PETALING JAYA, May 6 — Former Health Minister Dr S. Subramaniam opposes an immediate abolition of the parallel pathway programme, saying the local Master’s programme alone cannot train a sufficient number of specialist doctors.
Dr Subramaniam said sentiment among a group of medical professionals that the country should strengthen the Master’s programme and slowly remove the parallel pathway “has been going on” since his term as health minister from 2013 to 2018.
“But what we saw was the Master’s programme was not able to provide the number of places to train the number of specialists which we genuinely require,” Dr Subramaniam told CodeBlue in an interview here last April 24.
“I remember until about 2008 or 2010, the number of people going for Master’s programmes was less than 500. Then, during my time, they slowly increased it and I think, by the time I left, about nearly 1,000 places were given for the Master’s programme”.
The former health minister pointed out that about 4,500 medical graduates entered housemanship in 2016, a number that has since declined to about 3,000 annually.
“Take an average of 4,000 or so now,” Dr Subramaniam said. “If we are only training about 1,000 [for specialisation], then what happens to the remaining 3,000 people? Where are they going to train?”.
He strongly held that every doctor should be given equal opportunity to specialise. “It is not a chosen right for just some people and the others cannot”.
He also noted that in 2022, when about 1,100 or 1,200 doctors were registered as specialists, about 700 or 800 of them came from the Master’s programme, with the remaining from the parallel pathway.
“So, if you close that [parallel pathway] down, that extra 300 to 400 who are coming into the system will not be able to come. You are blocking that process”.
Dr Subramaniam explained that the constraints on the number of positions available in local Master’s programmes for specialisation in medicine were due to limited Public Service Department (JPA) scholarships and limited funding in the Ministry of Higher Education.
When CodeBlue asked about his stance on abolishing the parallel pathway and relying solely on local Master’s programmes for medical specialty training, Dr Subramaniam said that such a transition might occur in the next decade or so, but not currently.
“Not now. Whether it [parallel pathway] is going to go out in 10 or 15 years time, only time will tell. At the present time, purely, in the face of capacity, I think it will not be wise for any attempt to remove that,” he said.
National Postgraduate Curriculum Aims To Address ‘Weakness’ In Parallel Pathway Training Structure
Dr Subramaniam acknowledged a “weakness” in the structure of the Ministry of Health’s (MOH) parallel pathway training with royal colleges in the United Kingdom, compared to the “very structured” local Master’s programmes.
“The other ones, which are under the Royal Colleges, to a great extent — although the skill sets are defined, what kind of training you undergo is defined — but they don’t conduct the training. The training is done by us. So it’s up to us to structure the training,” he said.
“That is the one which the National Postgraduate Curriculum attempted to do. And I think they actually proposed a structure which will reconcile these differences so both sets of doctors have equal degree of exposure and equal history of training”.
Dr Subramaniam said there is a role for both the parallel pathway and local Master’s programmes, given the shortage of medical specialists in the country.
“I think if you take MOH, which is the biggest provider of health care in this country, until last year, I think, they only had less than 9,000 specialists, and I mean, there is an aspiration that 30 per cent of the number of doctors who work in MOH should be specialists.
“Now, even if they work very hard, we won’t be able to reach that target. To reach this target, we need to actually increase the number of training specialties for specialists. In our country, we have two systems. The way forward is to see how we can ensure both systems can co-exist side by side.
“If you want to give the opportunity to more and more doctors to specialise, then of course, the number of places has to be increased. That’s why we said that we need to widen. During my time actually, we did say that we will widen the parallel pathways and strengthen it”.
MOH More Than Equipped For Specialist Training
Dr Subramaniam downplayed claims that MOH hospitals are not recognised or accredited for specialist training.
“The answer is, they (MOH hospitals) have been recognised as such because even in the Master’s programme, there are many of these Master’s programmes, in which a portion of the training has been done in the Ministry of Health hospitals.
“They have programmes where one year or two years of the training, they do in the Ministry of Health hospitals, supervised by the consultants within the Ministry of Health.
“So, the universities themselves have actually indeed recognised the hospitals within the Ministry of Health as potential training hospitals.
“So that issue whether MOH hospitals can be recognised as training hospitals doesn’t arise because of this, and the specialists who are in MOH have also been recognised as mentors, supervisors, and trainers under the Master’s programme. So, that issue doesn’t arise because you already recognise them,” Dr Subramaniam said.
He added that the capacity within MOH, in terms of patient load and the number of facilities, is much more than universities.
“There is no hospital bigger than KL GH (Kuala Lumpur Hospital) in this country. That’s the largest hospital with the largest number of specialists, and the largest number of specialities also. So they are centres which are equipped to be good training centres by any standards.
“In moving forward, I think these small issues have to be resolved so that MOH hospitals can be centres for training for specialisation. MOH consultants and specialists can also be doctors who can be accredited to be trainers for such programmes, and the training programme within MOH, through standardisation, can be of equal standards with what is done by the universities.
“So whether the person comes out through the Master’s programme or whether he comes out with a membership from the Royal Colleges, their standards of skill-sets should be the same. So I think that’s the direction in which we are moving forward,” Dr Subramaniam said.