PERMANENT but painful solutions are necessary to deal with the glut of medical graduates, said the dean of a top medical school, Dr Adeeba Kamarulzaman.

The Universiti Malaya Medical Faculty dean said current methods, such as cutting the intake of students pursuing medicine at local public and private institutions, are a temporary measure.

Long-lasting solutions could include merging and closing private medical schools in the country and reviewing the number of government scholarships to study medicine, said Adeeba.

Parents also need to be discouraged from sending their children to local and international medical schools of dubious quality, she said.

The glut of junior doctors should also be decreased by ramping up postgraduate medical programmes to train specialists, as there is a lack of such doctors in the country.

“There needs to be a special task force that comprises of the Education and Health Ministries, Public Services Department (JPA) to look through this (problem) carefully and come up with short-, mid- and long-term solutions to the problem,” she said.

“There needs to be a more comprehensive solution to address this issue between the ministries and the Malaysian Medical Council to address this together. There seems to be a lack of coordination among all parties involved.

“Some of the solutions, for example, are not going to be very palatable. We have too many medical schools for our population. What would the solution be for that? Merge or close some schools would be the obvious answer. Are we prepared to do that?”

The oversupply of medical graduates who have to wait months for limited houseman spots in government training hospitals came into the spotlight again when it was revealed that about 1,200 of them were left in a lurch.

Adeeba said the problem in quantity and quality of graduates lies in the large number of schools, both public and private offering medical courses, some of which are not up to par.

It is estimated that the government recognises medical programmes at 346 universities, of which 34 are local.

“The solution is not as simple as cutting the number of enrolments for local medical programmes – although yes, we have actually done that.”

UM, Universiti Kebangsaan Malaysia (UKM) and Universiti Sains Malaysia (USM) have all reduced their intakes of students for undergraduate medical programmes while focusing on strengthening their postgraduate specialist training courses.

For the last five years, UM, for example, has reduced its intake from 220 medical students per year to about 150.

Surgeon-turned lawmaker Dr Ko Chung Sen suggested that the government force all schools, private and public to cut their intakes for medical courses by at least 20% to bring down the number of medical graduates.

Ko, who has written about the healthcare industry when he was Kampar MP, said at present, the country’s medical schools are churning out about 5,000 graduates per year. But the government is only able to absorb 3,400 into its houseman programmes to train doctors.

More specialist training

Reducing the number of local graduates, however, would not whittle the supply of graduates if the government continues to provide scholarships to study medicine overseas, says Adeeba.

“There are still students being sent overseas with scholarships from Bank Negara Malaysia, JPA and Mara despite there being so many schools in Malaysia. We need to also address the quality of medical graduates by relooking at the selection criteria into medical schools.

“And what about those going overseas to study? Imposing a licensing exam upon return is one way, but essentially the horse has already bolted. We need to discourage parents from sending their children to medical schools of dubious quality.”

The glut of junior doctors cannot be solved without also creating more slots to train specialists, she said.

Currently the master’s programmes run by the universities and the MoH are limited by the 1,000 scholarships given out every year. Doctors have to sit for the Royal College exams which are mostly based in the United Kingdom and Ireland.

“Approximately 1,000 scholarships per year for all the medical specialities. Considering that there is a huge shortfall of specialists in all disciplines, this is obviously not enough.”

The medical universities are currently working hard to revise their current master’s programmes to create a unified national medical postgraduate training program that should open up many more training posts for specialists, she said.

“We hope that by having a revised curriculum, training is done to a standard that is agreed upon across all disciplines and all training sites. 

“Implementing this will entail that all parties work together (the ministries and JPA) to overcome existing barriers and regulations that are currently in place.” – January 9, 2019.