KUALA LUMPUR, July 17 — The Medical (Amendment) Bill 2024 was tabled for second reading last night, with five MPs participating in the debate before the sitting was abruptly adjourned.
Two government backbenchers – Lim Guan Eng (PH-Bagan) and Howard Lee (PH-Ipoh Timor) – expressed support for the bill in recognising parallel pathway programmes for medical specialty training, citing the country’s dire shortage of specialists and long waitlists for heart surgery.
Two Opposition MPs – Dr Alias Razak (PN-Kuala Nerus) and Dr Ahmad Yunus Hairi (PN-Kuala Langat), both medical doctors – expressed concerns of quality with parallel pathway programmes and the decoupling of the Malaysian Qualifications Agency (MQA) from the Medical Act.
Health Minister Dzulkefly Ahmad, when tabling the bill, maintained that irregularity was found in both the parallel pathway and local Master’s programmes in medicine, not just the parallel pathway, due to the interpretation of “recognised training institutions” (under the existing Medical Act) applying to training centres.
Both the parallel pathway and university programmes use Ministry of Health (MOH) facilities as specialist training centres. The existing Medical Act defines “recognised training institution” as a “higher education provider”. MOH is not a higher education provider.
“Therefore, trainees in the parallel pathway specialist training and Master’s programmes in medicine who did their training in MOH hospitals or facilities actually do not have the right to be registered as specialists under Act 50,” Dzulkefly said.
Lim Guan Eng: Patients Dying on Waitlists
During last night’s debate, Lim noted that the Medical amendment bill was prepared in just less than four months.
“I recently met a surgeon at a public hospital, who expressed regret that many of their patients died while waiting for surgery. In that hospital, two people have passed the Ministry of Health’s parallel pathway programme, but were still not recognised as a surgery specialist and hence, could not perform their duties as specialists,” Lim told the House.
“How many more patients have to die if we don’t pass this bill?”
The DAP lawmaker noted that the Malaysian Medical Council (MMC) currently does not recognise four parallel pathway programmes, including cardiothoracic surgery, plastic surgery, and family medicine.
Lim expressed support for Dzulkefly’s proposal to amend the Medical Act “to recognise specialist doctors in the parallel pathway.”
“We must remember that if we don’t pass the amendments, we will lose 1,538 specialist doctors in Malaysia. How many [patients] will lose their lives? The brain drain of talent is a huge loss, besides the RM113 million that has already been spent.”
Howard Lee: Those Who Stop Medical Amendment Bill Are Killing the People of Ipoh and Perak Who Need Surgery
Lee highlighted the number of referrals for coronary artery bypass grafting (CABG) or heart bypass surgery from Raja Permaisuri Bainun Hospital (HRPB) in Ipoh, Perak, to other cardiac centres last year: Pulau Pinang Hospital (89), National Heart Institute (58), and Universiti Malaya Medical Centre (19).
The DAP lawmaker also pointed out that the elective procedure waiting list at Serdang Hospital was 779 people as of last Monday, while 1,400 patients are awaiting cardiothoracic surgery in Pulau Pinang Hospital.
Lee slammed critics of the parallel pathway, claiming that Malaysian doctors and surgeons who were trained and qualified decades ago are now suddenly framed as being “unsafe”. The parallel pathway programmes involving the MOH, local specialist societies, and foreign institutions, actually only began in 2014.
“They simply criticise and say it’s dangerous. And then they say, ‘it is not easy to become a surgeon’. Who doesn’t know that? When there are insufficient surgeons, when it is not easy to become a surgeon, you do not make it even more difficult when you need more surgeons.”
Senior consultant cardiothoracic surgeon Prof Dr Raja Amin Raja Mokhtar from Universiti Teknologi MARA (UiTM) wrote an op-ed for CodeBlue last month titled, “It’s Not Easy To Become A Heart Surgeon, Howard Lee.”
“I don’t want to intimidate or threaten anyone, but whoever stops this amendment bill that is bound to save the lives of more Malaysians who need surgery, whoever blocks the qualifications that should be given to those who are already qualified – they are killing the people of Ipoh and Perak who need surgery,” Lee said.
Dr Alias Razak: Don’t Compromise on Quality and Competence for the Sake of Producing More Specialists
Dr Alias said the parallel pathway programmes – which began in 2014 on the basis of memorandums of understanding (MOU) involving local specialist societies, foreign institutions, and the MOH – did not “fully comply” with local laws and regulations.
“In fact, compliance with existing laws that have been gazetted is crucial to ensure that all medical education programmes, whether domestic or international, are quality assured and that the specialist doctors produced are authoritative, competent, and guaranteed safe,” he said.
The PAS lawmaker said non-compliance of the parallel pathway programmes with the 2012 amendment of the Medical Act included provision of specialist training despite MOH not being a higher education provider, while specialist fraternities like the Malaysian Association of Thoracic and Cardiovascular Surgery, the Malaysian Urological Association, and the Academy of Medicine of Malaysia (AMM) are societies registered under the Registrar of Societies.
He also noted that the parallel pathways did not undergo the programme accreditation process by the MMC, based on the recommendations of the Joint Technical Committee (JTC) established under the MQA Act.
“I am concerned that with the proposed amendments, specifically the saving clauses that approve [graduates of] the parallel pathway programmes to be directly registered on the National Specialist Register,” Dr Alias told the Dewan Rakyat.
“Specialists registered on the NSR will be able to work in any hospital without supervision. Therefore, the direct entry of those who completed the parallel pathway into the NSR, without undergoing sufficient training or having sufficient maturity, is akin to giving those who are not yet specialists the power to treat patients without supervision.
“This can harm patients, which will eventually increase MOH’s burden.
“I want to stress that we’re not opposing this bill because we want to stop MOH from producing more specialist doctors. But we don’t want to compromise on quality and competence that may risk patient safety, due to pressure to produce more specialists.”
Dr Ahmad Yunus Hairi: No Check and Balance on Quality Assurance of Specialist Training with MQA Decoupling
Dr Ahmad Yunus – who is also head of PN’s health committee and a member of the Health parliament special select committee (PSSC) – expressed concerns with the bill’s proposed decoupling of the MQA from the Medical Act and concentration of power in the MMC to recognise specialty qualifications, training institutions, and training programmes.
“This means that there is no check and balance in terms of the autonomy for quality assurance because the same Council implements all processes,” the PAS lawmaker told the Dewan Rakyat.
“This is different from the process undergone by local higher education institutions that obtain approval from the Ministry of Higher Education to run their programmes, as well as quality assurance from the MQA. This is the same quality assurance process practised internationally.
“Giving sole power to the MMC will open up opportunities for abuse of power. If this bill is passed, it will expose the quality of our health care system to reputational risk that will damage the country’s international image.”
The Opposition MP also questioned the List of Registrable Specialist Qualifications and List of Subspecialty in the new Fourth and Fifth Schedules of the Medical Act in the 2024 amendment bill.
“We don’t know how qualifications in the Fourth and Fifth Schedules were listed. Do they contain dubious qualifications?” Dr Ahmad Yunus said. “The listing of dubious qualifications will smear the integrity of the Schedule of qualifications and cause public mistrust.”
Health PSSC Chairman: Six-Month Gazettement Crucial to Ensure Same Standards for Parallel Pathway and Local Master’s Programmes
Suhaizan Kayat (PH-Pulai), who is also chairman of the Health PSSC, appeared to straddle the fence on the parallel pathway conflict that has erupted mainly between specialist doctors who are also university professors and specialist doctors working in the MOH.
AMM, with its 12 colleges or specialist fraternities, and some other medical societies support proposed amendments to the Medical Act. AMM was one of the signatories of MOUs with the Royal College of Surgeons of Edinburgh for the cardiothoracic surgery parallel pathway.
The Health PSSC has conducted a few stakeholder engagement sessions with both proponents and opponents of the parallel pathway on the proposed Medical amendment bill, including one that included the health minister last July 10.
“Although they have differing opinions, I believe they have the same intention – which is to provide the best service in hospitals,” Suhaizan told Parliament.
He said specialist doctors who qualified from the parallel pathway programmes have a “proven capacity to provide treatment and save lives”, besides pointing out that trainees received government scholarships.
“When there is irregularity, it is our responsibility as the government to fix the mistake.”
Suhaizan noted that there are two “different” standards in medical specialty training or postgraduate medical education, as qualifications from local universities’ Master’s programmes are regulated by the MQA, whereas the parallel pathway programmes do not require MQA accreditation.
He said the six-month gazettement period for specialists is meant to ensure the same standards for both programmes.
“We don’t want a situation of some having a high standard, and others having a low standard. That equivalence will be achieved through gazettement.”
Only five MPs managed to debate the Medical amendment bill, even though Deputy Speaker Ramli Mohd Nor had listed 12 MPs for the debate last night, after Deputy Minister in the Prime Minister’s Department (Law and Institutional Reform) M. Kulasegaran abruptly tabled a motion to immediately adjourn the sitting.
