Only 7,000 Specialists In Malaysia, We Need More Doctors To Specialise

It is hard to believe that we live in a country where heart disease is found to be the number one killer disease in the last 10 years, and the National Heart Institute revealed that it treats at least 150,000 heart patients per annum, yet we have roughly less than 500 cardiologists, amongst our population of 32 million people.

But looking beyond cardiology, the situation is more worrying as a recent report from The Star revealed that Malaysia has approximately 7,000 specialists throughout the nation – which is regarded as insufficient – and there are too many General Practitioners (GPs). The article highlights we are severely lacking in five areas namely adolescent medicine, paediatric rheumatology, intensive care medicine, urogynaecology and forensic psychiatry.

So why the shortage? The excessive workload coupled with the duration has often been blamed as to why most medical graduates and Medical Officers (MOs) refrain from specialising, despite the fact that majority of them have shown a keen interest in specialising – but is it really true?

Medical Students Share Their Two Cents

With Malaysia plagued with cardiovascular-related health problems, 26-year-old Camilla Ongexpressed her determination to specialise in cardiology once her housemanship comes to an end, as she underlined that Malaysia is in desperate need of more cardiologists and emphasised that time or the workload will not stand in her way.

“The hospital that I’m currently attached to has one cardiologist and when he was away, a patient was in critical condition, which prompted us to send the patient to a nearby hospital,” she recounted.

“When such situation occurs, the hospital is either required to send the patient to another hospital or call in a specialist from another hospital,” and emphasised that the practice should not be a norm as not every patient has time as a luxury.

The future cardiologist also emphasised that medical students ought to pursue medicine and specialise for the right reason, adding that the workload and commitment is expected of them as they are in the field of serving the people.

“We are here to save people and to serve them; that should be a good enough motivation to keep our fire burning – do not use excessive workload as an excuse when you haven’t even given yourself the chance to see what you are capable of.

“And as for time, we know the programme will come to an end eventually. So plan ahead if you wish to have a family. In fact, teaching institutes now permit us women to take maternity leave,” the Selangor-born lass put forth.

Meanwhile, Hanna Mohd stated that being a specialist is a goal for her, yet she has not set a solid plan – especially in regards to timing.

“Specialising in geriatric medicine occurred to me after knowing the growing number of the older population due to better healthcare,” the 25-year-old shared.

“I think Malaysia has sufficient supply in some fields, while some fields are insufficient. The demand for each specialty varies depending on the health of the population in that particular country,” she points out saying not everyone in the population requires a specialist.

However, the increasing demand is a source of motivation for medical students, graduates and officers as the goal is to provide more chance for patients to seek treatment from specialists without waiting too long and lessen the burden of other specialists.

“Medical specialists are top ranking doctors. They are hardworking, passionate and dedicated in saving lives and improving health of the nation,” the aspiring geriatrician opined.

MO Shares Experience In Masters Programme

To gain insight as to what MOs go through whilst specialising, Malaysian Digest spoke with Dr Khairil, who is a practicing doctor and a second year Internal Medicine student at a teaching hospital in the East Coast.

“Even prior completing my degree programme, I’ve already made up my mind to specialise but the journey was not as smooth as I had hoped,” the 32-year-old doctor confessed.

“Competition was tough due to the high number of applicants; not all fields are offered as area of specialisation at every teaching hospital or institution; and aside from the uncertain waiting period, you also have other commitments,” he shared.

Dr Khairil who graduated from Universiti Malaya in 2009 with a Degree in Medicine relayed that upon completing his two-year housemanship in 2011, his request to specialise was declined multiple times due to the immense competition as well as the varying requirement for each field.

But the trials that stood in his way did not falter his spirit to be a specialised medical practitioner as he noted, “I’d like to be one of the medical practitioners who help meet the country’s healthcare demands so that we will be at par with developed nations.

“It is also a great feeling knowing that your family not only supports your decision but believes in you as well,” the father of five conveyed and added that new set of challenges arise as soon as he began his Masters programme (specialising).

The aspiring Internal Medicine specialist revealed that a paradigm shift exists in age and family responsibility, especially the latter as his decision to specialise inherently demands his wife to shoulder the responsibility of both parents.

“I’m not saying I’m free of my fatherly commitments, but majority of the time my wife wears the hat as both mother and father as I am on-call most of the time,” he lamented, but expressed that his beloved wife’s sacrifice gives him more motivation to achieve his goals.

“Though the workload is high, to say it is excessive is subjective as there is no parameters to indicate what is excessive and what is subtle because at the end of the day, I believe it depends on the individual themselves – self-motivation is of utmost importance.”

On that note, Dr Khairil strongly urged for MOs to specialise, especially in times when information is accessible via the internet, and therefore permitting patients to self-diagnose themselves.

“People have become more knowledgeable and well-informed. So it’s important for doctors to specialise so that it provides patients with more confidence with their (the doctor’s) diagnoses and expertise.

“But it will also be beneficial if the MoH can make it more flexible for medical graduates and MOs to specialise as well as ensuring the programme is available in every district hospitals,” he opined.

Many Look To Specialise, But Not All Are Able To Pass

Malaysian Digest then got in touch with the Dean of Faculty of Medicine at Universiti Kebangsaan Malaysia Medical Centre (PPUKM), Professor Dr Zaleha Abdullah Mahdy, who has been working in the medical field since 1989 and is a specialist in Obstetrician and Gynaecology (O&G) since 1997.

“Over the years, UKM has seen a tremendous increase in medical graduates applying for the Masters programme in various fields – so much so that we have entrance exams to ensure that we select the best and most competent students.

“For instance back in 1981 when O&G was first introduced as an area of specialisation, the institution received two or three candidates per intake. But now we accept roughly 25 candidates per intake, just in UKM alone,” the experienced medical practitioner relayed whilst adding that the number of intake per year differs from one field to the next.

As to why the statistics have drastically increased over the years, Dr Zaleha detailed that, with the enormous increase in depth of knowledge and new evidence in every field of medicine, specialising is the current trend for the medical practitioner to remain relevant in clinical practice.

“Even general doctors have a specialisation of their own called Family Medicine Specialist or Family Physician, whereby the candidate studies every field from the perspective of a family physician prior to sub-specialising in fields such as adolescent mental health, stroke intervention,” she added.

Nevertheless, she relayed the number of candidates passing their Masters programme differs according to fields, and each comes with its own sets of challenges – all of it different, yet equally challenging.

“For instance, paediatrics has a higher attrition rate possibly because paediatrics appears to be immensely stressful. Treating smaller patients is not an easy task as when they get sick, they can deteriorate quickly.

“While adults may have a standard dosage for medications and fluids, each child will have a different dosage and hence why paediatricians always carry calculators,” she revealed.

Oddly enough, the mother of four also revealed that Malaysia is not only lacking in paediatricians but there is difficulty in finding candidates to enter the programme due to its high demand in terms of meticulousness.

“Another field that Malaysia is lacking in specialists is oncology and radiotherapy as in my opinion, one has got to be exceptionally emotionally strong and stable to handle the stresses of cancer patient management.

“On the other hand, although certain fields such as Cardiology and Neurology, which are subspecialty areas, are more popular, but when compared with the volume of cases to be handled, one can never be too certain that the statistic is sufficient,” Dr Zaleha opined.

Advice To Aspiring Specialists

The duration it takes to complete the Masters programme in becoming a specialist has long been regarded as a hindrance amongst some medical graduates.

But Dr Zaleha emphasised it is more structured in training as opposed to theoretical training and therefore, the four-year programme aims to provide medical graduates with experiential learning that will help hone their skills even further.

“I strongly encourage medical graduates to specialise, especially for those who are looking to continue with their clinical practice because the knowledge obtained from your basic medical degree may not equip you with a thorough insight into a patients’ medical problems.

“The programme will provide graduates with a structured apprenticeship whereby they are guided by their mentors on the proper way to manage and treat patients, on top of gracing them with constructive feedbacks that will widen their knowledge and improve their skills,” she relayed, adding that the most valuable takeaway is the experience itself.

Dr Zaleha also suggests for the administrative level to work together in making it simpler for graduates to specialise by permitting them to specialise earlier on in their career – especially bright and decided candidates.

“I also disagree with a two-year housemanship,” Dr Zaleha shared.

“With the current overflow of medical graduates and MOs, it would be better to expedite specialisation.”

“It may have been a coincidence, but one cannot help noticing that it was after the extension of the housemanship programme to two years that we saw a steep rise in the statistics of housemen dropping out from the programme,” she added.

Citing that being a medical practitioner is not a glamorous job, Dr Zaleha assured that the satisfaction of becoming a doctor comes from knowing that your knowledge and skill has helped save the lives of patients.

“The medical field is a progressive field that is often regarded as a lifelong learning process as doctors will only improve as time passes by updating their knowledge and widening their experience.

“Specialising is indeed the way to go. Challenges will definitely surface but it will only shape you into becoming better doctors. So do not be discouraged by the perceived hardship of the long duration – the programme will come to an end eventually.

“In the end, persistency and resilience is key. It all comes down to how you manage your time, your family, your social life and what you yourself deem as a hindrance from pursuing the postgraduate programme,” the doctor advised.

What The Ministry Says

To think that MoH is oblivious of the predicaments faced by aspiring specialists and specialists attached at government hospitals could not be further from the truth.

MoH in a response to Malaysian Digest acknowledges that Malaysia is currently facing a shortage in specialists, but assures that they are trying their best to address the issue aside from making it more appealing for MOs to specialise.

Acknowledging that there are those who complain of being rejected from specialising due to failing to pass the entrance exam, MoH highlighted that the stringent entrance exams are necessary as a means to identify the best of the best, especially in times when limited hospitals and teaching institutes offer Masters programme.

Other than that, the ministry has also made a few amendments to specialists’ remuneration in a sense that they are permitted to have private practice on the side as they understand that some specialists would like to personally manage a patients’ case aside from generating additional income.

Evidently Rome was not built in a day, but to know that the MoH acknowledges these issues and are looking for solutions should bring comfort to aspiring specialists and practicing specialists alike.

– Malaysian Digest


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