The Malaysian Medical Association said there was an oversupply of medical graduates, with more than 22,000 doctors on contract with the government since 2016
Malaysia’s health ministry does not have the capacity to absorb all the medical graduates being produced in the country annually, says a former deputy health minister.
Gopeng MP Dr Lee Boon Chye said the issue was not simply the number but also the lack of those with adequate training.
The PKR man said the 3,000 medical graduates produced by Malaysian universities in 2020 had already exceeded the health ministry’s capacity to absorb them into permanent posts.
“Imagine if this increases to 4,000 medical graduates per year. There are 1,000 to 2,000 overseas medical graduates returning to Malaysia yearly.
Dr Lee Boon Chye. “The ministry cannot have enough posts to train fresh medical graduates as housemen. It also does not have enough capacity to provide permanent posts after their stints.
“At the moment, the waiting time to get houseman posting is six to 12 months.”
Higher education minister Noraini Ahmad told the Dewan Rakyat 2,967 medical students had graduated from higher learning institutions in 2020.
She said her ministry’s target was to produce 4,000 new doctors yearly to reach the recommended ratio of one doctor for every 400 people by 2025.
“The current intake capacity of medical students at all institutions in the country is 4,820 students,” Noraini added.
Fresh doctors have been put on a contract system in recent years instead of being absorbed permanently into government service.
It was recently reported that 1,497 contract doctors had resigned since 2017, including 514 between January and November this year.
Lee said the quitting of contract doctors meant that the nation was being deprived of trained doctors and even specialists, adding that some of them would leave the field altogether to take up unrelated jobs.
Outstanding issues like the lack of permanent posts and the opportunity to go for specialist training were the main reasons they quit, he added.
The Malaysian Medical Association (MMA) said there was an oversupply of medical graduates, with more than 22,000 doctors on contract with the government.
MMA: Surplus of medical grads due to poor past policies
The overproduction of medical graduates and over 22,000 doctors on contract with the government are the result of poor policies of the past, says the Malaysian Medical Association (MMA).
Its president Dr Koh Kar Chai called on the present government to rectify these past mistakes, saying that the current lot of contract doctors arose out of the fact that there was a mushrooming of medical schools and medical programmes over the years.
This, coupled with the large number of foreign medical institutions given recognition, led to an uncontrollable rise in the number of new medical graduates to the extent that the Health Ministry was not able to offer them adequate positions for houseman training, he said.
“Higher Education Minister Datuk Seri Noraini Ahmad has mentioned that a total of 2,967 medical students graduated from local institutions of higher learning in 2020.
“According to her, there needs to be an average of 4,000 new doctors every year in order to achieve the target ratio of one doctor for every 400 population by 2025. She said this is according to the Health Ministry’s 2016-2020 strategic plan.
“However, it appears that the number of foreign medical graduates returning home, which matches the number of local medical graduates, seems to have been left out of the equation,” said Koh in a recent statement.
He said the large number of medical graduates had led to an unhealthy imbalance in the job market and the country’s aspirations, adding that the issue of neglected contract doctors was there for all to see.
Currently, there are also 34 public and private medical schools in the country which was as many as there were in the United Kingdom, Dr Koh said, adding that there were between 3,000 and 6,000 medical graduates produced each year.
“There is something terribly wrong with this picture,” he said.
Dr Koh pointed out that there were manpower shortages in healthcare while the healthcare needs of the nation were increasing and no permanent positions were available for contract doctors.
MMA had warned about the overproduction of medical graduates in 2010, he said.
“We wish to (point out) once again that out of the 23,000 medical officers placed under contract since the contract system was introduced in 2016, only around 1,000 were given permanent posts.
“The same government that closed its eyes to the mushrooming of medical schools and programmes also introduced the contract system.
“The more than 22,000 medical officers on contract today is a result of poor human resource planning and poor policies of the past,” he said.
Dr Koh added that the Health Ministry recently had a discussion on the planning of healthcare human resources but the MMA was not called even after the ministry reportedly promised it would be included.
“There is a moratorium on the number of new medical schools and medical programmes at the moment and we were made to understand that this moratorium will be extended further.
“However, the statement that the Higher Education Ministry was updating the approval mechanism for the establishment of new faculties and the offering of medical programmes through the establishment of the Technical Committee for the Bachelor of Medicine and Bachelor of Dental Surgery programmes have left us confused.
“The MMA wishes to seek clarification from the minister on her statement,” said Dr Koh.
He added that if indeed the moratorium was being ignored, Malaysia would continue to see the issue of thousands of medical officers on contract as the current situation is today.
Dr Koh said the MMA wished to throw a challenge to the government of the day to “correct the mistakes of the past while the opportunity to do so still exists.”
No Jobs for Malaysia’s Medical Graduates in 2022
There are too many medical students graduating every year and not enough hospitals to train and provide jobs for them, said the Malaysian Medical Association.
If the situation continues, there would be no place for these graduates to undergo training by next year, its president Datuk Dr N.K.S. Tharmaseelan said. He said there were “too many medical graduates, and too many private medical colleges; almost 40 now for a population of about 28 million”.
“This is probably one of the highest per capita in the world. For many years, the MMA has vehemently opposed the flooding of the market to overcome the shortage of doctors. However, as we were regularly assured that many rural areas still lacked doctors and that there was no likelihood for jobless doctors, many continued to pursue medical courses.
“Today, with about 5,000 medical graduates every year, we have the highest number in Malaysian history.”
The government is planning to reach the World Health Organisation’s (WHO) standard of one doctor to 400 patients, said Dr Tharmaseelan, and while it was fine to set standards, the nation needed to achieve that gradually.
“Trying to speed track this without adequate infrastructure, such as enough hospitals to train and provide jobs for doctors, will surely create unemployment.”
In the last five years, only two government hospitals were built, bringing the number to 132. According to the 2014 Budget, there is only one planned in the next five years.
There are 40 private medical colleges in the country and 375 recognised colleges overseas. Those from unrecognised colleges need to complete two years of housemanship, two years of compulsory service and sit for a medical qualifying exam before being given full registration certificates.
“Most states have only one state hospital that serves as a referral centre. This is certainly inadequate. Medical graduates need to be trained. For that, you need hospitals. We will surely see jobless graduates next year as the figures from the Health Ministry show that they have already filled all available posts.
“According to the ministry’s annual report in 2011, there were 28,309 medical officer posts, of which 21,765 were filled. Today, the remaining 6,544 posts have probably been filled.
“Just as we have about 15,000 unemployed nurses, a few thousand jobless lab technicians and similar number of physiotherapists who are facing the same predicament, the number of doctors will also reach that figure sooner than expected.”
Dr Tharmaseelan added that part of the fault lay in inadequate coordination between the Health and the then Higher Education Ministries.
“One lacks infrastructure while the other allowed the opening of more and more medical colleges, and offered nursing, physiotherapy and other allied health professional courses without determining whether they can assimilate these individuals or provide jobs.
Medical colleges have sprouted up and the entry qualifications into these colleges are frighteningly low; only four B4 credits in the Sijil Pelajaran Malaysia or Sijil Tinggi Persekolahan Malaysia examinations are needed.
“This decision was probably made to fill the vast number of places in medical colleges. “We must enforce a strict moratorium on medical colleges. Colleges which are not performing should be closed down. “This is the only country where we build colleges and supply candidates to fill them up.
“How do you allow medical colleges to function without sufficient staff and exposure to patients? Medical training is not just classrooms, mannequins or robotics training. Most medical colleges overseas have their own hospitals but here, medical institutions share public hospitals to cut costs.
“The consequence of these mass, factory-like productions is insufficient exposure to patients.
“Some hospital units have up to 150 doctors. How is it humanly possible to train or monitor them?
“When I joined the medical service three decades ago, there was one house officer (HO) manning an entire ward of 40 to 50 patients. Now, we have more HOs than patients in a ward.
“How will they ever get the opportunity to learn the intricacies of medical practice? It’s a well acknowledged fact that the standard of medical practice in the country is gradually waning,” he said.
Dr Tharmaseelan stressed that it is time the Malaysian Medical Council (MMC) queried the standard of private medical colleges. He said initially, the MMC’s regulations stated that a medical graduate had to complete one year of housemanship and three years of compulsory service.
Later, it was increased to two years of housemanship followed by three years of compulsory service.
“However, due to the increasing number of doctors, the compulsory period of service has been reduced by a year.
“Now, I believe that the government is mulling to waive the compulsory service period completely,” he said.
The MMA is appealing for several measures to be taken immediately to arrest the situation.
“There needs to be a moratorium on more medical colleges. Admission criteria should include an interview to assess aptitude, attitude and general knowledge, with a limit of 100 students per year.
“Also, medical colleges should have sufficient tutors, lecturers and infrastructure, including their own training hospitals and clinical research wings.
“The Health Ministry should ensure there are enough hospitals built to cater for training doctors, and the MMC should constantly review and monitor the standards of medical colleges both in Malaysia and overseas.”