Concerns are being raised about the quality of young doctors in Malaysia, with the country's biggest doctors' association raising the red flag on foreign medical colleges and experts also warning of sub-standard local training.
The Malaysian Medical Association (MMA), the main representative body for all doctors in the country, has called on the government to review its list of recognised foreign medical colleges.
Those that have failed to meet the government's mandatory standards, it said, should have their accreditation withdrawn.
"It is a known fact that doctors who failed to obtain the minimum (O-level equivalent) requirements... to enroll into medical schools have been slipping into the Malaysian health-care system," Dr N.K.S. Tharmaseelan, president of the MMA, said in a statement on Sunday.
The problem is not only with foreign medical colleges, experts say. Over the years, the government has allowed a mushrooming of private medical colleges in the country, as it strives for developed nation status.
Currently, there is one doctor for every 780 in the population. The goal is one doctor for every 600 people in the country by 2015, and one for every 400 by the year 2020.
But the private medical colleges have lower entry requirements than public institutions. Furthermore, once these doctors graduate, they hit a bottleneck in training, with the country's teaching hospitals struggling to absorb the growing number of graduates.
Fresh graduates now wait up to nine months to do their two-year compulsory training in government hospitals, known as housemanship.
"The waiting time will just get longer every year," Dr Tharmaseelan told The Straits Times recently.
Entry into one of the nine publicly funded medical schools such as the University of Malaya is difficult as the number of places offered is limited. These public schools, viewed as prestigious institutions, are known to accept mainly those who score four As in the Malaysian equivalent of A levels. But the 30 or so private medical colleges have much lower minimum requirements - five Bs at the equivalent of the O levels, or one A and two Bs at the equivalent of the A levels.
In addition, the government recognises some 375 foreign medical colleges. Another 1,000 medical colleges are not recognised, but graduates from these schools may still practise after passing a local qualifying examination.
Today, some 4,000 students graduate from medical school each year, more than half from private medical colleges in the country and abroad. The number of new doctors is expected to rise to 5,000 in 2015.
Recognising the problem, the government stopped giving licences to open new private medical schools in 2010.
Even though the number of graduates has multiplied, the number of spots to train them has not kept up, experts say.
Recent medical graduates have shown a lack of clinical and hands-on practice, such as stitching wounds or taking blood samples from patients, said Dr Ernest Chan, 32, a doctor of seven years.
"When you have 50 housemen attached to a consultant, and some of them already lacking in clinical skills they ought to have obtained in medical schools, you cannot expect these doctors to be properly trained," he said.
Currently, there are 44 teaching hospitals in the country. The ratio of trainee doctors to patients is one to three. Singapore has one to eight, while Britain has one to 12, Dr Tharmaseelan said.
The government is attempting to spread the trainee doctors out by allowing more district hospitals and clinics to take them in. It plans to open two new training hospitals, as well as allow army hospitals to take trainees.
This is not enough, said Dr David Quek, a council member of the Malaysian Medical Council (MMC), an institution that regulates practising licences for doctors and medical schools.
"We need more stringent quality control on private medical colleges as well as graduates from unrecognised medical colleges overseas," he told The Straits Times.
Dr Quek said the MMC conducts annual reviews on medical schools and can revoke their licences. But he admits it is more difficult to monitor the performance of medical schools abroad.
One of the newer private medical colleges, Quest International University in Perak, which opened in 2008 with about 128 students currently, said it screens its students strictly and keeps classes small. "The shortlisted candidates are interviewed by a panel of academicians including a psychologist," Dr Alam Sher Malik, dean of the faculty of medicine, said.
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