Featured
THE NEED TO SPECIALISE, SPECIALISE AND SPECIALISE IN THIS MODERN ERA FOR MEDICAL GRADUATES
** Download this article - Click Here
Prof
Sachchithanantham Kanagasabai FRANZCOG, FRCOG, FACS, FICS DIMH MBBS &
Dr.Devinaga Rasiah
A
Senior Gynaecologist ,academician teacher, editor & author of multiple text
books and clinical articles having spent
32 years training post graduate
students locally and abroad tells his story of
his fervent rhetoric as why the medical doctors of today need to
specialize and is most qualified to do
so.
The yesteryears
I
suspect that when i go down memory lane back to the seventies when I joined the
medical career that most current medical graduates are not aware that the medical
practice in this country was managed by the medical officers and a few
specialists. The Local specialists were few in number and the rest were mostly
expatriates from India and Burma, perhaps one to a unit and none in fields like
pediatrics and ENT, and their scarcity led to on many occasions for the less
qualified to do the decisions on their behalf .However it cannot be denied that
the medical officers of the era were well trained that they would duplicate the
activities of their superiors and rise to the occasion to provide exemplary
treatment
It
was during the eighties when both critical medical education and health care
reforms were developing throughout the country and abroad. The early post-graduation
was done by doctors from this country obtaining their FRCS (general surgery
/ophthalmology,orthopaedics was part of General Surgery), MRCOG and MRCP from
the United Kingdom. These
physicians who were formally trained were mostly educated in the schools of
England and Scotland, and to a lesser extent in Europe. Many were graduates of
the University of Edinburgh’s School of Medicine, which, during the 18th
century, was considered to be one of the leading medical schools in Europe, if
not the world. Hence, this school had great influence on medical practice
throughout the world, and even into the early 19th century.
It
was in the early eighties that the first postgraduate programme in orthopedics
was drawn up the National University of Malaysia as its inception and hence
examined the rise of specialization and the establishment of other specialties
in the two premier Universities in Kuala Lumpur. Although initially the
programmes were limited to a few candidates in view of the limited number of specialties,
it paved the way for the development of residency programs throughout the Country
during the period 1990 to the present.
Today there are five Universities offering postgraduate studies
Current scenario
This
article published: August 19, 2013 reiterates the country’s needs
Malaysia needs more
medical specialist, says Health minister
Despite an increasing number of medical graduates, the
country is facing a shortage of specialist doctors. Today’s statistics from
Health Malaysia 2012 mentions that there are a total of 38,718 doctors
practising, 27,478 in the public sector and 16,240 doctors in the private
sector.
It cannot be denied that approximately 6% are specialists in
the public sector and the numbers are dwindling as migration in large numbers to
the private sector due to better remunerations by the private sector .The
private hospitals are currently numbering 220 when compared to public hospitals
which number 138.Ironically the private sector sees approximately 4 million
patients compared to 49 million in the public sector.
To address this shortage of specialists currently, about 500
to 600 doctors are sent for training each year to become specialists every
year. This has been an ongoing feature
for the past twenty years .It is not the numbers that go for training which are
of concern, but the dropouts from this programme is of concern, so the final
numbers produced is not sufficient to address the pending crisis now and in the
near future.
Apparently doctors who can specialise in cardiothoracic,
hepatobiliary surgeries and other new infectious, lifestyle and chronic
diseases are in dire need the most.
The country currently has 36, 607 doctors including
specialists with a doctor population ratio of 1:791 based on the estimated
population of 34 million.
The Ministry is hoping to have 85,000
doctors by 2020 to reach the standard ratio of 1:400 by 2020. It may be obvious
why medical officers are reluctant to embark on a post-graduation, likewise the
reasons for doing post-graduation too are pretty obvious. What is pertinent at
this junction is to address the reasons for reluctance so that we can hope for
a large cohort of specialists in the various discipline to man the needs of the
country.
REASONS FOR RELUCTANCE
TO SPECIALIZE.
1. The long trying hours
at housemanship resulting in loss of passion for medicine. Eventually work
becomes a chore and not relinquished, resulting in disappointment of having
chosen the medical profession.
2. The perception that
Specialisation requires long devoted time, unable to make time in this modern
era when other priorities take precedence, like getting married and having
children.
3. The current salaries
being paid for housemanship and Medical officers are handsome and having
achieved a sense of positioning in society with this economic satisfaction
reached deprives one to further continue with further studies.
4. Lack of motivation by peers,
seniors and Mentors. Apparently the mentors of today need motivation in view of
the large numbers of litigation faced by them
5. Not a priority at this juncture inevitably resulting in
postponement to make a decision
6. No guidance from
established institution especially Universities to show ways and means of
securing information to pursue postgraduate studies.
7. The Medical officer
applicant need to be confirmed in service when applying and after submitting
the application, he may not be selected.
8. Recurrent applications
for post-graduation to universities which can be turned down further aggravating
the situation.
9. A genuine reason being
encouraged to take over the family practise
REASONS WHY ONE SHOULD
SPECIALISE
1. Sense of being doyens of their respective discipline
2. The pride, grandeur and leadership of being a specialist
should be a strong motivating factor
3. No senior medical
officers in the respective unit should be left to idle, owness is on the senior
consultant to motivate, provide study leave, monetary benefits for attending
courses and admire their success.
4.From the perspective of return of investment, Specialist in public
sector have easy access to promotions and a Superscale C ‘s take home with
allowances can easily be in the region of 23K.The prospect in the private
sector could range from 50k to100k.
5. If one does not qualify
for the local postgraduate programme, it would be easy to start studying for
the British Post graduate in MRCS, MRCP, MRCOG, MRCP (Paeds), Radiology in
selected hospitals etc.
6. Those who want to migrate or work overseas
would fear better if one has a foreign post graduate degree.
7 Ultimately the country
needs a large number of specialists in view of the large number of patients who
attend the public hospitals
CONCLUSION
The above recommendations are perhaps long term measures
to get more specialists .However in order to fill the void, get the medical
specialists trained overseas to return home .This may require the Government to
have salary revisions to attract them. The second option would be to increase
the number of post graduates admitted for training. This certainly would
require the cooperation of the Universities .The third option would be for
Government to approach the Private medical colleges to initiate their own post
graduate programmes. Lastly collaboration with the Royal Colleges abroad to
have local training programmes which can be accredited.
If one fails to embark on a postgraduate programme sooner
or later there is a high probability of ending up as a glorified medical
officer at the hospital. Subsequently anger, disappointment and frustration
will get the better of one, forcing these officers to the private sector as a general
practitioner where the challenges can be insurmountable.
0 comments: