KUALA LUMPUR, Jan 16 – Representatives from the Universiti Malaya Medical Centre’s (UMMC) medicine department have proposed a parallel house officer (HO) system for the university hospital to recruit its own housemen.
In response to a January 2 letter from the Department of Medicine’s (DOM) acting head and a few doctors on a critical shortage of housemen in UMMC, doctors within the department said the quaternary hospital in the Klang Valley should hire and train its own house officers to eventually become medical officers (MO) and specialists.
“We [propose] overseeing the hiring of our own HOs, and maybe even nurturing them to be our service medical officers. This will create a parallel HO system and requires much thought, as well as negotiation and coordination, with the MOH (Ministry of Health).
“However, we have all the specialties and subspecialties available for this to happen. If we are a training hospital for [postgraduate] Master of Medicine (MMed), I am sure we can train HOs as well.
“We can even set out the criteria for absorption (which can include objective aptitude tests/ subjective multidisciplinary feedback/ interviews) of said HOs into our service MO pool to encourage healthy competition amongst them,” the doctors from UMMC’s DOM stated in their three-page letter last January 3, as sighted by CodeBlue.
Currently, the MOH manages the recruitment of all house officers from graduates produced by both private and public medical schools, including Universiti Malaya, and decides their placements in its own hospitals, as well as teaching hospitals under the Ministry of Higher Education (MOHE).
Doctors at UMMC’s medicine department also suggested, in their feedback to the acting DOM head, the recruitment of more permanent service medical officers to address the house officer and medical officer shortages.
“Hire more permanent service MOs to cover the HO/ MO shortage in the long term. Each unit [should] come up with the optimal number of MOs for the units to run smoothly and comfortably (including ward and clinic work, accounting for emergency leaves/ medical leaves/ lack of MMed students). In return, those MOs will be given the opportunity to rotate amongst the units and eventually progress in their career (MRCP or MMed).
“I am sure with our hospital’s reputation and the contract doctors’ conundrum in MOH, many will jump at the chance to join us if their pathway to specialisation is clear and guaranteed. This will eventually lead to us being a hospital which is entirely self-reliant, without having to depend on MOH supplying us with MMed students,” the feedback read.
The DOM doctors acknowledged that some of their proposals may be controversial, but said “these are desperate times and desperate measures are needed.”
CodeBlue reported yesterday a “dire shortage” of house officers and medical officers at UMMC’s Department of Medicine, prompting the department’s acting head to call for a “Zero HO Protocol”, urging staff to operate under the assumption that the services of trainee doctors are no longer available.
The protocol at the largest department in UMMC involves smaller units forgoing house officer services, prioritising house officers in high workload units like respiratory medicine and infectious diseases, discontinuing “indiscriminate” test requests, and practising “mindfulness” in admitting patients.
The January 2 letter by the acting DOM head and a few other doctors also said the medicine department was in the process of cutting certain services and collecting reported cases of “suboptimal care, near-misses, or morbidities” that have occurred as a direct or indirect result of the “severe” manpower shortage.
“We fear the day may come, sooner rather than later, that the reputation of UM as a Centre of Excellence may not be upheld if we cannot ensure even the most basic issue of patient safety,” the letter stated.
Often, No Medical Housemen On-Call At All. ‘Nada. Zilch.’
Doctors from UMMC’s medicine department said in their feedback to the acting head that the DOM was now suffering an “extreme, unsafe shortage” and “gross” maldistribution of HOs.
“Medical MOs now must ‘shoulder the burden of addressing all the issues, minor or major, including mundane duties like phlebotomy’, as HOs are practically non-existent, or non-existent at all. This is very tough during office hours, but the difficulty is amplified during on-call hours,” the DOM representatives said.
“It beggars belief that it is not an infrequent occurrence that UMMC (‘Centre of Excellence’) has NO Medical HOs on-call at all. Nada. Zilch. To put into context, can you imagine NUH (National University Hospital) of Singapore having no HOs during on-calls?”.
The DOM doctors also complained that although they were told that the HO shortage was a hospital-wide or nationwide problem, other departments in UMMC like orthopaedics, surgery, the anaesthesia critical outreach team, and psychiatry frequently have house officers.
Specialist Training Fast Becoming Housemanship 2.0
Another issue highlighted in the feedback was the overburdening of medical officers. The point included a brief summary of the jobs that medical officers in DOM must do nowadays.
“The exhaustion is amplified during on-calls without HOs. Ask any of us how we are feeling and the answer is invariably some variation of the word, ‘tired’.
“MMed training is fast becoming Housemanship 2.0 and future specialists will be very proficient in blood taking, peripheral vein cannulation, and male bladder catheterisation. I am sure this is not what we envision.”
The group also proposed a more short-term but “controversial” suggestion, involving pulling house officers from other postings to cover some medical wards during on-call times.
“Detractors might say this will hinder their learning. However, issues that occur during on-call times in surgery/ orthopaedic/ other specialties’ wards are not uncommon in our medical wards (other than post-operation specific complications). If this shortage is a hospital-wide issue, surely the solution must also involve the different hospital departments.
“Perhaps the heads of departments can come together and devise a mechanism to ensure that HOs are spread equally amongst departments, at least during on-calls or weekends. This suggestion is bound to ruffle some feathers, but extraordinary circumstances require extraordinary measures.”
VC: University Won’t Tolerate Underperformance At UMMC
Meanwhile, a January 7 message from Universiti Malaya vice chancellor Noor Azuan Abu Osman warned those “underperforming” at UMMC that the university “will not tolerate” any staff that has “not been serving the hospital and our patients well”.
“All policies, reminders and warnings to our staff in UM will apply to all of the staff in UMMC, ensuring that each of our staff will be in the same line of direction and repercussions.
“All staff that are not performing to the standards and expectations that are expected based on pure merit and competence, will not be tolerated, regardless of which unit, department, centre, faculty, or any other affiliated entities of UM, including UMMC.
“We are here to lead our nation and serve humanity, and we will need the best from our human capital to fully recognise the scale of this importance,” Noor Azuan said in her message, as sighted by CodeBlue.
Noor Azuan said UMMC has been the university’s pride and legacy, serving the people and the nation for decades. “It remains the best and the biggest teaching hospital in the country with state of the art physical medical assets and human capital, from the best doctors to various achievements in the medical field.”
