Friday, May 3, 2024

A Career in Medicine: The Pros and Cons

 

Following my article on the “The Applications of Biotechnology in Sciences and Medicine here:

https://scientificlogic.blogspot.com/2024/

someone yesterday asked me through WhatsApp what would be the scope for his son who has recently graduated as a medical doctor.

My reply to him is,  medicine is a good profession with a lot of scope and opportunities if he can first get a permanent job as a medical officer with the government. All jobs have advantages and disadvantages, including medicine.  Here’s my view.

Medicine used to be very lucrative in private practice until around the mid-1980's with too many doctors leaving government service to go into private practice. But no more now where on every street you see 2 or 3 clinics competing with no patient inside either of them. Patients these days go to government clinics to get treatment for free. It used to be a time when it cost only RM 10 – 15 to get treated for coughs, cold, fever, vomiting and diarrhoea. These days for the same simple ailments it cost RM 60 – 80. This is because the cost of everything has gone skyrocketing. So, the clinic cannot maintain it except to charge exorbitantly. I was told by a few doctor friends of mine that in private practice it costs about RM 20,000 to RM 35,000 a month to maintain a clinic. Where to get all that money just to maintain a practice except to charge the patient as much as possible. Unfortunately, the more they charge, the less patients they get. The patients all go away to the government clinics where they get free investigations, free treatment and free medicine even though they need to wait in long queues and overcrowding. But they don’t mind the wait unless they are in a hurry. 

If you work just as a GP without specialization you can’t do much. A GP can only treat simple uncomplicated ailments such as coughs, cold, nausea, vomiting, diarrhoea, fevers, pains here and there, or simple infections, diabetes and high blood pressure among other common ailments.  Anything more than these, you need to refer. 

So how to earn a living like that in private practice unless they are specialists in a private hospital. In a private hospital they only want specialists not ordinary doctors, and even that, private hospitals don’t pay the specialists a salary. They are on their own with their own private practice, their own private consultation rooms and own facilities within the hospital. They only use the hospital facilities for surgeries and ward admissions, and for that it is the hospitals that charge the patients, not the specialist.  

But to be a specialist for a doctor is still a long way. The current starting salary for a newly graduate medical doctor as a medical officer in government service in Grade 41 is only RM 2,500 per month, and even that, they need to have a permanent job with the government, and not on contract basis as far as I know so that they can be attached in a specific department they are interested in to get exposure and experience in that field they intend to specialize.

Those days in the 1970’s a medical officer in government service got a starting pay of only RM 750 per month. This applied to all graduates irrespective of their field of studies. But if you have a Master’s degree the starting salary will be doubled at RM 1.500 which is a servant’s pay today (2024). But it was big money those days when a brand-new car like the one I bought was only RM 7,000 and a storey terraced house cost only RM 10,000, and if it was a corner lot with a garden the price was only RM 12,000. Today (2024) the same car cost RM 120,000 and the same house RM 450,000, 17 times jump for the car and 45 jump in price for the same house today. But the starting salary for a medical house officer then and now at RM 750 and RM 2,500 increase is only 3.3 times. Salaries today for all graduates, whether they are medical graduates, dentists, or science officers or any graduate, as long as they have only a Bachelor’s degree, they will not be able to catch up with the skyrocketing cost of living. 

Those years in the 1960’s and earlier cost of living was very low. Although a doctor or any graduate starting salary was extremely low by today’s standard, those income was very big money then. Today (2024) the minimum salary of a servant is RM 1,500 compared to a graduate half of that at RM 750 per month in the 1960's. But a graduate then lives like a king when he could easily buy cars and houses even without bank or government loans provoided he did not spend on anything else. 

In short, a graduate in any field in civil service today is left far behind against the escalating cost of living compared to the 1960’s till the late 1980’s.  

In other words, a fresh university graduate in any field, as long as he has a Bachelor’s degree earning RM 750 per month in the 1960's, can buy a brand new car within 9 months, or a brand new single storey terraced house in just 1 year 1 month provided he stays with his parents with free accommodation and free food and everything else were free of charge without needing to pay for anything else.

 But it is far beyond the means of any graduate today in 2024, whether or not he or she is a medical, dental, science, engineering, law, economic,  business, IT graduate to buy a house costing nealy RM half a million these days, or even a new car within 5 to 10  years even if his starting pay is double at RM 5,000 per month. This scenario of escalating cost of living against income is going to get worse and worse each year to come. 

Today, if a  doctor wants to specialize, he need to attend another 4 years Master degree course in the field of specialization in medicine or surgery or a program conducted by the British Royal Colleges of Medicine, Surgery, Psychiatry, Pathology, .. etc. before they can practise as a specialist. 

A Membership or a Fellowship of the Royal College of Medicine or Surgery of Edinburgh or England is even better and more prestigious as they are internationally recognized especially in Commonwealth countries. 

It is a hard and long climb for doctors even in permanent service with the government.  They must work in a major tertiary hospital in a city or major town where there are specialists around for a number of years, and not thrown into some rural clinic to rot there without any specialists around to guide them.

Despite all these hurdles, medicine is a good field and profession to go for, provided there are not competitors around like the situation we see now in South Korea where doctors are on strike for many months now because their government wants to increase the number of students studying medicine who would later compete with them for a living and other reasons here:

2024 South Korean doctors' strike

https://en.wikipedia.org/wiki/2024_South_Korean_doctors%27_strike

Doctors cannot expect to be a specialist if they are employed temporarily as contract doctors or as GPs in private practice with competitors in every street corner. They need to have a permanent job to be placed in a specific department for a number of years in a major government or a teaching hospital in the first place. Even in private practice as a specialist, they are now also facing competition such that they now use Google to advertise themselves. We can check this out ourselves by keying inside Google any specialist you want in town, and a list of them are all there on the screen for us to choose.

Nevertheless, medicine is still a good profession provided they can make the grade.

On the negative side of this profession, their training is such that, their job can only treat sick people and not do other jobs such as in engineering, architecture, building designs and building technology, chemistry, whether synthetic or analytical chemistry, law, dentistry, pharmaceuticals, food science and food technology, rubber and plastic technology, etc, etc, let alone rocket technology.

The only job doctors can do whether as specialist or in general practice, is to treat sick patients. Maybe with a little bit of luck with some exposure, and sufficient money, they can go into business, but not as CEO of a corporate company with their medical degrees. A medical doctor’s degree is unlike all other degrees where other graduates, say in business, administration, economics, IT, computer science and computer technology, AI, are very versatile, such that these graduates can adapt and go into any field of industry or business they like to earn a good living. But medicine is stuck in treating only the sick. What other jobs can doctors do if they cannot get a permanent job in civil service, whereas outside practice is far too expensive to maintain with fewer, and fever patients coming with competition from another clinic a few hundred metres away.

If you were to ask me today what would I choose to become if I were to start all over again, I really do not know because my education and interest are so wide and varied 

Perhaps, I can try my hands on all odd jobs to see how each job stresses me

jb lim     

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