MALAYSIA - There are too many medical students graduating every year and not enough hospitals to train and provide jobs for them, said the Malaysian Medical Association.
If the situation continues, there would be no place for these graduates to undergo training by next year, its president Datuk Dr N.K.S. Tharmaseelan said.
He said there were "too many medical graduates, and too many private medical colleges; almost 40 now for a population of about 28 million".
"This is probably one of the highest per capita in the world. For many years, the MMA has vehemently opposed the flooding of the market to overcome the shortage of doctors. However, as we were regularly assured that many rural areas still lacked doctors and that there was no likelihood for jobless doctors, many continued to pursue medical courses.
"Today, with about 5,000 medical graduates every year, we have the highest number in Malaysian history."
The government is planning to reach the World Health Organisation's (WHO) standard of one doctor to 400 patients, said Dr Tharmaseelan, and while it was fine to set standards, the nation needed to achieve that gradually.
"Trying to speed track this without adequate infrastructure, such as enough hospitals to train and provide jobs for doctors, will surely create unemployment."
In the last five years, only two government hospitals were built, bringing the number to 132. According to the 2014 Budget, there is only one planned in the next five years.
There are 40 private medical colleges in the country and 375 recognised colleges overseas. Those from unrecognised colleges need to complete two years of housemanship, two years of compulsory service and sit for a medical qualifying exam before being given full registration certificates.
"Most states have only one state hospital that serves as a referral centre. This is certainly inadequate. Medical graduates need to be trained. For that, you need hospitals. We will surely see jobless graduates next year as the figures from the Health Ministry show that they have already filled all available posts.
"According to the ministry's annual report in 2011, there were 28,309 medical officer posts, of which 21,765 were filled. Today, the remaining 6,544 posts have probably been filled.
"Just as we have about 15,000 unemployed nurses, a few thousand jobless lab technicians and similar number of physiotherapists who are facing the same predicament, the number of doctors will also reach that figure sooner than expected."
Dr Tharmaseelan added that part of the fault lay in inadequate coordination between the Health and the then Higher Education Ministries.
"One lacks infrastructure while the other allowed the opening of more and more medical colleges, and offered nursing, physiotherapy and other allied health professional courses without determining whether they can assimilate these individuals or provide jobs.
Medical colleges have sprouted up and the entry qualifications into these colleges are frighteningly low; only four B4 credits in the Sijil Pelajaran Malaysia or Sijil Tinggi Persekolahan Malaysia examinations are needed.
"This decision was probably made to fill the vast number of places in medical colleges. "We must enforce a strict moratorium on medical colleges. Colleges which are not performing should be closed down. "This is the only country where we build colleges and supply candidates to fill them up.
"How do you allow medical colleges to function without sufficient staff and exposure to patients? Medical training is not just classrooms, mannequins or robotics training. Most medical colleges overseas have their own hospitals but here, medical institutions share public hospitals to cut costs.
"The consequence of these mass, factory-like productions is insufficient exposure to patients.
"Some hospital units have up to 150 doctors. How is it humanly possible to train or monitor them?
"When I joined the medical service three decades ago, there was one house officer (HO) manning an entire ward of 40 to 50 patients. Now, we have more HOs than patients in a ward.
"How will they ever get the opportunity to learn the intricacies of medical practice? It's a well acknowledged fact that the standard of medical practice in the country is gradually waning," he said.
Dr Tharmaseelan stressed that it is time the Malaysian Medical Council (MMC) queried the standard of private medical colleges. He said initially, the MMC's regulations stated that a medical graduate had to complete one year of housemanship and three years of compulsory service.
Later, it was increased to two years of housemanship followed by three years of compulsory service.
"However, due to the increasing number of doctors, the compulsory period of service has been reduced by a year.
"Now, I believe that the government is mulling to waive the compulsory service period completely," he said.
The MMA is appealing for several measures to be taken immediately to arrest the situation.
"There needs to be a moratorium on more medical colleges. Admission criteria should include an interview to assess aptitude, attitude and general knowledge, with a limit of 100 students per year.
"Also, medical colleges should have sufficient tutors, lecturers and infrastructure, including their own training hospitals and clinical research wings.
"The Health Ministry should ensure there are enough hospitals built to cater for training doctors, and the MMC should constantly review and monitor the standards of medical colleges both in Malaysia and overseas."