Before 2019, the pathway to becoming a Family Medicine Specialist (FMS) in Malaysia was straightforward – the Master’s programme or ATFM. Both have long been recognised for producing FMS who are clinically solid and well-rounded.
Then came 2019, when the MInTFM programme was introduced as a new route to specialist training. It spans four years: two years in the hospital and two years in primary care.
Today, four cohorts have completed the programme. After serving in several health clinics where these trainees were posted, I have begun to notice worrying patterns that raise questions about training quality.
Is The Clinical Exposure Truly Adequate?
MInTFM trainees are often allowed to see patients at their “own sweet time” under the banner of “learning.” However, this flexibility becomes problematic in real-world primary care settings.
When manpower is stretched thin and clinics are flooded with patients, medical officers (MOs) are sprinting to keep things moving, while trainees are not bound by the same urgency.
Some spend extended time chit-chatting with patients under the guise of “building rapport.” Some even selectively choose cases.
Based on clinic workload data: Trainee:Patient = 1:10, MO:Patient = 1:50. This gap is simply too wide to ignore.
While MOs are still struggling to finish the queue, MInTFM trainees are already getting ready for lunch or packing up to go home.
They are frequently excused from seeing patients – to do group discussions, CCT sessions, or optional online courses – even when the clinic is critically short of MOs.
Unlike other specialties, most academic sessions in other programmes occur after working hours or during weekends. Even hospital-based master’s trainees carry full service load, frequent on-calls, and high patient exposure, which sharpens their clinical maturity.
Theory matters, but in medicine, patients are the best teachers. And without adequate exposure, no amount of theory can compensate.
MInTFM Trainee Posts Occupying MO Posts
Another major issue is role imbalance. MOs manage overwhelming patient loads while juggling clinical portfolios, administrative responsibilities, and even weekend/public holiday duties such as health screening events and neonatal jaundice clinics.
Meanwhile, many MInTFM trainees are exempted from major portfolios in clinic, and often do not participate in weekend duty rotations.
They enjoy uninterrupted study leave every Wednesday, even when their classes are not from 8.00am to 5.00pm.
Realistically, this means they work four days a week without any on-call obligations in primary care. Despite this privilege, some still use regular clinic hours to study.
More concerning, higher management often reports that clinics “cannot receive new MO postings due to saturated positions,” when in reality, these positions are occupied by MInTFM trainees rather than actual service MOs.
This creates a mismatch where service demands grow heavier, yet service manpower does not.
The Final Product: Competency Gaps
This is the heart of the concern. Even after qualifying as an FMS, some graduates still struggle with fundamental clinical skills, such as:
- Performing antenatal ultrasounds.
- Distinguishing anterior vs. posterior ribs on chest X-rays.
- Calculating paediatric drip rates.
- Managing dengue cases.
- Handling ‘difficult/high demand’ patients.
These are not hyper-specialised tasks, since even MOs routinely perform them.
From observation, there seem to be two types of trainees in the programme:
- Those with long-standing primary care experience, who are generally more competent and grounded.
- Those from hospital backgrounds with zero clinic exposure prior to joining MInTFM, who spend only two years in primary care before becoming FMS, often without ever handling key portfolios.
This discrepancy directly influences the competency of the final product.
MInTFM is a promising pathway in theory, but it requires structural refinement to ensure it produces FMS who are confident, competent, and service-ready.
The intention is not to discredit the trainees, but to highlight systemic gaps that deserve attention.
Ultimately, MInTFM trainees receive the same salary and occupy the same posts as MOs, yet they often carry significantly fewer service responsibilities.
Aligning expectations, workload, and competencies is essential to uphold the standard of primary care in Malaysia.
The author is a medical officer at a public health clinic. CodeBlue is giving the author anonymity as civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
