The Malaysian Medical Association (MMA) wishes to thank the health minister for pledging his commitment to resolving the ongoing specialist training issues. We are indeed relieved to hear that the Ministry of Health (MOH) has no plans to abolish the Parallel Pathway Programme (PPP).
While the MOH has clarified its position concerning this issue, we hope that its policy will be reflected on the ground during its implementation.
MMA supports unequivocally the PPP for the training of specialists at MOH hospitals and clinics in Malaysia, in addition to the Master programmes being run by local universities.
For many years, the PPP has been complementing the local Master programmes and produced many of the country’s specialists.
Many junior doctors have written to MMA, complaining about the limited offerings in the Hadiah Latihan Persekutuan (HLP) scholarships programme and the long wait for entry.
Many have been waiting for years, while some have migrated overseas out of sheer frustration with the system. We are deeply concerned as these limited openings and long waits are affecting the morale of the medical officers (MOs) concerned, not to mention causing a massive delay in the production of specialists Malaysia so desperately needs.
As it stands, Malaysia is short of specialists across the board, especially at public health care facilities. Any curtailment will reduce the number of new specialists significantly.
It is important to note that the majority of specialists in certain fields like medicine, paediatrics, and even family medicine are from the PPP, with training being done in MOH hospitals and clinics, and by MOH doctors.
The government has set a target of producing 28,000 medical specialists in six years. However, with issues affecting the production of specialists, it is unlikely that we will achieve this target.
Malaysia’s population-to-specialist ratio is currently at 10,000: 4. The Organisation for Economic Co-operation and Development (OECD) average is 10,000: 14.3.
There are less than 13,000 medical specialists in both the public and private health care sectors. Around 9,000 medical specialists serve in MOH health care facilities.
There are more than 3,000 MOs in the PPP presently, mainly training at MOH hospitals. We don’t need another reason for MOs to leave. If they go abroad, it is unlikely we will ever get them back.
Presently, young doctors are distraught, due to many issues affecting their careers. Any additional restriction on training avenues, intakes, number of placements, or the need for HLP for PPP entry without the same benefits as the local Master programmes will cause more harm to the state of health care.
Young doctors need the right indication from the top that their future is clear and secure, and that training opportunities will be made available for them.
The present generation wants the freedom to decide. Having an internationally accepted degree will allow them to further their training abroad later when they want to sub-specialise. Malaysia will stand to benefit, should they return to practise.
The MMA recently conducted a postgraduate training pathway survey and will soon be releasing its findings.
There have been calls for putting the training of specialists under the exclusive purview of national universities, and some has opined that the PPP are not needed.
This is sadly a short-sighted view, where the nation’s needs and requirements are not prioritised, when in actual fact, the nation’s needs and requirements should be the touchstone in any decision-making process.
The government introduced the Health White Paper (HWP) last year to improve public health care services. However, it will be difficult to attain the goals with a reduced number of specialists, and especially so when those from family medicine — a medical speciality within primary care — are inadequate. This is also a field which the PPP is a contributor to.
Finally, MMA wishes to reaffirm that it supports training at both MOH hospitals and university hospitals, as has been the practice over many years. The strong goodwill between universities and MOH must be maintained.
Attempts by certain groups to dismantle the MOH’s PPP represent a backward step, will exacerbate the brain drain, and deepen the existing low morale among health care professionals.
It is disheartening to see that, instead of addressing the challenges, these moves will further complicate an already strained situation.
This will have dire consequences for the future generation, if it is allowed to happen.
Dr Azizan Abdul Aziz is the president of the Malaysian Medical Association (MMA).
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