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Tuesday, June 15, 2004

The Government Doctor Shortage

:: The shortage of doctors in government hospitals and clinics is not something new. It has been going on for years and years. The government appears not to have a definite policy as to whether it wants to keep doctors in government service or not. To many, the government and its health ministry have appear lackadiasical and ambivalent mostly, this is seen by the fact that it has directly or indirectly encourage the mushroooming of private medical centres and health tourism and the resultant flow of doctors to the private sector. For many doctors who have left government service, the reasons for leaving may not be just about money. There are many other reasons like job satisfaction, unreasonable transfers from one department to another, lack of promotional and further study opportunities and a feeling of a less than caring MoH. Even to this day there are doctors who have worked for 25 to 30 years who have applied and been given optional pension. These doctors can't have left for monetary reasons. On many occcasions in the past, there have been calls to have a separate commission or department to cater to government doctors. This has always been resisted by the government and the JPA. The argument is that other professionals would request for the same. If it be required then let it be so. Such a commission would then be able to deal with the perennial problem of doctor shortage in a holistic manner, from medical student education, training for the newly qualified doctors, further education for doctors, renumeration and promotional opportunities etc.

Recently, following a dialogue with the APHM or Association of Private Hospital Malaysia, the Minister of Health announced that doctors in private practice [DIPP] will be requested to serve in government hospitals for a certain period of time each year. If the response is poor, such a proposal may be made compulsory and tied in with the issue of the Annual Practising Certificate [APC]. The Star reported that the Minister said a joint committee represented by the ministry and the private healthcare sector, including the APHM, would be set up to work out the details for the compulsory service by the DIPP. The Minister has yet to state in which area the DIPP would be required to provide their services. But from my experience and what can be seen from my numerous visits to government health facilities the most problematic area is the outpatient departments where there are just too few doctors, too few paramedical support staff and inadequate and insufficient physical facilities to attend to too many patients in a reasonable time. If the DIPP are to help out this would be the area to do so. But the Ministry must first ensure that there are adequate supporting staff, sufficient rooms and equipments for these DIPP. Presently, in many outpatient departments doctors are sharing rooms, sharing nurses and sharing equipments and of course sharing the huge patient load!

Presently in most hospitals, with the specialist Master programme churning out specialists, there are more than adequate number of specialists to man the specialist units. In some departments some of them have been heard complaining that there is insufficient work to go around. It is unlikely that there is a need for the specialist DIPP to help out in this area. Anyway from what i have heard in the past, when this idea of DIPP helping out in government hospitals was mooted by previous Ministers of Health, often the government specialists felt that their turf was being invaded and their feathers were ruffled. A good number of them were worried that the DIPP were coming to 'steal' their patients, ironic indeed. The other thing, the government specialists were not too happy was the fact that many of the DIPP were their seniors and in some cases even their former bosses. The government specialists were also worried that the DIPP would not be in touch with the latest up-to-date management protocols. So for the DIPP, the specialist units are a no-go area. So where can the specialist DIPP be of help? As presently there is also a shortage of medical lecturers in the medical faculties, such specialist DIPP, especially those who have been teaching before leaving government service and those who also have kept themselves updated, they should be of help in overcoming this medical lecturer shortage. But for the specialist DIPP to serve in lecturer capacities, the Ministry of Education must also be involved.

Surely, renumeration must be the last consideration for the DIPP, but the Ministry must come out with a detailed plan for the DIPP to help out in government facilities. It wouldn't be in anyone's best interest to have arm-twisting and underhand tactics like making the whole exercise compulsory and linked to the renewal of the APC. The new Minister has gone on the wrong footing right from the word go. As mentioned earlier this idea is not new [though the present Minister is and he may also think his proposal is brand new] and it has been mooted many times in the past, but without proper and detailed planning the idea has had many false starts and fizzled out even before getting off the ground. Many toes were 'perceived' to have been treaded on and sensitivities disturbed.

Apparently, the Minister is reported to have fired at the Malaysian Medical Association [MMA] and has told it not to pay lip-service over the proposal that DIPP contribute their services to help overcome the shortage of doctors in government hospitals. He is quoted as saying ::
"I understand that only seven or eight doctors came forward about three years ago when the ministry asked doctors in the private sector to help government hospitals."[please note at that time Datuk Jimmy Chua was the Minister, my friends among the DIPP, pooh-pooh the quoted numbers]
Describing the response as "worst than tokenism", [seem to be the latest catch word for the Ministers] Dr Chua said that doctors in the private sector, "as Malaysians, have a social responsibility" to the nation.[as a Minister, the Minister of Health must also remind himself that he has a responsiblity to the rakyat , equal to if not greater than the DIPP]

Coming out thus with his guns blazing and being confrontational is not going to have the problem of government doctor shortage alleviated and the social and health responsiblities to the rakyat taken care of. Keeping cool heads will help instead. So dear Minister please be cool, have thorough brainstorming sessions with the DIPP and all concerned and come out with a detailed structured plan so that the DIPP will be able to voluntarily help out and address their social responsibility and in the end benefit the rakyat. Surely the Minister does not expect to compel all 8,000 DIPP to descend on the government hospitals and clinics, for then there may not even be standing room for all! The other thing that may happen if all DIPP are compelled to compulsorily help alleviate the government doctor shortage, a situation may arise where the DIPP, when doing this new version of 'national service', be compelled to have government doctors run their practices in their absence. Dear Minister we wish you the very best in ensuring this new old idea take shape ASAP :: Jasa Kapada Rakyat :: Thank you.

LONE's rantings for all interested, COMMENTS/KOPI-0s welcomed. Comments are solely the views of their makers
MALAYSIA, a great place to be in, BUT we can, will and must make HER better.
You may say I'm a dreamer but I'm not the only one
I hope someday you'll join us
And the world will be as one.
IMAGINE:youtube::John Lennon

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