new car at only RM 7,000?
A few years
later I bought my own house for RM 41,500, and the price of houses have already
shot up from RM 10,000 to over RM 40,000. This was more than 4 times as
much a few years earlier.
My
current same house is now over RM 400,000 which is nearly 10 times more than
when I first bought it around 1975.
A doctor’s or
a science graduate's pay is now between RM 4,000 – RM7,000 and no longer just a
fixed RM 750 per month as it was in the late 1060’s. The current grade of
salaries for doctors and other graduates depends on their years of service, and
yearly rise in salaries. Let us take an average of RM 5,000 per month for any
graduate, including medical, dental, pharmacy, nutrition, food science or any
graduate with a basic bachelor’s degree.
This “drastic”
increase is 6.6 times more than the RM 750 per month we got in the late 1960’s.
But the cost of an average single-storey house even in the rural areas these
days is over RM 400,000. This means a simple house is now 80 times the pay of a
graduate including a Medical Officer’s pay these days, compared to just 6.6 times
my pay then at RM 1,500, and 13.3 times for other all other graduates including
Medical Officer’s (MO)’s salary during my time. This also means I could buy a
house within less than 7 months or 13 months for other graduates provided we
stayed with our parents for free.
That’s why in
my area where I am now staying, we get a lot of cars parked outside the houses
belonging to the children of parents whose children cannot afford to buy their
own houses. So, they stay with their parents for free food and free lodging,
struggling to buy their own houses, which they may never be able to buy with
each passing year as prices of houses and other commodities keep skyrocketing
far beyond their rise in salaries or income.
The cost of
living has skyrocketing over 10 times for everything from food, lodging to
buying a house within just 53 years from my time in the early 1970’s and this
escalating cost of living is not an arithmetical rate, but an exponential event
due to a corresponding rise in population, human social and economic demands.
Turning to the
question on problems faced by doctors in this country as in the linked article
above, it is not the question of them just migrating to Singapore or elsewhere
to work, but it is the question if their medical degrees are recognized for
practice elsewhere other than in Malaysia. For instance, as far as I know all
medical degrees from all public and private universities except from the
University of Malaya and National University of Malaysia (UKM), are not
recognized for practice in Singapore This includes all foreign medical degrees
from Indonesia, Middle East and Pakistan as well as those from India are not
recognized in Singapore or registrable by the Singapore Medical Council
(SCM). The only medical degree from India that is registrable by the SMC
is an MBBS from All India Institute of Medical Sciences (AIIMS). But Malaysian
doctors with British or Australian medical degrees are recognized in Singapore,
but rarely from other foreign universities. Singapore, like all other
countries, has their own standard for recognition in medical practice. So it is
not as easy as that as the newspapers claim that all Malaysian doctors can just
cross over to Singapore or to any other country to practice there if they are
not happy here or unable to get a permanent job in this country. It all depends
on if the country recognizes their medical qualifications for registration in
that host country. But if a medical doctor qualifies from any British
university whose degrees are registrable by the GMC (General Medical Council)
in the UK, then that is not the problem for almost all countries in the world
to accept them because traditionally British universities have a very high
standard of education. Their degrees in almost any field of study have that
academic gold standard. If GMC accepts them for practice in the UK, then they
are very safe since almost all countries, especially the Commonwealth countries
will accept them. But it is not easy to gain admission to study medicine in the
UK, especially at the University of London, Oxford, Cambridge or at Edinburgh.
It cost at least RM one million to complete a five-year course there. So,
students go to Indonesia, Middle East, India and Pakistan to study medicine
which is a lot much cheaper, only to land up with a medical degree that is not
recognized / registrable in most countries except in the country they qualify
Singapore,
which is our nearest traditional, political, social, cultural and geographical
neighbour just across the Causeway, and it is unfortunate not every doctor can
just cross over and set up a practice there. Hence it is not true that there is
a brain drain of doctors qualified from any university here or abroad to just
cross over to Singapore to practice medicine there. Even if they are
specialist doctors qualified from local or other university, SMC is only
interested in their basic bachelor’s medical degree which must be registrable
first unless they hold Memberships or are Fellows of the Royal College of
Physicians (MRCP / FRCP) or Members / Fellows of the Royal College of Surgeons
(MRCS / FRCS) from England or Scotland or are Fellows of Royal College of
Psychiatry or Fellows of Royal College of Pathologists.
This is very
unfortunate when their basic medical degrees are not registrable in Singapore
or elsewhere. They are all stuck here unless they find other jobs to earn a
living, unlike all other graduates in other fields of study that are more
flexible and adaptable where they all already able to find very well-paid jobs
in Singapore and elsewhere, get married, have a family and were already
able to buy a few houses and settled down peacefully for good, while younger
doctors are still stuck here as contract doctors, underpaid and overloaded with
all kinds of patients walking in and walking out, besides writing tons of
notes, often non-clinical in nature. So, what were they trying to prove by
choosing a pathway to become a doctor?
How then do we
expect these thousands of doctors on contract in government service in this
country going to practice elsewhere? They have no choice but just stay put here
in this country to practice on their own. This is not easy with tens of
thousands of private clinics now in the country. I heard from my former
Director at IMR it takes RM 20,000 – RM 50,000 per month to run a simple GP
clinic. In order to cover the cost of running a private GP clinic, the contract
doctors in government service need to spend at least RM 650 - RM 1,700 per day
to maintain their clinic where they need to pay rentals, staff salaries,
electricity, water bills, medicines, overheard charges, etc. Then the question
is how much are they going to charge each patient to cover up their cost?
Unfortunately, the more they charge, the lesser patients will get, as patients
now go in doves to the government health centres, clinics and hospitals where
they get free treatment despite a longer wait. Foreigners pay a nominal fee in
government hospitals and clinics.
So, our
question is, where are all these doctors going to go – they are on temporary
contract with the government, and with medical degrees not recognized or
registrable anywhere outside the country, not even in nearby Singapore. Running
their own GP practice is now highly unprofitable and competitive with almost
empty patients outside. It is prohibitive to run any clinic even in smaller
towns due to cost.
Private
hospitals will not accept ordinary medical doctors, unless they are senior
specialists with rare higher qualifications where they also need to buy their
own rooms in the private hospitals. Private hospitals are not going to pay them
any salary. They are on their own, having to buy their own rooms there at over
a million Ringgit each.
Furthermore,
medical doctors cannot do any other jobs like switching jobs to become
engineers, lawyers, architects, food scientists, analytical chemists or even do
nursing or become a dentist or pharmacist as they belong to another
profession. Neither can they go into business without any capital or do
they have any clue about how to do business, let alone having a sharp business
acumen. They can only treat sick patients, and nothing else, and not
everyone is sick. So where are they going to go or do to earn a living?
At least for
other general graduates they can diversify into any other fields to work. They
can go to Singapore or wherever they like to work in as many areas they wish in
any industry.
I think this
dilemma we have of having too many medical doctors in this country is because
students when they embark into a career, they have no direction. They either listen
to their own peer group who are equally blind which path to take when they are
still in school, or their equally uninformed parents want them to be doctors.
It is a blind leading another blind.
I remember
when I was in school, my English literature teacher singled me out in the whole
class as one, “in the valley of the blind, the one-eyed man is the king”.
Luckily, after
hearing what he said about me, I took it as a warning to ask me to diversify in
order to have a very wide spectrum of education in most branches in sciences
and medicine, even in astronomy, evolutionary biology, forensic toxicology as
hobbies long after my retirement as senior medical research officer at IMR.
Think
carefully before we leap. Fools rush in where angels fear to tread.
Lim ju boo
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