Only 15pc of Malaysia’s Housemen Finish Training Within Two Years

The average housemanship stay increased from 22.8 months in 2009 to 27.8 months in 2016.

KUALA LUMPUR, Sept 9 — The registration of housemen in Malaysia as medical officers within two years continuously declined from 85 per cent in 2009 to just 15 per cent in 2016, a researcher revealed.

Independent policy researcher Lim Chee Han noted a rising number of trainee doctors who took longer than 24 months, since the day they provisionally registered themselves at the Malaysian Medical Council (MMC), to finish their housemanship, from 368 in 2008 to 3,402 in 2015, before dipping to 2,872 in 2016.

“So, there’s a serious problem; it’s getting aggravated,” Lim told the Second Federation of Private Medical Practitioners’ Association, Malaysia (FPMPAM) Malaysian Health Care Conference here recently.

He said more housemen either waited longer for placement in government hospitals, or needed extension of training, or both. MMC issues medical graduates a provisional registration license after they receive a house officer post offer, with MMC saying in December 2015 that it would give medical graduates an endorsement letter first as waiting for housemanship could take as long as six to nine months.

Lim also observed longer stays as house officers, from an average 22.8 months in 2009 to 27.8 months in 2016.

“I don’t know if the ministry has handled it well or not, but the problem is getting worse.”

Number of housemen in Malaysia who are registered as medical officers within 24 months. Graphic by Lim Chee Han.

Lim said between about 50 and 60 per cent of housemen who dropped out from training, or still failed to obtain full registration as medical officers from 2010 to 2016 graduated from foreign institutions. In 2014, about 83 per cent of overseas dropouts graduated from Russia, Indonesia, India, and Egypt.

He observed a rapid addition of accredited local private medical institutions that shot up from zero to 23 since 2000, and claimed that new medical institutions were being recognised despite a moratorium on medical programmes in Malaysia.

“They say there’s a moratorium since 2011, but you can see their numbers putting into the Second Schedule, even up to 2017,” Lim said, referring to the recognised medical institutions listed in the Second Schedule of the Medical Act.

“I don’t know what justification you can give because it’s so long after 2011. You can still see these numbers keep coming in.”

Number of housemen in Malaysia who finish their training in more than 24 months. Graphic by Lim Chee Han.

According to Lim, Malaysia recognised 34 medical schools as of last March, compared to 33 in the United Kingdom, and 13 each in Australia and Indonesia.

Health Minister Dzulkefly Ahmad told Bernama in June 2018 that to resolve the glut of medical graduates who have yet to get placements in public hospitals, the ministry has enforced a moratorium on medical programmes in Malaysia from 2011 to 2021 that will see no new medical programmes at the degree level and no increase in the medical student intake quota.

Lim said the optimum ratio of trainer to mentee was one to five, which would require 423 houseman trainers across 47 housemanship training hospitals per core discipline, or nine specialists per core discipline per hospital to train medical graduates.

But the number of Ministry of Health (MOH) specialists this year were below 423 for core disciplines like general surgery (285), obstetrics and gynaecology (329), and orthopaedic surgery (292), as well as for elective disciplines like emergency medicine (255), family medicine (318), and psychiatry (210).

“The number of specialists just simply couldn’t make it to meet 400 something specialists. That means you will only expect to see housemen in a very large group, so I think this will dilute the quality of their training,” Lim said.

The average and median of housemanship length in Malaysia. Graphic by Lim Chee Han.

He cited a study by MOH’s Institute for Health Management, surveying housemen from 2009 to December 2013, that found a third of trainee doctors were extended yearly beyond their two-year training period. About 55 per cent were extended because of incompetence, while 45 per cent were extended because of disciplinary issues. Those who extended due to maternity leave were excluded from the research.

Lim cited another research by the Institute for Health Management and Institute for Health System Research under MOH that found about 59 per cent of mentoring junior doctors in public hospitals was a spontaneous arrangement, while 67 per cent of mentoring meetings or activities were held on an ad hoc basis. Almost half, or 48 per cent, of mentors had more than five mentees each.

“So this is also a problem and they don’t have enough specialists and too many housemen on board.”

Lim urged MOH to retain more specialists to ensure quality training for medical graduates, and to establish an independent tribunal or ombudsman to address grievances by housemen who claim overwork or mistreatment.

“Local private and overseas medical education institutions must be more tightly regulated,” he added.

He also urged private hospitals to train housemen, saying: “If our country has inferior doctors in future, this will also bite the private sector.”

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