NEW doctors in Malaysia need proper guidance to be effective in today’s healthcare settings. They will tackle the burden of preventable aliments, such as cardiovascular disease, diabetes, cancer and chronic respiratory conditions, besides prescribing solutions for the prevention, treatment, rehabilitation and recovery from other disorders. But, the future remains uncertain for many of these young doctors unless more training hospitals accept them. The crux of the matter is that there are not enough government hospitals to train the large number of doctors graduating each year. And, people also suspect that graduates of universities abroad are not up to the mark.
The impact of too many graduates chasing too few training hospitals is that quality will be compromised because these institutions are forced to absorb more house officers. Ideally, one specialist should supervise five housemen with one taking care of 14 hospital beds, depending on discipline. But, this is not the case any more. Each specialist is said to be supervising four times as many housemen compared with a decade ago. A houseman used to look after 10 or more patients in hospital wards at any one time, but now, the ratio is reportedly one to fewer than three new patients daily. The worry is that these interns are seeing fewer patients, with limited opportunities to carry out adequate procedures. In some hospitals, there are more housemen than patients. Senior doctors are also irritated by the attitude of some of their charges, who reportedly lack responsibility towards their patients and are ignorant about work approaches.
The Health Ministry is mindful of the issues raised by the public and healthcare professionals, and has put in place reforms to transform and further enhance its Housemanship Training Programme, according to Director-General of Health Datuk Dr Noor Hisham Abdullah. One measure to ensure adequate clinical exposure and quality training for new medical graduates is increasing the number of public hospitals that offer housemanship programmes — from 38 hospitals in 2009 to 44 hospitals last year. Several other hospitals will be accredited as Housemanship Training Hospitals in the near future, including Shah Alam Hospital and Langkawi Hospital. Additionally, Royal Military Hospitals have been approved for accreditation and will begin accepting house officers beginning next year. Another action involves extending the period of housemanship training from one to two years. This started in 2008. These steps are among several that the ministry has introduced to address problems associated with insufficient training.
Is it possible to have too few and too many doctors at the same time? In a sense, yes. It appears that there is a lack of connection between the types of doctors we have trained, or are training, and where they are located, and understanding what types of doctors are needed, and where, across Malaysia. A decade ago, the complaints were about a shortage of doctors. Malaysia went on a fast-track system that saw private medical institutions sprouting up everywhere without the necessary infrastructure, and the outcome is a glut of new doctors and its attendant problems. The medical profession is in a crisis and the relevant authorities must find a way to overcome it.