We offer our opinion to assist all Members of Parliament who are concerned citizens and representatives of the people; MPs who are keen to ensure that the Medical Act amendment bill 2024 passed by Parliament guarantees the quality and safety of health care for our people by ensuring the country produces medical specialists from high quality training programmes.
These specialists must be able to improve their knowledge and skills constantly and to keep pace with the rapid changes in the field of medicine, especially on recent advances to treatment, including advanced technology.
Malaysian Medical Council (MMC) Is Given Excessive Power
- Sole power to recognise qualifications
The proposed amendment has removed Section 4A(2)(h) “recognise and accredit medical qualifications based upon the recommendation of the Joint Technical Committee establish under Malaysian Qualifications Agency Act 2007 [Act 679] for the purpose of registration”; substituting it with new paragraphs (i) and (j):
“(i) recognize specialized 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.”
Comment: This means MMC does not have to refer to the MQA Act to recognise qualifications.
- Sole power to recognise training institutions
By deleting the definition of “recognized training institution”; and substituting Paragraph 14(2A)(a), MMC is empowered to determine the training programme in any institution.
Comment: This means recognition of educational/ training institutions shifted from the Ministry of Higher Education (MOHE) to the MMC. This is a major policy change in higher education and will likely affect other professions. Has MOHE studied the impact of this amendment on other professional programmes?
- Sole power to recognise programmes
MMC has sole power to recognise programmes by inserting after the definition of “Specialist” the following definition:
“specialized training” means a specialized training referred to in subsection 14B(3);’’
This section refers to “Person entitled to be registered as Specialist
14B(3) The specialized training referred to in this Act shall be construed as a reference to —
(a) a training approved by the Council in relation to a specialty as specified in the first column of the Fourth Schedule as provided by—
(i) the Ministry of Health;
(ii) a local higher educational institution; or
(iii) any other institutions within Malaysia as approved by the Council; or
(b) any other training acceptable to the Council which is provided outside Malaysia in relation to a specialty as specified in the first column of the Fourth Schedule or subspecialty as specified in the Fifth Schedule.”
Overall Comment:
This amendment means that the MMC is empowered to recognise institutions, training programmes, and qualifications on their own. The same Council implements all processes; hence, there is no check and balance to guarantee a proper quality assurance process.
This is different from the process that local educational institutions go through i.e. obtain approval to run programmes from the Ministry of Higher Education and undergo a quality assurance process according to MQA. This is the correct process that guarantees integrity of the quality assurance process, very much the same practice internationally.
Giving sole power to only one body, the MMC, will open opportunities for abuse and misuse of power. If this bill is passed, we will expose the quality of the health system to a reputational risk that will affect the country’s image at the international level. The most important impact is on medical tourism.
Recognition Process
Amendment to insert after paragraph (h) the following paragraphs:
“(i) recognize specialized 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.”
Comment: The additions of (i) and (j) are unclear. What exactly is the purpose of appointing this medical practitioner? Will he/ she do accreditation, evaluation of programmes and institutions, or develop standards? Can these tasks be assigned to a medical practitioner? The person may be an expert in his/ her field but for recognition process, what is important is transparency, and the ability to make comprehensive judgments from various aspects and representativeness. This amendment is totally unacceptable.
Council Membership
The amendment reduces university representation from nine people to five and increases the membership of the delegation recommended by the Director General and approved by the Minister from three to seven people.
Comment: This means that the voice of influence from practitioners appointed by the Minister will increase. In a situation where the authority to recognise qualifications, training institutions and training programmes is centred in the MMC, the influence of the Minister’s appointment, especially in terms of bias towards the programmes run by the Ministry of Health, shall be very high.
Person Entitled to be Registered as Specialist
The new amended Section 14B:
(1): A person is entitled to be registered as a Specialist under this Act if—
(a) he has been fully registered under section 14;
(b) he holds any of the specialist qualifications as specified in the fourth column of the Fourth Schedule for a duration of recognition that may be determined by the Council;
(c) he has completed a specialized training;
(d) he has—
(i) successfully undergone supervised work experience that shall be determined by the Council; or
(ii) proven his work experience to the satisfaction of the Council; and
(e) he has proven to the satisfaction of the Council that he is competent and is of good character.
(2) Notwithstanding paragraph (1)(b) or (c), any person may be entitled to be registered as a Specialist under section 14c where the Minister, upon the recommendation of the Council, is satisfied that he has any other comparable qualification or comparable specialized 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.
(3) The specialized training referred to in this Act shall be construed as a reference to —
(a) a training approved by the Council in relation to a specialty as specified in the first column of the Fourth Schedule as provided by—
(i) the Ministry of Health;
(ii) a local higher educational institution; or
(iii) any other institutions within Malaysia as approved by the Council; or
(b) any other training acceptable to the Council which is provided outside Malaysia in relation to a specialty as specified in the first column of the Fourth Schedule or subspecialty as specified in the Fifth Schedule.
(4) The Minister may from time to time, after consulting the Council, add to, delete from or amend the Fourth Schedule and Fifth Schedule by order published in the Gazette.’’
Overall Comment:
This amendment introduces the Fourth and Fifth Schedules (14D) that never existed in the Amendment Act 2012. If the schedules are to be approved, the qualifications must have gone through the recognition process by the MMC first. We do not know how the qualifications in Schedule 4 and 5 are included. Are there any questionable qualifications added?
The two Schedules must be presented and debated first before we accept them. Entry of dubious qualifications will certainly tarnish the sanctity of the Schedules and will not be trusted by the public.
With regards to the amendment in which “training is provided outside Malaysia”, we must ensure that the training and qualifications given, are accepted and registrable as specialists by the country of origin This condition must be included in 3(b).
Regarding the Minister’s authority in (4), we strongly recommend both Schedules to be reviewed and amended at least every five years. This will ensure that the qualifications in the Schedules are up-to-date in terms of recognition, either locally or abroad. For example, for surgery specialties after 2020, only the Intercollegiate examination is accepted. Otherwise, we risk having outdated qualifications in the schedules.
MMC must study this carefully. Ministers do not need to interfere in professional matters.
Saving and Transitional Clauses
Comment: It is unclear how clauses 6, 7, 8 and 9 are considered without first developing the regulations for their recognitions. Their inclusion cannot be automatic because the qualifications have not been evaluated according to the amendment. Exemption should only be given to those whose qualifications and training have been accepted by the Council in amendment 14B.
(6) Any person who, on or after 1 July 2017 and before the date of coming into operation of this Act —
(d) has been appointed as a specialist by the Director General, shall be deemed to be registered as a Specialist under this Act.
Comment: Saving clause (6)(d) is problematic. Are those gazetted by the Director General for payment of Specialist allowances accepted directly as Specialists? These doctors are still being supervised despite completion of training; they have not reached the level of Expert who can manage patients independently; including them is simply absurd.
Suggested Amendments:
As citizens who value quality, we demand that two amendments be included:
- With regards to improving the knowledge and skills of all specialists, we demand that a clause be included for MMC to conduct a regular process of assessing the current competence of specialists (continuous quality enhancement), e.g. conducting recertification and validation of a medical specialist. This is done in all developed countries such as the UK, Australia, Canada, and so forth.
- We demand that the Director General of Health is not automatically made President of the MMC to avoid reoccurrence of non-compliance with the Act.
Finally, the Medical (Amendment) Act 2024 could be avoided if the government considered the existence of the Independent Committee Report chaired by Prof Emerita Dr Sharifah Hapsah Syed Hasan. This report explains the issues and solutions without the need to amend the Act.
We, the undersigned, Medical Doctors:
- Dr Dayang Anita Abdul Aziz, National Council of Women’s Organisations Malaysia (NCWO)
- Prof Dr Raja Amin Raja Mokhtar, Society of Thoracic Surgeons of Malaysia
- Prof Dr Zainuddin Wazir, Majlis Perundingan Melayu
- Prof Dr Tahir Azhar, Profesor G70
- Prof Dr Noor Hashim Ismail, G70
- Dr Zarida Hambali, Former Director, Higher Education Department, Ministry of Higher Education
- Dr Abdul Razzak Mohd Said, Former Member of the Medical Education Committee, Malaysian Medical Council
- Prof Dr Mohd Zamrin Dimon, Director, Hospital Al-Sultan Abdullah
- Dr Zainal Ariffin Omar, Public Health Activist
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
