KUALA LUMPUR, July 15 — The 2024 Medical Act amendment bill removes the Malaysian Qualifications Agency’s (MQA) purview over and ends universities’ exclusive jurisdiction of medical specialty training by opening it to entities that are not higher education providers.
Section 14B(b) of the 2012 amendment of the Medical Act 1971 (Act 50), which was enforced in 2017, states that a person is entitled to be registered as a specialist under the Act if they attended specialised training in that specialty in a “recognised training institution”.
“Recognised training institution” is defined, under Section 2, as a “higher education provider” as defined in the MQA Act 2007. The amendment bill deletes that definition.
The Medical Act amendment bill – which was tabled by Health Minister Dzulkefly Ahmad in the Dewan Rakyat today for first reading – amends Section 14B by listing completion of a “specialised training” as one of the criteria to be registered as a specialist.
Under the new Section 14B(3) of the amendment bill, “specialised training” refers to “a training approved” by the Malaysian Medical Council (MMC) in a new Fourth Schedule of the Act, as provided by the Ministry of Health (MOH), a local higher educational institution, or “any other institutions within Malaysia as approved by the Council”, or “any other training acceptable to the Council which is provided outside Malaysia” in relation to a specialty or subspecialty listed in the Fourth or Fifth Schedule.
Malaysia’s cardiothoracic surgery parallel pathway programme – which produces the Fellowship of the Royal College of Surgeons Edinburgh in Cardiothoracic Surgery qualification – was carried out solely on the basis of memorandums of understanding (MOUs) entered into by the Royal College of Surgeons of Edinburgh (a surgical society based in Scotland), the Academy of Medicine of Malaysia (AMM), and the Malaysian Association of Thoracic and Cardiovascular Surgery (MATCVS).
According to MMC’s June 15 affidavit in a court case involving cardiothoracic surgery parallel pathway graduates, the programme is carried out fully in MOH facilities and administered by MATCVS. MATCVS also carries out assessments. RCSEd simply provides the exit exam and the FRCS Edinburgh in Cardiothoracic Surgery qualification.
However, MATCVS and AMM are societies registered under the Registrar of Societies. MOH wasn’t a party to those MOUs with the RCSEd.
The Medical Act amendment bill, therefore, presumably expands provision of medical specialist training to medical societies or non-governmental organisations (NGOs) registered under the Societies Act.
Under the original 2012 amendment of the Medical Act, Section 4A(2)(h) empowers the MMC to “recognise and accredit medical qualifications based upon the recommendation of the Joint Technical Committee established under the MQA Act for the purpose of registration.”
However, the 2024 amendment bill replaces Section 4A(2)(h) with “recognise qualifications for registration of medical practitioners under this Act”, and adds more powers for the MMC: (i): “recognise specialised training for registration of specialists under this Act” and (j) “appoint any registered medical practitioner to represent the Council in any committee, panel or institution where that person would subsequently make recommendations to the Council on all matters relating to the qualification of medical practitioner or the regulation of the practice of medicine.”
Section 14(2A)(a) of the original 2012 amendment of the Medical Act states that a person may be fully registered as a medical practitioner if they intend to teach, do research or pursue a postgraduate course in a specialty area under such “recognised training programme in any recognised training institution.”
The 2024 amendment bill replaces “recognised training programme in any recognised training institution” with “training programme in any institution as determined by the Council”.
Section 36(2)(u) of the original 2012 amendment of the Medical Act on MMC’s powers to prescribe regulations, with the Minister’s approval, lists “the form and manner in recognising the training institution and the qualification awarded by the recognised training institution.”
The 2024 amendment bill replaces this with “the form and manner in recognising a qualification”, besides creating a new Section 36(2)(dda), “all matters relating to specialised training”, following the existing Section 36(2)(dd), “any other committee for the purposes of this Act.”
MMC Membership: University Representation Halved, MOH Representation Doubled
The 2024 Medical Act amendment bill retains the Health Director-General as president of the MMC. However, the bill reduces universities’ representation, while increasing MOH representation on the Council.
Under the amended Section 3A(1)(b) of the 2024 amendment bill, representation of representatives from local universities and university colleges – to be nominated from among the members of the faculty by the governing bodies of the respective universities and university colleges and appointed by the Minister – is halved from nine to five members on the MMC.
Under the amended Section 3A(1)(d), representation of representatives from the public services – to be nominated by the Director-General and appointed by the Minister – is doubled from three to seven.
Despite previous calls to reform the election process of the MMC or to make the presidency an elected position, the 2024 amendment bill proposes no other changes to Section 3A on the composition of the Council.
Minister Empowered to Register Specialist Doctors and Qualifications, Registrable Specialist Qualifications List Put In New Schedules
Section 14B(2) of the 2024 Medical Act amendment bill empowers the Health Minister to register specialist doctors, “upon the recommendation of the Council”, if the Minister is satisfied that the applicant “has any other comparable qualification or comparable specialised training, as the case may be, which is of special value to this country, subject to such restrictions and conditions as the Minister thinks fit” – notwithstanding the proposed Section 14B(1)(b) and Section 14B(1)(c).
On a person’s entitlement to be registered as a specialist, Section 14B(1)(b) of the 2024 amendment bill requires holding any of the specialist qualifications in the new Fourth Schedule “for a duration of recognition that may be determined by the Council”, while Section 14B(1)(c) requires completion of “a specialised training.”
Section 14B(4) of the 2024 amendment bill empowers the Health Minister, “after consulting the Council”, to add, remove, or amend the list of registrable specialist qualifications in the new Fourth and Fifth Schedules, by order published in the Federal Gazette.
The new Fourth Schedule contains the List of Registrable Specialist Qualifications, while the new Fifth Schedule contains the List of Subspecialty.
Transferring the “List of Recognised Postgraduate Qualifications” from MMC’s website (now renamed “List of Registrable Specialist Qualifications” and “List of Subspecialty”) to Schedules under the Medical Act means that any new specialty or subspecialty that the MMC wishes to register must go through the Health Minister as subsidiary legislation, to be gazetted by the Attorney-General’s Chambers.
Schedule of Registrable Specialist Qualifications, Subspecialty Contains Qualifications Not In MMC’s Current List
The new Schedule 4 and Schedule 5 contains qualifications and subspecialties that are not currently on MMC’s List of Recognise Postgraduate Qualifications on its website.
For cardiothoracic surgery, MMC’s website lists, among others, “Fellow of Royal College of Surgeon (UK & Ireland) – Intercollegiate Specialty Board in Cardiothoracic Surgery.”
In the new Schedule 4 of the 2024 Medical Act amendment bill on “List of Registrable Specialist Qualifications”, under United Kingdom qualifications, Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery, Fellowship of the Royal College of Surgeons of Glasgow in Cardiothoracic Surgery, and Fellowship of the Royal College of Surgeons in Cardiothoracic Surgery (under the Royal College of Surgeons of England” are listed.
For neurosurgery, MMC’s website lists, among others, “Fellow of the Royal College of Surgeons (Edin, Eng, Glas, Ire) Intercollegiate Specialty Board in Neurosurgery”.
Schedule 4 of the Medical Act amendment bill lists Fellow of the Royal College of Surgeons in Ireland in Neurosurgery, among qualifications from other countries.
Schedule 4 also lists Master of Pathology (Medical Genetics) from Universiti Sains Malaysia, a qualification that is not on MMC’s website.
FRCS Edinburgh in Cardiothoracic Surgery, FRCS Ireland in Neurosurgery, and Master of Pathology (Medical Genetics) have all previously been highlighted in the media, due to ongoing lawsuits filed by graduates whose applications to register on the National Specialist Register (NSR) were rejected by the MMC.
Despite advocates fighting for nearly two decades since 2007 to get clinical immunology recognised as a subspecialty, clinical immunology isn’t listed on Schedule 5 of the amendment bill.
Clinical research and other non-clinical specialties held by medical doctors, like Master’s of Business Administration (MBA) or medico-legal, aren’t listed on Schedule 4 or 5 either.
The 2024 amendment bill also contains several “saving and transitional” clauses to register specialists and “specialised training” between July 1, 2017 (when the 2012 amendment came into force) and the date of coming into operation of the 2024 amendment.
