Obstetricians in Malaysia are quitting

Obstetricians in Malaysia are quitting
PHOTO: The Star/ANN

PETALING JAYA - Health Ministry director-general Datuk Dr Noor Hisham Abdullah said there would be an increase in workload in government hospitals and risk of substandard maternity care if the private sector loses its obstetricians.

"With the obstetrics and gynaecology specialists almost equal in numbers in both sectors, there is definitely going to be increased demand. We will not face a shortage of O&G specialists but rather a mismatch in the distribution and the corresponding workload."

"It is also important to note that there will be a definite spill-over effect to the neonatal and the anaesthetic services. With this scenario, there will be an increased chance for delayed or substandard care," he said.

Dr Noor Hisham said the excessive court awards and punitive damages used to penalise doctors would negatively impact doctor-patient relationships.

For the public sector, all negligence claims costs are borne by the Government.

Last year, 18 cases involving obstetric cases were filed against the Ministry of Health, 10 more from the eight recorded in 2013.

A total of 462,626 babies were delivered in both private and public hospitals as well as by private midwives, alternative birthing centres and estate hospitals.

Out of the number, 63,063 were delivered at private hospitals while the most, or 83.9 per cent, were still delivered in public hospitals and clinics.

Meanwhile a medical law lecturer has called for research on the effects of changes to indemnity protection for obstetricians and gynaecologists.

Dr Sharon Kaur of Universiti Malaya said the authorities should look at court decisions, amounts awarded and gauge if the changes in policy could have a knock-on effect.

"If private healthcare services are cut, the burden will fall on public services," she said.

Senior obstetricians in private practice in the country are opting out of delivering babies as a result of changes in their professional indemnity coverage.

The shortfall of these specialists is expected to create a rise in the workload in government hospitals, increasing the possibility of sub-standards or delays in maternity care.

The Medical Protection Society (MPS), the world's leading indemnifier of health professionals, changed its policy for obstetricians and gynaecologists this year - from occurrence-based protection to claims-based coverage, under which these doctors have to pay annual premiums for 25 years.

This means if a doctor retires at 60 after delivering a baby, he or she must continue to pay for the coverage until the age of 85.

According to the MPS, the changes were made because of global challenges and risks associated with obstetric claims and litigation.

In Malaysia, the highest protection coverage is taken up by obstetricians, who used to pay more than RM70,000 (S$25,000) a year for unlimited indemnity.

Under the claims-based coverage, the amount to be paid annually is lower but the time frame is longer.

More than 500 obstetricians and gynaecologists are covered under MPS, which has over 4,000 members in Malaysia.

MPS has more than 300,000 doctors, dentists and medical students as members worldwide.

Dr Tang Boon Nee of Subang Jaya Medical Centre said many of her colleagues had decided to stop delivering babies as a result of the change in policy.

"As we are liable for up to 25 years after delivering a child, many of us who are older obstetricians will have to pay for coverage well after retirement," she said.

Dr Tang, who has been an obstetrician for 20 years, said "phenomenally high" damages had been paid out in obstetric claims.

"There was a case last year in which the amount awarded was RM6.9mil. To protect ourselves, we will have to continue paying MPS well into our retirement because of the claims-based system.

"It is not fair as many of us will not be making that much money," she said.

KPJ Damansara Specialist Hospital's Dr Gunasegaran Rajan said the occurrence-based indemnity had no ceiling on coverage, but claims-based was capped at RM10mil.

"Recent payouts have already touched RM7mil, and this can only increase. I would have to pay out my of own pocket if the damages awarded are above RM10mil."

He said that his best option was to stop practicing obstetrics as the future left him vulnerable.

"It is a great shame that the skills and knowledge many obstetricians have acquired over the past 25 years cannot be used to help Malaysian women's maternal health due to this policy," he said.

Another obstetrician and gynaecologist, Dr S. Shankar, said doctors could not run the risk of not being covered.

"We don't have much choice. Our legislation should come up with a better system, like New Zealand which has a no-fault compensation scheme. Personally I will get out of obstetrics as fast as I can."

In a statement to The Star, MPS defended its policy change, saying that claims-made protection was the more common form of coverage for obstetricians in many countries.

"Claims-made protection requires members to be in continuous membership both at the time an adverse incident takes place and when it is reported to MPS to make a claim.

"It was introduced to price subscriptions for obstetric risks more accurately and fairly as it can be difficult to predict long-term risks.

"This is because obstetric claims can often arise many years or even decades later," it said.

MPS assured members that even with the new system they would continue to receive high-quality service and support.

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