Desperation of junior doctors

Yet another letter in a desperate attempt to highlight the problem of unemployment among junior doctors. This dilemma with no concrete solutions, is bound to escalate as medical schools continue to churn out medical graduates.

We did write in 2013 about this impending issue, however we expected that the number of post graduate training positions be increased to ease the glut among more junior ranks. However this has not happened. In fact, it has reduced due to the economic downturn and the health sector has taken a hit form recent budget cuts. Even universities are not spared from this exercise in frugality.

Public universities are attempting to reduce the number of medical seats. This action alone is insufficient and may also deprive potentially bright students a rightful place in medicine. It may then force many to take up seats in private medical schools.

It is imperative that the government steps in and takes concrete action to resolve the situation. If it cannot accommodate these students, then an alternative path must be offered.It may be important to revive the idea of utilising private hospitals in placing housemen, especially the more senior ones.

They must also attempt to consolidate the medical schools and prevent some, with more dubious standards from operation. They must also start deregistering the long list of recognised foreign medical schools.

More concrete action must be taken.

Below is the article from the Pre-housemanship joint

Junior doctors trapped in catch-22 predicament

by FMT

By Dr Muhammad Firdaus Syukri B Ahmad ZubaidiIn the past decade or so, the number of university graduates has soared in most professional fields. This, coupled with the current challenging global economic slowdown, has consequently led to higher unemployment among graduates.

Until recently, the medical field has been relatively spared from this crisis. With promises of guaranteed employment, more and more people have ventured into the medical field. However, unemployment has finally caught up. Many spend hundreds of thousands, if not millions, on their medical education, only to graduate and realise that the paradigm has shifted.

The past few years have witnessed an exponential increase in medical graduates produced both locally and abroad. The increment in number would not normally be as big an issue in other fields; however the medical field is unique.

A graduate interested in pursuing a career as a doctor has limited options to continue his or her junior training – in fact, they only have one. In order to be recognised to practise in a country, a graduate must obtain a full medical licence, which they receive upon completion of housemanship training.

Housemanship training is only provided by accredited government and university hospitals, and junior doctors are solely dependent on these limited training posts to continue their careers in medicine. Yet, as the number of graduates has increased in the past five years, the number of training centres and houseman posts has remained relatively static.

Inevitably, this has led to a mismatch between the number of graduates produced and the places for their training. With limited posts available, graduates now have to wait many more months before it is finally their turn to enrol into housemanship.

And as the number of medical graduates increases year by year, so does the waiting period for housemanship. Medical graduates of 2013 waited an average of three months before starting housemanship while graduates of 2016 have yet to be employed after eight months of waiting. The promise of a secure career in medicine is now a thing of the past.

The long waiting period does not come without a cost. As graduates are not able to put their knowledge into practice, their medical knowledge becomes rusty and withers by the day. Not to mention the skills learned in medical school – the art of communicating with patients and carrying out procedures such as drawing blood will surely be lost without constant practice.

Corporations and non-governmental bodies offering pre-housemanship courses have mushroomed of late, but the fees charged are steep and can only be afforded by the more affluent graduates; even then, how much can a two- to three-day crash course substantiate five years of medical school teaching?

This is probably the major cause of the ever growing complaints of poorly performing house officers, and less the “failures” of medical school programmes to nurture the passion to care and heal. House officers are doomed even before they begin work.

And when a house officer performs badly, they are viciously scolded and harassed by their superiors as mistakes in the medical profession could potentially costs lives. Is it any wonder that the rates of depressive illnesses are high among junior doctors in training?

This further leads to poor learning and poorer performances, aggravating an already vicious cycle. Poorly performing house officers have to undergo extended training, taking up posts designated for new house officer intakes and further escalating the problem of limited posts. As house officers are the first line of doctors serving in tertiary government facilities, at the end of the day it is the rakyat who bear the brunt of the housemanship crisis.

You may be wondering what most graduates do while waiting for their housemanship. According to an online survey conducted by the Malaysian Pre-Housemanship Joint, a whopping 80% of graduates remain unemployed during this waiting period.

The remaining 20% are mostly employed in part-time jobs such as tutoring, sales marketing, driving for ride-hailing services or as research assistants. Many complain that it is difficult for them to get jobs because not many companies are keen to employ medical graduates, some even citing “over qualification” as an excuse.

The frustrating and ambiguous housemanship waiting period deters employers from hiring medical graduates as they prefer hiring workers who can commit to the job for a decent period of time.

On the other hand, the uncertainty also makes it cumbersome for graduates to decide whether to take up job offers such as research assistants which require commitment for a stipulated period. These employment obstacles results in most medical graduates being without a job and faced with a looming socio-economic catastrophe.

The landscape of the medical field has changed dramatically. But the rakyat has been virtually oblivious of the severe and dramatic repercussions that have befallen junior doctors entering the work force.

Society needs to revise their perspectives of the medical profession. Those intent on a career in medicine and surgery must be made cognisant of the damning changes currently at play and not be misled by false societal perceptions of this once noble vocation.

It is no longer the safe haven it used to be where graduates were virtually guaranteed a good livelihood post-graduation. The private sector is not willing to employ a doctor without a full medical licence, while other countries have laid out strict entrance and linguistic examinations for foreign doctors.

Thus, neither the private sector nor working abroad are viable options for junior doctors – public service is the only option. We are beholden to the mercy of the Public Services Department (PSD) and the health ministry.

In the final analysis, medical graduates are worst off compared with other graduates. Junior doctors are trapped in a catch-22 predicament not entirely of their making. They bear the brunt of the policies of the PSD and healthcare systems (MOH).

Dr Muhammad Firdaus Syukri B Ahmad Zubaidi is spokesman for Malaysian Pre-Houseman Joint (MPHJ).

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