MOH Excludes Parallel Pathway Opponents From Stakeholder Engagements Despite Patient Safety Concerns

MOH has excluded parallel pathway opponents and certain subject matter experts from its stakeholder engagement meeting today on Medical Act amendment bill: Prof Emerita Dr Sharifah Hapsah, ex-MMC member Dr Abdul Razzak, and UiTM cardiothoracic surgeon Prof Dr Raja Amin weren’t invited.

KUALA LUMPUR, June 12 — The Ministry of Health (MOH) has excluded opponents of the parallel pathway from stakeholder engagements on proposed amendments to the Medical Act 1970, despite their concerns over patient safety.

According to a letter dated June 7 from Dr Mohd Azman Yacob, director of MOH’s medical development division, the MOH is organising a stakeholder engagement session at the Putrajaya International Convention Centre this afternoon on the government’s proposal to amend the Medical Act 1971 (Act 50) to “regularise the process of recognition and registration of specialists”.

This followed a joint Cabinet memorandum presented last June 5 by Health Minister Dzulkefly Ahmad and Higher Education Minister Zambry Abdul Kadir. After the Cabinet meeting, Dzulkefly announced plans to table the proposed Medical Act amendment bill in the upcoming Parliament meeting that is scheduled to begin in less than two weeks on June 24.

Yet, the only stakeholders invited to MOH’s stakeholder engagement meeting today on a key piece of legislation that potentially affects the future of Malaysia’s medical profession were exclusively proponents of the MOH’s parallel pathway programmes with foreign royal colleges for medical specialty training.

According to the invitation list for MOH’s briefing today on the proposed Medical Act amendment bill, as sighted by CodeBlue, the ministry invited up to 31 individuals from all 12 medical fraternities of the Academy of Medicine of Malaysia (AMM), the Malaysian Medical Association (MMA), the Association of Private Hospitals of Malaysia (APHM), the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS), the Malaysian Urological Association (MUA), the Academy of Family Physicians of Malaysia (AFPM), the Malaysian Family Medicine Specialists’ Association (FMSA), and the Malaysia-Ireland Training Programme for Family Medicine (MinTFM).

Aside from MinTFM, which is the family medicine parallel pathway programme, all of the other organisations invited to MOH’s stakeholder engagement meeting today – AMM, MMA, APHM, MATCVS, MUA, AFPM, and FMSA – previously issued statements in support of the parallel pathway.

MOH’s list of invitees did not include any representatives from the Malaysian Medical Council (MMC), even though the regulator of the medical profession is the key party at the heart of the parallel pathway conflict, holding the power to register specialist doctors on the National Specialist Register (NSR) under the Medical Act. Health director-general Dr Muhammad Radzi Abu Hassan, who is also MMC president, was invited to the stakeholder engagement session in his capacity as Health DG.

It is unclear why the presidents of all 12 medical specialist societies under the AMM were invited to MOH’s briefing today, rather than just the College of Surgeons, since the imbroglio over the parallel pathway mainly concerns cardiothoracic surgery due to MMC’s non-recognition of the FRCS Edinburgh in Cardiothoracic Surgery qualification, besides potential MMC recognition problems with the family medicine parallel pathway programme.

It is also unclear why the MMA and APHM were allocated a whopping five representatives each for MOH’s briefing today, considering that both groups aren’t exceedingly involved in the parallel pathway issue. Yet, not a single individual or organisation from the medical profession or university professors directly involved in medical specialty training or recognition – who oppose proposed amendments to the Medical Act – were invited to today’s stakeholder engagement meeting.

MMA mainly represents private general practitioners (besides also speaking up on issues affecting the welfare of doctors in the public health service through its Schomos section). As a representative of private hospital operators in the country, APHM’s stake in the parallel pathway issue is mainly as a beneficiary, since specialist doctors need NSR registration before they can practise in the private sector.

“The parallel pathway will resolve the shortage of medical specialists and expand medical specialty training, as well as increase quality and access to treatment. Tomorrow’s stakeholder engagement session is important prior to the tabling by the Minister in Parliament. Support this initiative for the good of all Malaysian citizens,” MMA secretary general Dr R. Arasu posted on X yesterday, attaching a screenshot of MOH’s invitation letter to its briefing today on proposed amendments to the Medical Act.

Prof Dr Adeeba Kamarulzaman, who was not listed in the MOH’s invitation letter, told CodeBlue that she was forwarded an invite to the meeting, but cannot attend due to a scheduling conflict. Dr Adeeba heads a task force set up by the MMC to resolve the parallel pathway issue.

The health minister’s press secretary, Nik Azmi Nik Fathil, told CodeBlue that today’s meeting was part of a “series of engagements” on the proposed Medical Act amendment bill, but declined to disclose details about any other future stakeholder engagement sessions with other groups, except for a planned media briefing, even as the Dewan Rakyat will begin meeting in just 12 days starting June 24.

Parallel Pathway Opponents Also Key Stakeholders

Dr Abdul Razzak Mohd Said, who is also a former MMC council member, described it as a “really sad day” for the medical profession if the proposed Medical Act amendment bill is passed without considering input from “all stakeholders”.

“Then again, the MOH started the parallel pathway programmes without any due diligence. In the process, it flouted the law that is in its ministry. And now, they want to amend that law to cover their wrongdoings,” Dr Abdul Razzak told CodeBlue yesterday.

“The cover storyline is the lack of specialists. To me, this is artificial. The MOH failed to retain specialists and medical officers in service. There is no country in the world that says it has enough specialists. Malaysia never had enough specialists since we had medical service. So, is this news? There is no noble intent here as it is portrayed to be. 

“All I can see here is ill intent,” Dr Abdul Razzak added.

He pointed out that these comments below, taken from senior consultant cardiothoracic surgeon Prof Dr Raja Amin Raja Mokhtar’s recent op-ed for CodeBlue, have been shared in his medical alumni group.

“For the Control of Smoking Products for Public Health Bill, the MOH held a whopping 129 stakeholder engagement sessions over a period of about two years – including with tobacco and vape companies – before the bill was passed by Parliament in December 2023 as the country’s first standalone tobacco and vape control Act.

“If the MOH could engage even with Big Tobacco, Public Enemy No. 1, then surely fellow medical professionals in the ministry can meet us – their very own colleagues – on an issue that concerns our profession?”

Dr Dayang Anita Abdul Aziz, a senior consultant paediatric surgeon and retired professor of paediatric surgery from Universiti Kebangsaan Malaysia (UKM), stressed that the biggest stakeholders are not the medical professionals but the rakyat.

“The whole issue is about MOH not wanting accreditation for the programmes they run the last 10 years, yet, they insist that MMC recognise qualifications from these programmes and they want to push immediate entrance of ‘specialists’ into the NSR,” Dr Dayang Anita told CodeBlue in a statement.

“The amendment of the Medical Act 1971 in 2012 is to avoid matters like this. Not calling intellectuals like Prof Emerita Dr Sharifah Hapsah Syed Hasan Shahabudin, who developed the Malaysian Qualifications Agency (MQA) Act and champions quality, excellence, and integrity in higher education, including professional education, is simply illogical.

“As president of the National Council of Women’s Organisation (NCWO), representing over 200 women’s NGOs as affiliates, she is the right person for the government to consult on how our women view this issue. 

“Stakeholders’ meeting with only selected NGOs, which, by the way, are proponents of the parallel pathway lacks transparency and smacks of insincerity (lepas batuk di tangga).”

Dr Sharifah Hapsah previously served as the first woman vice chancellor of UKM. She is currently the chancellor of KPJ University.

Dr Dayang Anita and other opponents of the parallel pathway have previously expressed “genuine concerns” about the competency of parallel pathway graduates and the potential impact on safety of patients and the public, alleging that the parallel pathway programme does not comply with local standards and laws.

Prof Dr Raja Amin – who is on the Board of Studies on the cardiothoracic surgery postgraduate programme by a collaboration between Universiti Teknologi MARA (UiTM) and the National Heart Institute (IJN) – described the MOH’s stakeholder engagement meeting today as just “wayang” (theatre) by the MOH to appear as though they are engaging with all stakeholders.

“They must also involve UiTM, which is the only programme that is recognised by MMC and MQA-approved, and the only training centre other than parallel pathway available in Malaysia. UiTM should be invited to the stakeholder engagement meeting,” Dr Raja Amin told CodeBlue.

Prof Dr Noor Hassim Ismail, head of the Group of Professors of Health and Medicine, accused the MOH of holding stakeholder engagement meetings merely to “fulfil requirements” (memenuhi syarat sahaja), since only pro-parallel pathway groups were invited to today’s briefing.

“It is clear they do not want to accept the fact that there is no need to amend the existing Act. So far, the MOH has kept secret which parts of the Act they intend to amend,” he told CodeBlue.

List of Individuals/ Organisations Invited to MOH’s June 12 Briefing on Proposed Amendments to the Medical Act

Academy of Medicine of Malaysia (AMM) [13] 

  • Prof Dr Rosmawati Mohamed, Master
  • Dr Ahmad Sharifuddin Mohd Asari, College of Dental Specialists president
  • Dr Alzamani Mohammad Idrose, College of Emergency Physicians president
  • Emeritus Prof Dr Cheong Soon Keng, College of Pathologists president
  • Prof Emeritus Dr Lokman Saim, College of Otorhinolaryngologists, Head and Neck Surgeons president
  • Prof Dr Paras Doshi, College of Physicians president
  • Prof Dr Siti Zawiah Omar, College of Obstetricians and Gynaecologists president
  • Prof Dr Ina Ismiarti Shariffudin, College of Anesthesiologists president
  • Dr Anita Suleiman, College of Public Health Medicine president
  • Prof Dr Norlisah Mohd Ramli, College of Radiology president
  • Prof Dr Shatriah Ismail, College of Ophthalmologists president
  • Dr Siow Sze Li, College of Surgeons president
  • Prof Dr Thong Meow Keong, College of Paediatrics president

Malaysian Medical Association (MMA) [5]

  • Dr Azizan Abdul Aziz, president
  • Invitation extended to four other representatives

Association of Private Hospitals of Malaysia (APHM) [5]

  • Dr Kuljit Singh, president
  • Invitation extended to four other representatives

Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS) [4]

  • Dr Basheer Ahamed Abdul Kareem, president
  • Invitation extended to three other representatives

Malaysian Urological Association (MUA) [1]

  • Dr Noor Ashani Md Yusoff, president

Academy of Family Physicians of Malaysia (AFPM) [1] 

  • Dr Isriyanti Rafae, president

Malaysian Family Medicine Specialists’ Association (FMSA) [1]

  • Dr Norsiah Ali, president

Malaysian-Ireland Training Programme for Family Medicine (MinTFM) [1]

  • Dr Nazrila Hairizan Nasir, deputy national clinical director

Editor’s note: The article has been corrected to reflect Dr Abdul Razzak Mohd Said’s current designation. Dr Abdul Razzak completed his tenure as the Pro Vice Chancellor of Manipal Academy of Higher Education (MAHE) on 14 July 2020 and no longer has any association with MAHE or Manipal University College Malaysia. 

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