KUALA LUMPUR, April 1 — Six pathology graduates in medical genetics from Universiti Sains Malaysia (USM) have taken the Malaysian Medical Council (MMC) to court for rejecting their applications to be registered as specialists under the National Specialist Register (NSR).
Their judicial review application – which was filed in the High Court here last November 16 and subsequently granted leave by the court last January 3 – accused the MMC of misconduct and deemed its refusal to register them on the NSR, as per MMC’s letter dated August 21, 2023, as “irrational and unreasonable”.
The applicants’ legal counsel from Lee Hishammuddin Allen & Gledhill (LHAG), one of the biggest and leading law firms in Malaysia, cited several grounds, including alleged inconsistencies in the MMC’s evaluation process and arbitrary decision-making.
“The respondent’s (MMC) decisions have adversely affected us. Our career and livelihood have been severely impacted by our inability to register on the NSR. The decision also carries wide ramifications in the context of public medical services,” said the six applicants, who are all registered medical practitioners, in their November 16 affidavit, as sighted by CodeBlue.
Even though the applicants could find jobs in either the Ministry of Health (MOH) or university hospitals, they claimed that non-registration with the NSR would impede their professional career progression, including potential ineligibility for sub-specialisation in medical genetic pathology.
“USM specialist graduates who work as university lecturers are ineligible for promotion in their profession. They also will not be able to direct a clinical laboratory as they lack the mandatory requirement of NSR registration.
“At worst, they are at risk of being terminated for the incapacity in fulfilling their primary duty as they are prohibited from further teaching in any clinical field,” said a representation letter, dated June 22, 2022, by the USM graduates’ former legal counsel from Perem Segar to the MMC’s Special Education Subcommittee.
This lawsuit is another twist in the ongoing saga on MMC’s recognition, or non-recognition, of specialist doctors under the NSR, particularly graduates from parallel pathway programmes by the MOH with overseas royal colleges.
But while some in the medical fraternity have been up-in-arms over the MMC’s rejection last December of NSR registration applications by four pioneer graduates of the cardiothoracic surgery programme by the Royal College of Surgeons of Edinburgh (RCSEd), this judicial review application by USM graduates involves a top local public university.
Both rejections by the MMC of NSR registration applications in USM’s medical genetics pathology and the RCSEd in cardiothoracic surgery, on the basis of not recognising these specialist qualifications, occurred under MMC president Dr Muhammad Radzi Abu Hassan, who was appointed Health director-general in April 2023.
Without registration under the NSR, graduates cannot practise as independent specialist doctors in Malaysia or, in the case of the six USM graduates, as genetic pathologists. The MMC is a statutory body that regulates the practice of medicine across both the public and private sectors. Under the Medical Act 1971, the MMC president is the Health DG, who also oversees the public health service in the MOH.
USM Graduates Received Full Government Scholarships for Medical Genetics Pathology Programme
According to court documents in the case of the six USM pathology graduates versus MMC, as sighted by CodeBlue, the applicants seek several remedies, including the annulment of MMC’s decisions, a declaration of their compliance with registration requirements, and the issuance of a mandamus order – an official directive from a court of law – compelling MMC to approve their specialist registrations with NSR. USM isn’t a party to the suit.
The dispute dates back to when the six applicants first received government scholarships from either the Ministry of Higher Education (MOHE) or the MOH between May 2011 and May 2017 to pursue the Master of Pathology (Medical Genetics) programme at the School of Medical Sciences at USM – the first and only university in Malaysia to offer such a postgraduate course.
The four-year specialised programme was fully funded; the graduates were obliged to serve the government for seven years post-graduation, as stipulated in their scholarship agreements. Failure to fulfil this commitment may render each of them liable to reimburse the government RM160,000.
Upon completing their training in different batches between 2015 and 2021, the graduates were appointed as pathologists (medical genetics) by various institutions, including Universiti Teknologi Mara (UiTM) and Tunku Azizah Hospital in the MOH.
The appointments of four of the graduates were gazetted in the Federal Gazette as pathologists (medical genetics), while the other two, who are also medical lecturers, received credentialing and privileging approval at Hospital UiTM to conduct clinical practice in genetic pathology from 2022 to 2025. The duo had also undergone gazettement at Kuala Lumpur Hospital or Tunku Azizah Hospital.
The six applicants also received specialist incentive payments from the government, which they continue to receive until today. These payments are only made to medical practitioners who are recognised as specialists by the Health director-general or an equivalent authority.
MMC Doesn’t Recognise USM Qualification Despite MQA Accreditation
Despite their credentials and contributions to the medical field, as claimed by the applicants, the MMC refused to register them as specialists, citing non-recognition of their Master of Pathology (Medical Genetics) qualification from USM.
“In the letters, the respondent said they were unable to process our applications for two reasons: (a) we did not have a recognised postgraduate qualification; and (b) we [did] not comply with the requirements for registration as specialist, prescribed in Section 14B of the [Medical] Act,” the applicants said.
Among the requirements under Section 14B of the Medical Act to be registered as a specialist, one must hold a “recognised specialist qualification”.
The 2012 amendment of the Medical Act and 2017 regulations that came into force in 2017 included a mandate that all doctors must be registered under this Act to practise as specialists to ensure compliance with qualifications and standards set by the MMC.
The applicants argued that their qualifications were duly recognised by government bodies and the Malaysian Qualifications Agency (MQA) throughout their academic journey.
The USM graduates also contended that MMC’s demand for re-accreditation of their programme, years after graduation, was “unfair and illogical”. They pointed out that no similar requirement was imposed on any other specialist courses offered by USM or other public universities.
“The position taken by respondent (MMC) was odd, as the programme had been duly recognised and accredited by the relevant ministries and MQA at all material times prior to March 2022,” the applicants said.
The judicial review initiated by the USM graduates highlighted the financial and professional impact of MMC’s decision, such as their inability to practise as specialists and the alleged squandering of public funds invested in their education.
The graduates’ incapacity to register with the NSR would render both government scholarships and the USM programme itself, reliant on public funding, as “defeating their purposes”.
Without NSR registration, the applicants claimed they cannot work as medical specialists or medical lecturers in the field of pathology (medical genetics), undermining the programme’s core objectives and resulting in a significant waste of public resources.
It should also be noted that the government continues to offer scholarships to enroll in the Master of Pathology (Medical Genetics) programme at USM. “The respondent’s decision to refuse to register specialists who graduated from the programme, is therefore incomprehensible, unreasonable and irrational,” the applicants said.
USM’s Website Says MOHE and MOH ‘Established and Approved’ Master of Pathology (Medical Genetics) Programme
Currently, MMC’s website lists eight qualifications in pathology, including a Master of Pathology at USM starting June 2013, but the four recognised modules for majoring in pathology (anatomic pathology, chemical pathology, haematology, and medical microbiology) exclude medical genetics.
USM’s School of Medical Sciences’ website still lists the Master of Pathology (Medical Genetics) among its postgraduate courses offered. A 2022 document on that programme at the Human Genome Centre at USM’s School of Medical Sciences at its Health Campus in Kubang Kerian, Kelantan, does not mention that the specialty isn’t recognised by the MMC for NSR registration.
Instead, USM said its Master of Pathology (Medical Genetics) programme – which started in 2010, with its first graduate in 2014 – has been “established and approved” by MOHE and MOH to be incorporated into the Master of Pathology (MPath). The aim of the programme is to produce genetic pathologists to aid in the diagnosis, management, and treatment of patients with disorders arising from genomic mutations.
“Currently, USM is the only centre in Malaysia offering this programme. Up till 2021, ten Genetic Pathology students have graduated and are now working in the hospitals under the MOH and public universities in Malaysia, whereas a total of fourteen candidates have enrolled in this programme,” said USM’s 2022 document on its Master of Pathology (Medical Genetics) programme.
USM’s School of Medical Sciences was established in 1979; its postgraduate training in medicine began in 1987.
