Specialist Recognition Rejection Puts Heart Surgery Patients At Risk: MATCVS

The Malaysian Association for Thoracic and Cardiovascular Surgeons says MMC’s rejection of specialist registration applications by four parallel pathway graduates in cardiothoracic surgery places heart surgery patients at risk, amid a severe heart surgeons’ shortage.

KUALA LUMPUR, Feb 6 – An association has questioned the Malaysian Medical Council’s (MMC) rejection of specialist registration applications by four pioneer parallel pathway graduates that prevents them from practising as independent cardiothoracic surgeons.

The Malaysian Association for Thoracic and Cardiovascular Surgeons (MATCVS) explained that the Ministry of Health (MOH) initiated the parallel pathway programme in cardiothoracic surgery in 2016 in collaboration with itself, the Academy of Medicine of Malaysia (AMM), and their international partner, the Royal College of Surgeons of Edinburgh (RCSEd) in the United Kingdom.

This programme was approved by the MOH, the AMM, and the National Heart Institute (IJN), with the government providing full scholarships with bonds attached for postgraduate training in cardiothoracic surgery.

Qualification awarded at the end of training is the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery, which MATCVS pointed out is a fully recognised qualification in Singapore, Hong Kong, and Brunei, besides being acceptable and registrable in the UK.

“The MATCVS is alarmed and extremely concerned to learn that the Malaysian Medical Council has recently rejected specialist registration applications for National Specialist Register (NSR) by four pioneer parallel pathway graduates, disabling them from practising as independent cardiothoracic surgeons,” MATCVS president Dr Basheer Ahamed Abdul Kareem said in a statement yesterday.

“We are puzzled as there are Malaysian surgeons with the same qualification who graduated from Singapore, who have already been admitted to the register as early as 2007 and are now in good practice.

“The MATCVS is in dismay about this decision, which poses great dangers to the running of critical cardiothoracic surgical services within MOH, disrupting succession and workforce planning and possibly promoting brain drain in view of the qualification being accepted globally but not in Malaysia.

“Furthermore, we are also risking international disrepute by reneging on previous MOUs signed with our international partner RCSEd, presided and witnessed by previous Ministers of Health and Director-General of Health.”

The MMC is a regulatory body – currently headed by Health director-general Dr Muhammad Radzi Abu Hassan – that regulates the medical profession in Malaysia. Besides 17 elected members, the MMC has nine appointed members from local universities and university colleges, as well as five appointed members from the private and public sectors.

According to MATCVS, 33 surgeons have entered the parallel pathway programme in cardiothoracic surgery since 2016, with 22 of them sponsored by the MOH and the remaining trainees from IJN and Universiti Malaya.

After passing entrance exams and interviews, medical officers are enrolled into a “rigorous” six-year programme that involves rotations to various local and overseas centres, trained by top surgeons in Malaysia with standards comparable to the UK’s National Health Service (NHS).

MATCVS added that these doctors are subject to continuous competency progress reviews, complete with a professional international examination run by RCSEd examiners flown in from the UK to assess trainees in Malaysia, Singapore, and Hong Kong in one pool towards the end of the programme.

MOH’s cardiothoracic centres and IJN have also been credentialed into this parallel pathway programme, after “continuous vigorous and tedious” on-site assessments by RCSEd inspectors.

“It is indeed a testimonial to standards achieved by our local centres, proving us to be on par with top training institutions in the world,” Dr Basheer said, adding that Hospital Canselor Tuanku Muhriz UKM (HUKM), a university hospital, became the latest addition to its accredited centres last year.

“We would like to reassure the public and the government that this is the only programme which is fully compliant to the National Curriculum for Cardiothoracic Surgical Training, an initiative of the Medical Deans Council and a collective effort by the local cardiothoracic surgical fraternity via MATCVS and University of Malaya, launched by the Director-General of Health in April 2022, ensuring that graduating surgeons are of good calibre by international standards and more importantly, able to provide safe cardiothoracic surgical care for patients.”

MATCVS highlighted long waiting lists in all seven cardiothoracic centres by the MOH, noting that Serdang Hospital in Selangor and Penang Hospital have more than 1,000 patients, with more than a year’s expected waiting time for life-saving heart surgery.

“This is worsened due to post-pandemic status and severe shortage of heart surgeons in service. There are only 14 surgeons working full time in MOH (11 permanent and three contract officers) currently, with some scheduled to retire soon while the attrition rates of surgeons migrating to the private sector remain very high,” said Dr Basheer.

“The MATCVS therefore would like to make a strong plea to the Malaysian Medical Council to kindly reconsider this decision and facilitate specialist registration for our future surgeons to avoid grave implications for thousands of patients awaiting open heart surgery in the country, especially the B40 group.

“The MATCVS has also always maintained that the parallel and local university Masters programmes should be allowed to continue and co-exist, based on acceptable standards and curriculum in order to cater for critical cardiothoracic surgical and overall health care needs for the country.”

MATCVS’ statement followed statements by the Academy of Family Physicians of Malaysia (AFPM), AMM, and the Malaysian Medical Association (MMA) that have all defended the parallel pathway programme for specialist training.

Doctors’ specialist training in the country is currently largely provided by public universities through clinical Masters programmes and the MOH via the parallel pathway.

The parallel pathway represents a form of on-the-job structured training provided by MOH for trainees who opt to sit for international examinations conducted by overseas Royal Colleges.

MMA claimed there were attempts by “certain groups” to dismantle the MOH’s parallel pathway programme, describing it as a backward step amid a shortage of specialists in the country.

Health Minister Dzulkefly Ahmad said recently that he would place the parallel pathway “problem” among his 100-day KPIs, adding that he has met with nearly all “feuding” entities, including MMC, AMM, and MATCVS.

“It’s not in the interest of KKM or the nation to abolish the Parallel Pathway,” he posted on X last January 27.

“But, it’s important that we promptly harmonise the training programmes that meet the requirements of our local laws, regulations, and standards, as to achieve our nation’s urgent needs for specialists.”

The health minister also stressed: “Even in dire need to increase the number of specialists, we must NOT compromise on our quality.”

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