The health minister and director-general of health have failed to understand the plight of unregistered doctors in Malaysia. This issue should not be treated as a platform for power or a battle of egos, or as a money-making scam.

Advantages of holding an unified examination

The aim of an unified examination should be to check the doctor’s competence in the faculties of medicine and their ability to function optimally within the Malaysian healthcare system. The qualifying examination system being held by the universities in the past years have proven to be a failure. Not only does one feel that this examination is biased, as proved by the results time and again, but it seems to us like an easy way to make quick money.

medical doctorsUnless a serious and honest attempt to modify the present system of examinations is made, this whole examination charade must be abolished. The aim of a training programme should not be a means of collecting proof of the foreign graduate’s incompetence as medical doctors, but, should be a means to ensure they are or are capable of turning into wholesome ‘safe’ doctors, suitable to the Malaysian public and healthcare system.

By conducting an unified examination, like the UK has PLAB and US has USMLE for all foreign graduates, one will benefit as follows:-

- There will be no unwarranted distinction between unrecognised and recognised colleges and universities.

- It will put an end to recognised colleges charging exorbitant capitation fees from foreign students. On receiving recognition status, they start charging an outrageous amount, doubling and even tripling the capitation fee, overnight.

- It will also put an end to agents/middlemen, who take huge cuts and hefty fee to enroll the desperate aspiring young students into a ‘recognised’ college.

This will help MMC avoid spending huge amounts of public funds to go to other countries to evaluate and award recognition status to other colleges and universities.

This will give an opportunity to middle class Malaysians, who cannot enter the local universities due to the quota system, to realise their dream.

Disadvantages of qualifying examinations being held at the universities

• The result of examinations conducted by the local universities are skewed. The system of training, examination and expectations of students vary greatly. Unscheduled students from some universities were placed for their training in non-teaching hospitals instead of the universities conducting the examinations. The university hospitals and the ‘teaching /non-teaching hospitals’ had very different methods of training, functioning and expectations. Appearing time and again for the same biased examinations has not only shattered our confidence and self-esteem, it has also put us into a huge amount of debt. Without employment, we are forced to borrow the required huge funds from the banks, relatives, parents, loan sharks and well-wishers, with the hope that we would have our dreams realised.

• Despite paying the exorbitant preparatory course and examination fee, one is not allowed to use any of the facilities at the universities. There is no access to the university library, no permission to go and examine patients or go on hospital grand rounds. Classes are not regular, and one is often informed that the concerned lecturers are busy. Needless to say, the results are appalling.

• The local students show a 100% passing rate. This could be due to –

o Local students have a university senate that have the authority to ask the university to pass a student if they are of good standing, despite failing three times. The unscheduled doctors find themselves at a disadvantage. We have no such God Father. So do we deserve to be brushed under the carpet?

o Foreign graduates are advised to be careful in answering as there was a carry-forward negative marking system. Unfortunately, this is not the case for local students.

o Local students have a choice of answering their exam papers in either Bahasa Malaysia or English. But, it is made compulsory for foreign graduates to answer only in English.

• Every time the health minister changes, or the MMC feels threatened, they throw a bone to us, asking us to sit for a ‘one –off exam’ which they have brought about thrice under three different health ministers. Old wine in new bottle.

• AIMS faculty is in its infancy. The health minister and director general expect full fledged doctors coming from 30 to 100 year old universities, to re-do Medicine in universities/colleges that have just started functioning, in the name of acquainting us with the Malaysian Healthcare System is insulting and ridiculous.

Statistics and current doctor-to-population ratio

Till date there are 450 qualified medical doctors in Malaysia, from unrecognised universities. One keeps reading ‘200 unrecognised doctors’, but all fail to realise that this count was taken in the year 2001. What happens to the doctors passing out every year. There are about 450 undocumented Malaysian citizens, who are unemployed despite having valid degrees. Many of the doctors, disheartened by the partiality being practiced in the medical sector, have left their home country, to a foreign land only to earn a livelihood. We are qualified doctors, and yet some of us work in pharmaceutical warehouses, car sales, insurance policies, and some of us resort to selling different products to make a living. Some of us are forced to sit at home; unable to get employment, as we know no other skills apart from the skills we have been trained and qualified for. We are qualified professionals, and yet we are ‘unrecognised’.

There has always been a critical shortage of doctors in Malaysia, and the Health Ministry and the Malaysian Medical Council have opted in the past and are still recruiting foreign doctors to fill in the vacancies, many of whom have their undergraduate qualifications from unrecognised universities. We are Malaysians, have a medical degree, and yet find ourselves unemployed.

The DG, Dr Mohd Ismail Merican, paid a working visit to Kota Kinabalu. He is quoted as saying, " ‘My door is always open’. I want to use this as an introduction to my topic this month of the Berita. I would like to open the door for doctors to serve in the less popular states of Sabah and Sarawak. The MMA, in particular Schomos, have always been concerned about the geographical distribution of doctors. In 1990, we published a booklet that addressed the needs of doctors reporting to Sabah. We were also involved in the production of a short video showing the benefits of serving in Sabah. However, all these efforts have been in vain as the figures below.

1968 Doctor – Population Ratio:

Sabah / Sarawak - NA

Malaysia – 1 : 4,162

2006 Doctor – Population Ratio:

Sabah – 1 : 4,000

Sarawak – 1 : 2,300

Klang Valley – 1 : 500

Malaysia – 1 : 1,500

According to Prof Mafauzy Mohammad, Director of Campus, Universiti Sains Malaysia Health campus, the present doctor to population ratio is about 1 : 1,500, and this needs to be brought down to 1 : 600 by the year 2020. He says that there are expectations of the Malaysian Healthcare to be on par or even better than the developed nations by the year 2020. But, if the present statistics are anything to go by, he says we are still behind and will likely remain behind if we were to persist with the present rate.

Mafauzy Mohammad, Director of Campus, Universiti Sains Malaysia, Malaysian Journal of Medical Sciences, Vol. 10, No. 1, Jan 2003 (1-3), Editorial, Medical Schools : The Supply and Availability of Qualified Human Resources – Challenges And Opportunities.

This is not just a question of giving us a job. It is helping us move on with life.

Dr. A, 43 years, passed MBBS in 1994. He left for survival abroad to further his career and employment. He was pursuing a Masters Degree in Forensic Sciences, Glasgow University, United Kingdom. Dato’ Chua Jui Meng announced that he was giving all the unrecognized medical graduates a chance to be absorbed. Dr. A, self-financing his course in the UK, thought this was an opportunity of a life time. He discontinued his course after completing one year, and returned homel to join the "Housemanship Programme", only to be disappointed yet again by all the false promises.

Dr. B, 34 years, passed MBBS in 2004. He dreams of doing MRCP, and enrolling in a Masters programme, but he is unable to pursue that as he is not registered as a medical practitioner in his country of domicile. Since he is not attached to any hospital, he is unable to get the required training to appear for the MRCP, and he is unable to obtain a letter of ‘Good Standing’, in order to apply for a master’s course outside Malaysia. He is Malaysian, but he is not allowed to apply for a Masters program in Malaysia, as he is from an ‘unrecognised’ university. Only foreigners from Sudan, Bangladesh, Egypt etc. can apply for masters programs and work in Malaysia, irrespective of their basic medical qualifications.

Dr. C, 37 years, passed MD in 2001. She has a flourishing family business, which extends worldwide. But no amount of money and fame can help her achieve her goal. Her passion is medicine and serving the people. Her only aim and dream is to serve in the Malaysian healthcare system.

Dr. D, 49 years, passed MBBS in 1992. He has eight children to feed. His eldest child is a straight A’s student, currently pursuing medicine in a local university. According to the Health Minister and Director General of Health, Dr. D must go for a three-year course, appear for an exam, hoping to pass not simply on the medical knowledge and skills acquired by him, but depending on the mood of the examiner. God willing, he passes, he will join as a houseman, long after his daughter has completed her compulsory government service.

Dr. E, 44 years, passed MBBS in 1994. He needs a loan for his mother’s treatment. No bank is willing to entertain him as he doesn’t have the necessary documents to support his application for a loan.

Dr. F, 34 years, passed MBBS in 2003. Her campus has both a medical college as well as a dental college. The dental college is recognised by the Malaysian Dental Council. For the purpose of theory and training in Anatomy, the dental students are required to go to the medical college, which is not recognized by Malaysian Medical Council. Due to the taboos attached to the label ‘unrecognised’ doctors, Dr. F is unable to get a suitable groom for marriage.

We ask you, as Malaysians, do we not have the right to employment. Do we not have the right to fight for justice and equality? All we ask is for us to be employed, so that we can sustain life and fend for our families.

Solution to the problem

Unscheduled doctors need employment. Malaysia needs more doctors. Malaysians deserves equality. All we ask is to give us a chance to prove our worth by allowing us to serve our country, and also giving us a means to earn our livelihood.

• Having undergone innumerable training programmes conducted by the local universities, MMC and Ministry of Health, we, the unrecognized doctors are now familiar with the working of the healthcare system in Malaysia, and request to be a part of it.

• Let us serve in any part of Malaysia, be it rural areas, Sabah and Sarawak, to ease the scarcity of doctors.

• Let us serve in the Military hospitals throughout Malaysia.

• At present, doctors joining the government service are required to complete 1 year of housemanship, and three years as a Medical Officer. Let us, unscheduled doctors, complete 2 years of housemanship and three years as a medical officer.

• Extended period of internship pending registration. Doctors not meeting the standards set by their superiors should be made to extend their tenure in that department until the level of competency is achieved.

Plight of unregistered doctors (Pt 1)

RITA DARLINGTON is the pseudonym for the wife of an unregistered doctor, who incidently has a MBBS degree from Mysore University and a Masters degree in Special Education.