LETTER | The housemen placement woes due to a glut of medical graduates in Malaysia could be a paradox. Although WHO prescribes a doctor-population ratio of 1:1000, many developed countries (France – 3.227:1000, Germany – 4.125:1000, US – 2.554:1000 and Singapore 2.2:1000) have always maintained a higher number to cater for their ageing citizens.
According to the Ministry of Health Malaysia (KKM) in 2017, Malaysia still lacks of doctors with a lower ratio at 1.6:1000. If our intention is to become a developed nation in 2025, why are we working backwards by limiting the growing number of doctors?
The root cause of the housemen placement issue is the lack of public healthcare training facilities for young doctors to complete their medical training. Based on the ministry's report in 2017, as of Dec 31, 2016, there were 144 government hospitals with an estimated 42,000 beds. In addition, there were 187 private hospitals contributing an additional estimate of 14,000 beds, to make the total beds available at 56,000.
Sadly, the number calculates only to 1.77 beds per 1,000 patients in comparison to Singapore which plans to further improve its current 2.5 beds per 1,000 patients ratio, to match the US which has 2.8 beds per 1,000 patients. These numbers clearly indicate the necessity for our healthcare facilities to increase.
In order to become a developed nation by 2025, it is imperative to use Singapore, our closest well-developed neighbour as a yardstick for healthcare management. Singapore which has a population of 5.6 million allocated SGD$10.2 billion out of its SGD$80 billion expenditure budget in 2016 for healthcare.
The figure makes up 12.5 percent of their total budget. On the other hand, Malaysia with a population of 31.2 million in 2016 allocated RM23 billion against its RM267 billion budget, which equals 8.6 percent. To illustrate an “apple with apple” comparison, Singapore actually allocated around RM5,464 per citizen while Malaysia spared only RM727 per citizen.
In 2016, the Association of Private Hospitals Malaysia voiced out against the proposal of placing housemen in private hospitals due to a myriad of issues such as medico-legal indemnity, supervision and specialist remunerations. Without support from the private sector, the Malaysian Medical Council and Health Ministry are left to find solutions on their own.
The measures to shorten the waiting period for housemen’s training, increasing housemen's training slots and limiting the number of medical graduates are indeed only temporary solutions to clear up the growing list for housemen placement.
Meanwhile, the hassle has caused us to lose potentially talented doctors. According to a report by the Penang Institute in 2017, the prolonged wait of five months to receive posting confirmation has caused a great deal of anxiety and stress to medical graduates. Many are heavily indebted due to servicing their study loans and unless they seek out part-time occupation, they are left with no means of income.
In addition, the long waiting period does not help housemen to be professionally and mentally prepared for the challenges that they are bound to face during training. They also risk losing touch with the knowledge and skills acquired during their years of study. As we speak, about 20 percent of housemen each year do not complete their two-year hospital training stint.
Despite the exorbitant course fees imposed for medical studies and this current issue, parents are willing to sacrifice their life savings and mortgage their properties to see their children graduate with a noble MD or MBBS. Are we about to shatter the belief of many Malaysian parents that a medical profession will secure a child’s future?
We need a healthy healthcare industry to keep us healthy. As the quote by Winston Churchill says, “Healthy citizen are the greatest asset any country can have”.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.