KUALA LUMPUR, March 20 — Parallel pathway graduates, including those in cardiothoracic surgery, have scored a major, albeit partial, victory, after the Ministry of Health (MOH) approved their gazettement as specialists.
However, despite gazettement under the MOH, parallel pathway graduates’ ultimate goal of registration under the National Specialist Register (NSR) as specialist doctors remains uncertain. NSR registration is crucial for private practice in Malaysia.
In a circular dated March 15 by Health deputy director-general (medical) Dr Nor Azimi Yunus, a Special Medical Committee (JKP) meeting on March 13 decided to approve a six-month gazettement process in the MOH for graduates from four parallel pathway specialist programmes:
- Cardiothoracic surgery: Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery (Royal College of Surgeons of Edinburgh)
- Family medicine: Fellowship of the Royal Australian College of General Practitioners (Royal Australian College of General Practitioners)
- Family medicine: Membership of Irish College of General Practitioners (Irish College of General Practitioners)
- Plastic surgery: Fellowship of the Royal College of Surgeons of Glasgow in Plastic Surgery (Royal College of Physicians and Surgeons of Glasgow)
“The medical officers involved will receive official letters by the Human Resource Division to commence the gazettement process, lasting a minimum of six months. Additionally, they will undergo an assessment upon completion of the process, as set by the Ministry of Health,” said Dr Nor Azimi’s circular, as sighted by CodeBlue.
The circular was addressed to MOH chief cardiothoracic surgeon Dr Basheer Ahamed Abdul Kareem, MOH chief family medicine specialist Dr Nik Mazlina Mohammad, and MOH chief plastic surgeon Dr Salina Ibrahim.
MOH’s approval of specialist gazettement for cardiothoracic surgery graduates – who trained in the MOH’s parallel pathway programme with the Royal College of Surgeons of Edinburgh (RCSEd) in the UK – was given after the Malaysian Medical Council (MMC) rejected NSR registration applications by four pioneer graduates from that programme.
Health DG at the Heart of War between MMC and MOH
Dr Basheer described the MOH’s approval of specialist gazettement as a positive step, but also a mere “token” for royal college graduates, questioning if the MMC would now permit them to register with NSR.
“The gazettement implies that MOH and the Public Service Department (JPA) – JPA handles allowances – endorse this parallel pathway programme and its graduates.
“If MMC still refuses to recognise these graduates, are they opposing the government? What is their goal? Are they safeguarding the nation’s health care or impeding it?” Dr Basheer told CodeBlue when contacted yesterday.
“MMC will need to clarify its position if it contradicts the government or MOH. It’s ironic that both decisions stem from the Health DG.”
The president of the MMC, which regulates the medical profession in Malaysia, is the Health director-general, currently Dr Muhammad Radzi Abu Hassan. At the same time, the Health director-general effectively runs the MOH that serves as the largest health care provider in the country.
Dr Basheer, who is also Malaysian Association for Thoracic and Cardiovascular Surgeons (MATCVS) president, said that prior to MMC’s corporatisation in 2017, the recognition and gazetting of specialists were overseen by JKP (Jawatankuasa Khas Perubatan) under General Orders of the Government. A gazettement by JKP held the same weight as registration with NSR at that time.
“During my time, I only had the government gazette. I submitted it to MMC, and they issued me the NSR,” Dr Basheer said.
MMC Vs JKP or Medical Act vs General Orders
It now seems that the authority granted to MMC by the Medical Act 1971 (Amendment 2012) conflicts with the authority of JKP under General Orders of the Government Chapter F (Section 27).
The Medical Act stipulates that all doctors must be registered under this Act to practice as specialists, ensuring compliance with the qualifications and standards established by the MMC.
Under General Orders of the Government Chapter F (Section 27), the Health DG, with the advice of three specialists selected by him or by a JKP established by the government for the same purpose, may appoint medical officers as specialists if they meet the requirements in Article (b). All appointments must be published in the government gazette.
Article (b) specifies that a medical officer shall not be appointed as a specialist unless the position held requires the performance of specialist duties and (i) they possess recognised scientific or specialised qualifications and satisfactory experience, as determined by the Health DG, and (ii) they have satisfactorily performed specialist duties for a considerable period.
“What is unclear is the relative weightage of gazettement and NSR registration. Gazettement, bestowed by the Yang di-Pertuan Agong to the Health DG in 1962, certifies doctors for specialist practice across the states of the Federation. This was before Malaysia was formed,” Dr Basheer told CodeBlue.
“The specialist allowance was created in 1970 when specialists in government service lost many of their privileges and were instead given a fixed specialist allowance decided by JPA. This precipitated the brain drain that is ongoing.
“Despite the Medical Act, JPA still only recognises doctors who are ‘diwartakan’ (gazetted) as qualifying for this allowance as their names are published in the government gazette.
“Acts of parliament only come into force after they are gazetted. Hence, can the MMC legally deny someone whose name has appeared on the government gazette specialist status? When NSR was under the academy, gazettement led to automatic NSR registration,” Dr Basheer said.
Health DG or MMC president Dr Radzi last month told CodeBlue that the parallel pathway programme was a “complex issue” that was “not easy to explain”. He said that MMC would issue a statement on its rejection of NSR registration applications by cardiothoracic parallel pathway graduates. However, the statement was never released.
