Houseman quitting

Editorial Comment

It is fundamentally important that individuals pursue medicine for all the right reasons. In Malaysia, becoming a doctor is fairly easy. There are many medical colleges to choose from and many of them have lower admission criteria. Standards during undergraduate training is also suspect. Many of these medical colleges must take the blame for producing doctors that weren’t up to par.

The years as a housemen can be grueling. At the lowest rung of the pecking order, life can be difficult. Let’s face it, this is true for all professions. New graduates are often ill prepared to face this reality and their ego is shattered during the transition from a final year medical student to a junior houseman. They are pulled back down to earth with a thud. The euphoria of graduating and having a title “Dr” before your name quickly becomes a distant past.

Finally the hierarchical mentality within medicine must end. There must be a team approach with the focus being on patient safety. Respect must be earned and not expected. Senior doctors must rid themselves of the need to exert authority. Perhaps one way is for a 360 evaluation where senior doctors are assessed by their junior colleagues.

Finally, medicine is hard work and perseverance. It is this mental strength that patients can have the confidence in putting their lives in your hands. Let there be no mistake about that. Leave if you feel you cannot fit that bill.

One in 5 housemen quit
From Free Malaysia Today

KUALA LUMPUR: The perennial problem of long hours and bleary eyes is taking a toll on young doctors doing the two-year housemanship in Malaysia each year: one in five in quit.

This is an alarming rate considering the high cost of studying medicine: up to RM500,000 to study medicine in Malaysia and up to RM1million for a foreign medical degree.

Some newly graduated doctors have also quit because of the long wait to be posted as housemen.

“About 1,000 of the 5,000 housemen employed each year do not complete the two-year training stint,” said Deputy Health director-general Dr S. Jeyaindran in an interview with The Star Online.

The number of housemen quitting has also been increasing the past three years.

These “unhappy” doctors have been found working as waiters and even running pasar malam stalls and a trainee doctor has also taken to the skies as an air stewardess.

The reasons for not completing the housemanship are manifold:

  • unable to cope with the long hours,
  • unsuitability for the profession as they were pressured to study medicine by their parents,
  • having a totally different perception of a doctor’s life,
  • and suffering from burnout.

A houseman’s workload in Malaysia is lighter than those in other countries, said Dr Jeyaindran.

A Malaysian housemen takes charge of four to six patients in a ward compared with 8-12 in Singapore, Australia and the United States.

“In Malaysia, a houseman works between 65 and 72 hours compared with an average of 80 hours a houseman puts in Singapore, Australia and the United States,” said Dr Jeyanidren.

Terminating the services of these unhappy Malaysian doctors by the Public Services Department (PSD) is tedious and could take up to several months to more than a year.

The termination process gets long and complicated if the houseman leaves without tendering an official resignation letter.
“Until the houseman’s service is terminated, the vacancy cannot be filled and those who replace them have to wait for their turn to start,” said Dr Jeyaindran.

The large number of medical students graduating each year is another reason for the long wait for postings as a houseman, especially under the new e-houseman system, which allows for newly qualified doctors to choose the place of their posting.
While the average waiting time is about six months, it can be longer for the more popular postings in urban hospitals.
“With 10,000 housemen in all the 45 training hospitals nationwide, these hospitals have varying degrees of waiting periods except for hospitals in Sabah, Sarawak, Kelantan and Terengganu,” Dr Jeyaindran said.

He said the ministry must explore other ways that allow for greater flexibility in employing housemen to replace those who had left.

He said the proposal to have a common entry or fitness to practice examination as proposed by the Malaysian Medical Association (MMA) was among the steps being considered.

Another was a longer induction period for housemen to have better understanding of their work.
“It is not to control numbers as proposed by MMA, but to ensure a minimum standard of competence,” said Dr Jeyaindran.
“The common entry examination is already in place in some Asian countries, the United States and Australia and it might become necessary to ensure safe medical practice, especially once there is a liberalisation of trades and services.”

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