有个医生这样说

For Future Doctors: General Misconception of being a doctor PART 1
November 11, 2010 by Pagalavan Letchumanan

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

Next: Postgraduate training…………………

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 3)

Let’s look at the postgraduate training in Malaysia. I have written about housemanship, district/rural postings and problems of oversupply of doctors in the near future. The issue of oversupply of doctors by 2015 will lead to another very big issue: postgraduate training. Many of the budding doctors and medical students are not aware that the postgraduate training in Malaysia has many limitations and problems. At this point of time, most postgraduate trainings are dependent on Master’s programme conducted by the local universities. Once upon a time, we were totally dependent on UK-based exams and training but unfortunately we lost it along the way. Currently, only MRCP (UK) – Internal Medicine, MRCPCH (UK) – Paediatric and MRCOG (UK) can be done in Malaysia. FRCS (for surgeons) used to be available to Malaysians but not anymore. None of our hospitals are recognised as a training centre for FRCS, which is now known as MRCS. Thus, for any surgical field in Malaysia, you will need to do Master’s programme!

MRCP (UK) – Internal Medicine

Membership of the Royal College of Physicians (UK) is a well-known exam all over the whole. It has a very strong reputation as an entry exam for speciality training in UK as well as in other parts of the world. It is conducted regularly, usually 3 times a year in various countries. Malaysia is one of the centres for the MRCP exams, all 3 parts.

MRCP Part 1 can be taken about a year after your graduation. It is a theory paper. After passing your Part 1, you need to clear your Part 2 (written paper) and Part 3 (clinical) within 7 years. It is usually coordinated by University of Malaya, where the exams are usually held. Just for your info, the passing rate for MRCP (UK) is always around 45-50% worldwide! You need to have a proposer to sit for these exams, who can verify that you have undergone sufficient training to sit for the exam. If you fail miserably, your proposer will be notified.

Since MRCP (UK) is not a specialist exam in the UK, the Ministry of Health, Malaysia only recognises and gazette’s you as a specialist after undergoing further training of 18 months post MRCP (UK). You will need to submit a log book and recommendation by your HOD before being gazetted. This rule applies for all other overseas degrees which include MRCPCH and MRCOG. You need to undergo this gazettement process in order for you to be recognised as a Physician by the National Specialist Register (NSR).

MRCPCH (UK)

MRCPCH is similar to MRCP (UK) but meant for those who wants to become a Paediatrician. It‘s examination structure is similar to MRCP (UK).

MRCOG (UK)

MRCOG has 2 parts but the second part has both written and clinical component. However, you need to undergo training in O&G department for at least 4 years before being allowed to sit for Part 2 exams. One of the major issues in sitting for MRCOG is the fact that there are not many MRCOG holders in MOH to sign as a proposer for you!

Master’s programme

Now, this is where a big problem is going to appear soon. For all other fields, you are totally dependent on Master’s programme. This includes all surgical fields. Master’s programme is a fixed 4 year programme.

In order for you to be eligible to apply for the Master’s programme, you should have completed at least 3 years of service with good SKT marks of at least 85% and above, recommendation from Head of Department and confirmed in service. You also need to attend an exam or an interview before being selected for certain disciplines.

The major problem that I foresee in the future will be the number of places that are being offered. As of this year, the total number of places available is only 600, all disciplines included. Imagine, with 6000 new doctors coming into the market every year from now onwards, only 10% is going to get into the Master’s programme annually. Furthermore, you must understand that the selection process is never transparent, the typical Malaysian scenario as well as the quota system! Most of it is done by the Universities.

The government is planning to increase the number to 800 next year but the situation is rather critical in the Universities as there are not many Senior Professors to supervise the programme. I must say that the standard of Master’s graduates have dropped significantly over the last 5-10 years. We have Master’s graduates who can’t do surgery but have passed the exams! I just hope that the Master’s programme do not become another “specialists mill” like our undergraduate medical schools!

There are 2 types of Master’s programme, the open and closed system. In the closed system, you will do the entire 4 years within the university, like in UKM Hospital, UH and USM Hospital. The open system may have various programmes, like 2 years in MOH hospitals and another 2 years in the Universities etc. You may even do the entire 4 years in MOH hospitals for some of the fields.

After completing your Master’s programme, you need to undergo another 6 months of gazettement process before being recognised as a specialist. Furthermore, you will be bonded for 5-7 years for receiving scholarship during the programme, which is compulsory!

Subspecialty training

With the advancement in medical field, every discipline now has subspecialty training. As such, everyone will try to do certain subspecialty after gazettment as a specialist by MOH. Generally, the subspecialist training is about 3 years except for certain field like Cardiothoracic and Urology which may take 4 years. Again, whether you get a place or not depends on availability of post and demand for that particular field. For example, the waiting time for Gastroenterology training can even go as far as 1-2 years.

Recently, to overcome this major problem, MOH has taken another step backwards. You can only apply for subspecialty training 1 year after you have been gazetted as a specialist. For MRCP holders, this means 2 and half years after passing MRCP (UK)!

Usually, the subspecialty training is divided into 2 parts, the first part (the first 2 years) will be done locally and the 2nd part (remaining 1 year) will be done overseas. The MOH will provide a fully paid scholarship for overseas training of 1 year but you will be bonded for 3 years. If you have received undergraduate scholarship and Master’s scholarship, you will be bonded a total of 20 years in service!!

Singapore

One good advantage that we have is Singapore. Unfortunately, only UKM and UM undergraduate degrees are recognised in Singapore. Our Master’s degrees are NOT recognised elsewhere. Thus, we would not be able to work in Singapore with any other medical degrees or even with our Master’s degree.

However, Singapore does recognise MRCP, MRCPCH, MRCOG and MRCS. Thus, if you have any of these degrees, it supersedes the undergraduate degree and you should be able to get a job in Singapore. Singapore is also a recognised centre for MRCS Part 3 training, which you can’t do in Malaysia. So, if you have MRCS Part 1 & 2, you can go to Singapore to finish your MRCS training and sit for the Part 3.

I must say that Singapore’s postgraduate training is more structured and organised with their BST (Basic Specialist Training) and AST (Advanced Specialist Training) programmes. I have written about this in my MMA article “Back from the Future: From 1st world to 3rd world”.

For all of you out there; budding doctors, medical students, houseofficers and medical officers; the future is very bleak for the medical field in Malaysia. The oversupply of doctors will get to you sooner or later. My advice to those who insist on doing medicine for passion is to choose an undergraduate course that is recognised internationally. Then, pursue a postgraduate degree that is also recognised internationally. If not, you will end up with a lot of frustration in the future. Jobless doctors in the future will be a reality!

读后感言：
由于本人现在不是一个很有大志的人，所以他所说的我都觉得还好啦。每个人都会有自己的故事，我们不需要一定要跟着别人设定的道路走。可是人会变，万一有一天我突然有大志却无法得志，我会怨吗？
哈，幸亏Monash是受别国承认的=)应该感到幸运。

我們小時候

最原始的yoyo是沒有燈的啦

兵兵

收集不同形狀的塑膠擦

我會收着很多鉛筆不捨得用

兩邊都可以開的鉛筆盒

裝上去按一按那圓圓的就會飛走

小時候很喜歡玩的牌

射了會粘在玻璃上

收集不同國旗的塑膠擦

依稀記得這玩意兒，但忘了怎麽玩了

男孩子的玩意

拉一拉腳車就會走動

把那粘粘的膠封着小管子的一端然後用力吹

我們叫它baguli，很多很美的顔色

裏面有玩具還有巧克力餅

圓圓一粒粒的塑膠糖

小小立的巧克力，吃完后盒子還可以當哨子吹

我家叫它atapci，阿嬤會買來拜地主公，拜完就我吃

這些玩意兒就是我的小時候的回憶。還有很多只須要一群朋友，而不需要花費就可以玩的，比如跳繩，跳飛機，AEIOU,Pepsi Cola...
生活在純樸的鄉下，
沒有電腦的日子，
孩子都和朋友到處亂跑，
輪流到不同的朋友的家玩。
現在的孩子，
應該沒有這種日子了吧！

跷跷板的人生道理

愛是...

看到電郵裏的這幅圖覺得它很可愛就決定放上來。

愛就是這樣吧，
互相欣賞，
互相扶持，
苦中也還能一起作樂。

有趣有趣

医生和黑社会相同之处：
1．都有自己的职业象征色：一黑一白
2．都是拿人钱财，替人消灾
3．工作风险高
4．常常有被打的危险，打人的一般都是客户
5．刚入行什么都做，以后渐渐专向化
6．都需要熬年资讲排位
7．身边都有被自己叫做老板和老大的人
8．谁手上都会有几条人命
9．被社会需要的同时不被理解，被魔鬼化
10．在一定程度上反感与法律有关的人——警察律师
11．受经济动荡的影响比其他行业小
12．每年都有年少无知的青年加入队伍
13．行内的相当一部分人最后都会转行
14．大都希望自己的子女不要子承父业
15．都经常被拍成电影或者电视剧荼毒年轻人
16．生活无规律，常常被一个电话打破梦境，披上长衣消失在黑夜中
17．离开该职业以后发现自己原来什么都不会
....
...
..
.

（摘自某部落格）

中国普通话VS马来西亚华语

马来西亚华人乃是晚清时广东省和闽南移民华侨的后代。
当地华人对华教的坚持、文化的传承是不留余力的。
我们堪称是海外华人中中文水准颇高的华人，但且看我们的普通话.............

> > 中国人：今晚你有空吗？我没空！
> > 马来西亚华人：今晚你得不得空？我不得空！
> > 中国人：饼干受潮了…。
> > 马来西亚华人：饼干'漏风'了…。
> > 中国人：从上海去苏州要多少个小时？
> > 马来西亚华人：从上海去苏州要几粒钟？
> > 中国人：难道他不可以来吗？
> > 马来西亚华人：你不给他不来啊？
> > 中国人：周杰伦不喜欢穿内裤。
> > 马来西亚华人：周杰伦不喜欢穿底裤。
> > 中国人：我一向都是这样的
> > 马来西亚人：我一路来都是这样的啦
> > 中国人：我的手机掉进沟渠了。
> > 马来西亚华人：我的手机掉进龙沟了。
> > 中国人：这样你不是很不值得吗？
> > 马来西亚华人：这样你'马'很不 '歹'？
> > 中国人：你真是聪明！
> > 马来西亚华人：你真是pan nai！(源自马来语pandai，聪明的意思)
> > 中国人：你安静！
> > 马来西亚华人：你diam diam！(源自马来语diam，安静的意思)
> > 中国人：我要去银行取款。
> > 马来西亚华人：我要去银行'按钱'。
> > 中国人：为什么？
> > 马来西亚华人：做么？
> > 中国人：你很强~
> > 马来西亚华人：你很够力~
> > 中国人：明天也叫他一起去吧！
> > 马来西亚华人：明天叫'埋'他一起去！
> > 中国人：我很郁闷~~~
> > 马来西亚华人：我很'显'（sien）啊~~~~（'显'比郁闷的境界更高）
> > 中国人：你再说我就打你！
> > 马来西亚华人：你再说我就hood你！（有点粗俗的）
> > 中国人：你在说什么？
> > 马来西亚华人：你在说sommok？
> > 中国人：你不要令我丢脸~
> > 马来西亚华人：你不要'下水'我~
> > 中国人：真被你气到…。
> > 马来西亚华人：被你炸到…。
> > 中国人：你别乱来~
> > 马来西亚华人：你表乱乱来~
> > 中国人：你很无聊
> > 马来西亚华人：你很废
> > 中国人：XX你
> > 马来西亚华人：Kanasai（意思是像大便一样，骂人的话）
> > 中国人：迫切
> > 马来西亚华人：bek chek
> > 中国人：我们一起吃这碗面~
> > 马来西亚华人：我们'公司'吃这碗面~（源自马来语的kongsi，就是一起分享的意思）
> > 中国人：我们结婚吧！
> > 马来西亚华人：我们结'分'吧！（'婚'字受粤语影响，所以音不标准）
> > 中国人：今天的天气很热~
> > 马来西亚华人：今天的天气热到。。。。。。。。。。。。。。~~~~~~~（'到'字要拉长，然后没有下文了）
> > 中国人：为什么会这样的呢？
> > 马来西亚华人：做莫会酱的？
> > 中国人：他的人很骄傲。
> > 马来西亚华人：他很'串'!
> > 中国人：哇!
> > 马来西亚华人：哇捞eh!!!!
> > 中国人：我受不了他！
> > 马来西亚华人：我behtahan他!
Malaysia Boleh!!!