Another day, another gripe at foreign-trained doctors. The letters Foreign-trained doctors sometimes misfits , Medical standards and the 'where' of it and the report Ramai pelajar perubatan tajaan kerajaan gagal pulang ke Malaysia refer .

I am forced to defend my lot.

First of all, the way medical training is managed in Malaysia, it does not allow very much flexibility in career choice and career progression. A graduate in Malaysia has to apply centrally for placement as a pre-registration doctor. This is followed by more centrally processed applications which pay little heed to the career aspirations of the applicants.

Example: An acquaintance of mine aspired to be an ophthalmologist. After graduating from a UK medical school, she returned to Malaysia, did her pre-registration posts and applied for senior house jobs in ophthalmology. She was sent to various rural and small town hospitals to work in obstetrics and gynaecology. This went on for three years. In the end, she quit 'government jobs' and joined her husband who was in the UK for his (non-medical) postgraduate course.

She then applied for jobs in ophthalmology and was granted one. Contrast the Malaysian system with the UK system whereby, after registration, a doctor can apply to various hospitals for basic training in medicine, surgery, general practice etc. And a UK-qualified doctor does not need to sit for language proficiency tests as stated by Beng.

Secondly, this Malaysian system inflexibility continues on to specialist training. If one is lucky enough to get on the right track and enter some 'prestigious' masters programme then well and good. But for further training, one has to apply to the ministry of health to be allowed to go abroad, instead of doing so independently.

Sadly, the qualifications obtained in Malaysia do not carry the same weight as qualifications obtained in the country where one hopes to further one's studies. Beng's enthusiasm for the Masters programmes is not shared by the hiring squad in the UK who often consider the foreign applicant lacking in basic knowledge and skills when compared to home-trained doctors.

If one were to enter specialist training in the UK, India or Australia, a UK-qualification i.e. membership of the British Royal Colleges carry more weight. This was eloquently stated in the letter Globalisation and doctors' movements . Many 'consultants' in Malaysia function as 'registrars' in the UK as part of their training. Further 'bonding' with the Malaysian government often follows.

All this talk about ungrateful foreign trained doctors also ignore the fact that doctors who continue their training abroad after graduation often do so without any financial support from the government. We are paid by the UK taxpayers, which include us doctors, thus saving the Malaysian government a lot of money.

Basic postgraduate training can be up to four years (permit-free) while specialist training up to five years or more. Examination fees for the Royal College of Surgeons Part 2 is 500 pounds sterling a shot and the pass rate is only about 40 percent, thank-you very much..

As for us being 'misfits' when we return, this is hardly a mature argument against specialist training abroad. Of course, some of us will be disappointed with the poor standards at Malaysian government hospitals throughout the country. Some of us will be disappointed by lack of investment in nursing care, doctors' working conditions and pay.

These concerns are also shared by our locally-qualified colleagues as expressed in Gov't doctors need to unite for better terms and Do not confuse doctors with Mother Theresa . It is hardly surprising that most doctors, irrespective of whether they were trained locally or abroad, defect to private practice at the earliest opportunity.

Perhaps there is a more sinister undertone here. The government would like to provide cheap hospital care on the cheap to the rakyat. The hospitals need to be run by an army of junior doctors. Poor pay and poor working conditions are one way of doing it. Keeping a large number of them bonded to government service via overseas specialist training is another. Vilifying doctors undergoing overseas training and threatening them with financial penalties unless they return with basic undergraduate qualifications may also achieve this end.

But what are the long-term costs to comprehensive healthcare in our country and when most of us are jumping off the sinking ship?

It would be appropriate for a representative of the Malaysian Medical Association or the ministry of health to respond to these allegations.