So why do you want to be a doctor?

APRIL 13 — I sometimes wonder if we are now reaping what we sowed.

A report by The Star quoted the health deputy DG as saying one in five housemen quit because of various reasons with some ending up working at the pasar malam, while another became a flight attendant.

While I agree some of us have good entrepreneurial skills and many look good in kebayas, we took up medicine to become doctors. And I believe many of us, despite our grouses and complaints, would like to practise and treat patients.

But if his numbers are correct, one in five, or 20 per cent of the total housemen quitting every year is a huge number and a cause for grave concern.

We have 22 medical schools, accept degrees from about 350 more overseas, produce an average of 5,000 graduates a year, and yet are looking at about 1,000 housemen quitting at every intake.

That, by any standard, is a worrying number.

Sure, I know there are those who complete their studies, get their degrees and say to their parents, “Alright, I’ve done what you want. Can I now do what I want?”

And there will also be those who realise that this is not what they want to do for a living during housemenship, and that there are other ways to help mankind.

A few maybe. But certainly not all the whole 1,000 who quit being housemen.

Lacking details

So what went wrong?

Attempting to answer that raises more questions.

For instance, how many of those who left were government sponsored, and how many were self-sponsored? How many were trained in our “world class” universities, and how many in real and “pseudo” world class medical colleges overseas?

Is it their syllabus that is lacking? Or the difference in management style between what they learn abroad and the practice at home?

And how many of them resigned because of the lack in interest and passion, pressures from family members etc? What is the ministry and medical colleges doing to reduce disillusionment among potential doctors, one of the main reasons identified for their departure from medicine?

Who is monitoring all this? More importantly, is anyone monitoring at all?

We also need to know how many of those whose tuition were paid by tax payers? What is being done to recover them?

Because as the deputy DG has correctly pointed out, RM500,000 (at a minimum) is not a small sum.

And it is never just about money, since the nation loses a five-year equivalent in terms of training, teaching, moulding someone into becoming a doctor for every houseman we lose.

The same person could have been trained into an engineer, teacher, nurse, architect in less time, and significantly contribute to their family’s economy and national development.

Then imagine when that is multiplied by a thousand. What could we have potentially achieved as a society and country? What could it have meant to the 1,000 families?

Does anyone care?

Bringing the numbers down

We have 22 medical schools for a population of about 30 million. Just as a comparison, United Kingdom, with a population of about 64 million has 34 medical colleges, Canada at about 35 million, has 17 institutions offering medical degrees.

While we cannot close down existing schools in the country, we can at least bring down the number of graduates they produce each year.

Logically, if each class is smaller, the schools would be able to focus more on students, improve the overall student to tutor, student to lecturer and student to patient ratios.

This should improve the overall quality of medical graduates and reduce the number of dropouts.

Next, we should consider reducing the number of schools we recognise overseas. The number is currently at about 350 schools, a big number considering the number of medical students graduating each year, and that some of these schools belong to countries engaging in conflict and territorial wars with questionable medical and basic infrastructural facilities.

Singapore Medical Council recognises only 150 schools, and there’s a huge discrepancy between our list and theirs.

According to the writer, Malaysia has 22 medical schools, accept degrees from about 350 more overseas, produce an average of 5,000 graduates a year, and yet are looking at about 1,000 housemen quitting at every intake. — AFP pic
According to the writer, Malaysia has 22 medical schools, accept degrees from about 350 more overseas, produce an average of 5,000 graduates a year, and yet are looking at about 1,000 housemen quitting at every intake. — AFP pic

For instance they only recognise one in Pakistan, none in Indonesia and we recognise 13 from each country.

They recognise nine schools in India, and we recognise 89. They do not recognise any medical schools in Bangladesh but we recognise four.

If the discrepancy is because of the difference in standards set, we need to revisit what constitutes the “Malaysian” standard. What do we base our “standards” on?

Bearing in mind that no standard is high enough when sending our brightest to study medicine.

Thirdly, and if the first two fails, what happened to the entrance exam for medical graduates mulled by the Ministry? We need that as a gatekeeper to only admit deserving graduates into the housemanship program and we need it yesterday.

And lastly, and as crazy as it sounds, I suggest medical colleges be held partly responsible should their graduates fail to complete housemenship, or fail in the proposed entrance exam.

Perhaps the ministry could impose a fine on them, or a reduction in the number of student intake the following year.

While we understand medical schools, like any other business entity, must remain profitable to support their operations, they also need to remember that they shoulder the responsibility of producing not just safe doctors, but doctors who are passionate about medicine and their patients.

The proposed penalty and reduction in intake will serve as a deterrent to schools interested only in profit, at the same time ensuring they adopt stringent and thorough interview processes prior to enrolling candidates while adopting a medical syllabus par excellence for those they allow into their faculties.

Studying medicine should be viewed by both students and their colleges as a privilege.

And not necessarily a choice.

There will of course be those who excel in their studies, and do everything right in medical school but somehow find a doctor’s life unsuitable for them. Excellent students do not necessarily make good doctors.

But they are the exceptions, not the norm.

Heroes are made, not born

The journey is meant to be long and difficult. Arduous and challenging. It is a reflection on their role as the guardian and saviour of men.

As CS Lewis rightly said, “Hardships often prepare ordinary people for an extraordinary destiny.”

After all, it is the doctors who will be with patients during their darkest hours, and fight for them when they have given up.

Hence the need to be very selective to ensure that not only those who can be entrusted with another’s wellbeing are smart, but also responsible enough to make the right call when it matters most.

Ministry of Health should ensure that all that can be done, is being done to safeguard the health and well-being of Malaysians.

And the well-being of all Malaysians starts with the well-being, the passion and preparedness of our housemen.

*This is the personal opinion of the columnist.

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