KUALA LUMPUR, July 29 — The Dewan Negara today passed the Medical (Amendment) Bill 2024 that opened up medical specialty training beyond universities to local specialist societies and the Ministry of Health (MOH).
The bill decouples the Malaysian Qualifications Agency (MQA) from the Medical Act, concentrating sole power in the Malaysian Medical Council (MMC) to recognise specialist qualifications, training institutions, and training programmes — without providing for a new independent and external entity to replace the MQA.
“Even though there are no longer cross references between Act 50 (Medical Act) and Act 679 (MQA Act), MQA is still relevant for specialist training programmes by local higher education institutions,” Health Minister Dzulkefly Ahmad said when tabling the bill for second reading in the Dewan Negara.
“At the same time, training programmes managed by other institutions also need to fulfil whatever standards set by the MMC before they can be approved to be implemented.”
While university programmes (regardless of field) need MQA accreditation – to be listed on the Malaysian Qualifications Register (MQR) – medical specialty training programmes by all training providers – irrespective of whether they are universities, local specialist societies, or MOH – do not need MQA accreditation for MMC recognition or registration of their graduates on the National Specialist Register (NSR), now that the MQA has been decoupled in the bill.
The 2024 amendment bill does not provide for differential treatment between these various training providers.
Clinical immunologist Dr Lokman Mohd Noh previously told CodeBlue that there should not be double standards in regulatory requirements for university versus non-university medical specialty programmes.
Senator Dr RA Lingeshwaran – during his debate on the Medical amendment bill in Dewan Negara – launched personal attacks against critics of the bill, naming senior consultant cardiothoracic surgeon Prof Dr Raja Amin Raja Mokhtar from Universiti Teknologi MARA (UiTM); senior consultant paediatric surgeon Dr Dayang Anita Abdul Aziz who retired as a professor of paediatric surgery from Universiti Kebangsaan Malaysia (UKM); Prof Dr Md Tahir Md Azhar, founding dean of International Islamic Universiti Malaysia’s (IIUM) medical school; senior consultant cardiothoracic surgeon Prof Dr Zainuddin Wazir from UiTM; and Hospital Al-Sultan Abdullah (HASA) UiTM director Prof Dr Mohd Zamrin Dimon.
“My checks found that Prof Raja Amin, Dr Dayang Anita Abdul Aziz, and Prof Dr Mohd Tahir were recognised as specialists with RCSEd and RCPEd qualifications. Do they also doubt their own qualifications since these programmes did not go through MQA?” Dr Lingeshwaran said in a diatribe in Parliament.
“This is akin to spitting to the sky and the spit falling on your own face (meludah ke langit, jatuh ke atas muka sendiri).”
According to the NSR, Dr Raja Amin’s Fellowship of the Royal College of Surgeons of Edinburgh was awarded over two decades ago in 2000. Dr Raja Amin also holds a Masters of Surgery from Universiti Malaya.
Contrary to perceptions by proponents of the parallel pathway, Malaysian senior consultant cardiothoracic surgeons who qualified decades ago had undergone different exams from the international exam taken in Malaysia’s parallel pathway programme that began in 2014. The JSF exam by the Royal College of Surgeons of Edinburgh taken by Malaysian parallel pathway trainees, who are fully trained in Malaysia, isn’t recognised for specialist registration either in the United Kingdom or Singapore that only recognise locally trained doctors in their respective jurisdictions.
“I also wish to question the qualifications of Dr Zainuddin Wazir and Prof Mohd Zamrin who only have a Masters of Surgery. Where did they do their cardiothoracic training? Was it in MOH facilities too? I’m uncertain about their qualifications,” Dr Lingeshwaran added.
“They (critics) suggest that MOH experts should not work in private hospitals because of long patient waiting times (in MOH). Likewise, these medical lecturers also shouldn’t work in universities’ private hospitals like UMMC (Universiti Malaya Medical Centre), UKMMC (UKM Medical Centre), and UiTM Specialist Centre because we’re facing a shortage of specialists.”
UMMC and UKM Medical Centre (now named Hospital Canselor Tuanku Muhriz UKM) are actually public hospitals run by UM and UKM respectively that have separate private hospitals, Universiti Malaya Specialist Centre (UMSC) and UKM Specialist Centre (UKMSC). UiTM Private Specialist Centre is indeed a private hospital run by UiTM that also runs a public hospital, HASA UiTM.
Dzulkefly maintained that medical practitioners who completed specialty training will not be “automatically” registered on the NSR.
“Passing your qualifications will not make you automatically eligible for NSR registration. What is done is not automatic because they still need to go through supervised work experience as one of the conditions for registration.”
The 2024 amendment bill 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.
During his winding-up speech, Dzulkefly cited the role of the “panel of assessors” several times, even though the bill repeals the role of the Joint Technical Committee (JTC), established under the MQA Act, from Section 4A(2)(h) of the Medical Act.
“MQA and MMC are still the same team. The panel of assessors is still the same.”
Under the 2012 amendment of the Medical Act that was enforced five years later in 2017, the standards for accreditation of medical qualifications are from MQA. The panel of assessors is nominated by the MMC’s Medical Education Committee (MEC), but appointments are by MQA to avoid conflict of interest.
The report from the panel of assessors doesn’t go to the MEC, but to the JTC. This mechanism is now gone – with the decoupling of MQA from the Medical Act – and will have to be replaced by new regulations for MMC alone to perform all of these functions.
Yet, qualifications have already been entered into the Fourth and Fifth Schedules under the bill, including new foreign ones that are not on MMC’s List of Recognised Postgraduate Qualifications on MMC’s website – even before regulations have been prescribed.
In a five-minute press conference held in Parliament after passage of the 2024 Medical amendment bill, Dzulkefly said he targeted two months to roll out regulations.
“In increasing the number of specialists, we won’t sacrifice quality,” he told reporters.
Health director-general and MMC president Dr Muhammad Radzi Abu Hassan, who issued a separate statement in both capacities, said the 2024 Medical amendment bill rectifies past irregularities and resolves ambiguities that arose out of the previous 2012 amendment to the Medical Act.
“The introduction of new provisions, oversight mechanisms, and the 4th and 5th Schedules are all measures to bring clarity to ensure greater transparency and accountability within the medical profession,” he said.
“The amendments also provide further clarity as to the requirements that applicants must fulfil in order to be included in the Specialist Register, and the inclusion of post qualification work experience (PQWE) and competence in Section 14B of the Act reflects the Ministry of Health’s commitment to maintain the highest standards in specialist training and services.
“These amendments are expected to lead to better health care outcomes and improved training quality for medical professionals, which will ultimately result in enhanced patient safety.
“With these amendments now in place, it is my fervent hope that the medical profession will close ranks and move forward together towards building a new chapter for the profession in Malaysia, where all parties work in tandem to fulfil the urgent need for specialists in this country without compromising on quality.”
