Too many new doctors and too few hospitals to train them

Star: PETALING JAYA: The number of medical housemen undergoing clinical training in most government hospitals has increased and this has given rise to concern that they may not get sufficient experience.
With new medical schools opening up locally and lower fees being offered at new institutions abroad, around 4,000 Malaysian medical students are expected to graduate annually from 350 universities all over the world in the coming years.
Senior Hospital Kuala Lumpur (HKL) consultant physician Datuk Dr S. Jeyaindran said each specialist was supervising four times as many housemen compared to a decade ago.
“Five years ago, one houseman looked after 10 patients in hospital wards at any one time but now it is one to four patients,” said Dr Jeyaindran, who is HKL department of medicine head and national head for medicine at the Health Ministry.
“The concern is that these interns are seeing fewer patients and hence, have fewer opportunities to carry out adequate procedures. In some hospitals, there are more housemen than patients.”
Dr Jeyaindran said they were not only concerned about the increase in numbers but also their attitude.
“Some lack responsibility towards their patients,” he said, adding that there were also those who did not know how to give an accurate diagnosis and relied too much on investigative tools instead of clinical skills and getting the proper patient history.
Malaysian Medical Council ethics committee chairman Datuk Dr Abdul Hamid Abdul Kadir said several specialists had expressed concern about the large numbers and training hospitals were finding it difficult to cope.
“In the past, it was five housemen in each department but now it could be 20 to 30 for each department,” he said, adding that some specialists were overburdened by the workload.

Health Minister Datuk Seri Liow Tiong Lai said the ministry was aware of the issue and would be increasing the number of training hospitals.
He said the ideal ratio should be one specialist supervising five housemen with one houseman taking care of 14 hospital beds depending on discipline.
There were 38 hospitals providing training to more than 3,058 housemen last year.
However, the number increased to the current 6,253 housemen since the ministry increased the duration of housemanship from one year to two.
“This led to most hospitals, including those in Sabah and Sarawak, having an excess of housemen,” he said.
Hospitals that were chosen must be able to cater to six areas in which housemen need training – medical, surgical, paediatrics, obstetrics and gynaecology, orthopaedic and accident, and emergency, he said.
Liow also said that they would be getting 58 contract specialists from Egypt, India and Pakistan next month to help supervise housemen and reduce the burden of the specialists now.
He also said that the ministry had taken steps to overcome the lack of experience among housemen by making training compulsory for two years instead of one.

More brain docs soon

Star: KUALA LUMPUR: There will be at least two neurosurgeons in each state to provide core neurosurgical works when the Government expands resident services in the discipline, said Health Minister Datuk Seri Liow Tiong Lai.
Currently, he said, eight states that still did not have resident neurosurgical services were Perlis, Kedah, Kelantan, Terengganu, Pahang, Selangor, Negri Sembilan and Malacca.
“We are now training 26 students to become neurosurgeons and once they graduate, we will be able to have at least two neurosurgeons in all these states,” he told reporters after opening the 8th Asian Congress of Neurological Surgeons and 1st Asian Neurosurgical Nursing Cong­ress here yesterday.
Liow said there were currently 74 neurosurgeons in the country with only 45 of them in the public sector.
“There is an acute shortage, especially in the east coast, northern region of the peninsula and East Malaysia.
“However, this is still a vast improvement as in 2004 there were only 36 neurosurgeons in the country,” he said.
However, he did not reveal the number of neurosurgeons needed based on the country’s population.
Liow said a comprehensive local training programme in collaboration with international faculties, which was established in 2001, had increased the number of trained neurosurgeons in the country since 2005.
He said the ministry also hoped to strengthen its six regional centres at Johor Baru, Kuala Lumpur, Sungai Buloh, Penang, Kuching and Kota Kinabalu with at least four neurosurgeons each to provide more advanced sub-speciality neurosurgical works.

Specialist centre to start operating on Jan 1, but minus some major services

Star: KUCHING: A long-delayed public specialist hospital in Samarahan will open by Jan 1, but without some major services that were planned initially.
A well-placed source said the facility would begin operations with heart care only, despite high-tech cancer care equipment already being installed at the facility, formerly known as the Sarawak International Medical Centre.
“At this point, all we know is that cancer care will have to wait. We hope cancer services will be included eventually,” said the source, who asked not to be named.
In June, Deputy Chief Minister Tan Sri Dr George Chan confirmed talk that the facility, which had never been used, would be converted and renamed the Sarawak Heart and Cancer Hospital.
According to several sources, no clear explanation had been given by the Health Ministry over its sudden back-tracking of planned services for the hospital.
One speculation, the source said, was that the Health Ministry was unsure about spending large amounts of money to operate and run a cancer centre in Sarawak, where specialists were scarce.
“It seems we may have to prove our capabilities first, before the original plan can be implemented. In fact, the ministry’s indecision is actually in line with the Economic Transformation Plan. They are calling for track record before spending,” said the source.
The hospital, which is about 20 minutes drive from Kuching city, has long been in the limelight, mostly for the wrong reasons.
It began construction in 2003 but the project was never completed.
The facility, owned by the state government under Sarawak Specialist Hospital & Medical Centre Sdn Bhd, was planned as a top-end private hospital, which could also do research.
Initially, US-based Mayo Clinic was hired as a consultant, but not long after the building started, the non-profit organisation pulled out. No reason was given.
For almost half a decade, the project was left idle and vacant, until the announcement of the turnaround plan earlier this year.
For now, the facility remains a construction site. Two weeks ago, the Association for Wives of Ministers, Assistant Ministers and Assemblymen (Sabati) visited the facility.
What they saw were buildings being cleaned and decontaminated, while cracked walls were fixed and mouldy ceiling boards changed.
It was understood that a few people closely related to the project were trying to get the association to fund minor projects for the hospital, like converting an existing site office into a half-way house.
Association members were brought to see for themselves the best and worst aspects of the facility.
They saw the linear accelerator – a room-sized device used to pinpoint cancer cells – that had been installed, but were told cancer services might not be available.
“Although there are signboards listing cancer services everywhere, the final decision on whether cancer care would be offered will only be made in the coming weeks,” said another personnel.
With plans up in the air again, even the name of the hospital cannot be finalised.
Meanwhile, National Heart Association Malaysia president Prof Dr Sim Kui Hian, said he was aware of the situation.
“We will begin with the Cardiac Unit first. We are already in the process of moving,” he said.
Dr Sim, who heads the Cardiac Unit at the Sarawak General Hospital (SGH) in Kuching, said he preferred not to speculate on the cancer facilities.
“Whatever happens, the heart unit will be operational no later than Jan 1,” he said.
The hospital would be the first new public medical facility in Kuching since Sarawak General Hospital opened in 1910, he said.
“For us to have gone this far in a few months since the turnaround plan was announced is itself quite an achievement,” Dr Sim added.
However, he said Sarawakians deserved better healthcare.
“There are still too many patients waiting for beds in SGH. The hospital bed-population ratio in Kuching must be improved,” he said.

Health Ministry to spur research in IMR and government hospitals

Star: PUTRAJAYA: The Health Ministry will work with the Special Innovation Unit (Unik) to patent and commercialise innovative products produced by the Institute of Medical Research (IMR) and government hospitals, said Datuk Seri Liow Tiong Lai.
The Minister said the IMR and government hospitals had come out with various innovative products that could benefit the public.
“The Health Ministry lauds the setting up of Unik under the Prime Minister’s Department and we hope the unit will spur innovation programmes among government agencies,” he said after opening his ministry’s Innovation Day at Putrajaya International Convention Centre here yesterday.
Prime Minister Datuk Seri Najib Razak, when tabling Budget 2011, had announced the setting up of Unik to assist research and development in universities and research centres so that innovative products produced by them could be commercialised.
Later, when opening the The 2010 Pharmaceutical Inspection Cooperation Scheme seminar in Kuala Lumpur, Liow said the generic pharmaceutical products industry would contribute US$5bil (RM15.4bil) in revenue for the country by 2020.
In this regard, he urged bioequivalent (BE) research centres to study quality generic products due to the high demand domestically and internationally because of their lower prices and easy availability.
“At present, there are only six BE centres in Malaysia. This number has to be increased because by 2012, the ministry will make it mandatory for all generic pharmaceutical products to be tested by BE centres so as to ensure only quality products are marketed,” he said.
The three-day seminar, organised by the National Pharmaceutical Control Bureau (NPCB), was attended by participants from 40 countries.

Liow said the ministry was now allowing doctors in the private sector to work in government clinics and hospitals on a contract basis.
He said the move was taken following discussions between the ministry and the Malaysian Medical Association in the wake of complaints that the 1Malaysia clinics had affected the income of doctors running private clinics.
On the health situation in Kedah and Perlis which had been hit by massive floods, Liow said only one case of viral infection had been reported in Perlis, adding that the patient had high fever and was being treated at a hospital.

Only 233 psychiatrists to treat 28 million Malaysians

Star: IPOH: Malaysia is running short of psychiatrists. Health Ministry technical adviser on psychiatry Datuk Dr Suaran Singh Jasmit Singh said the country only has 233 psychiatrists to treat the population, which works out to a ratio of 0.8:100,000.
“The ideal ratio is 1:50,000,” he said after the opening of a public forum on handling stress at Ipoh City Hall yesterday.
Dr Suaran, who is Hospital Bahagia Ulu Kinta director, said of the 233 psychiatrists available, 15 were attached with the Health Ministry and three with the Defence Ministry.
He added that there were 22 psychiatrists in Perak.
“Their number is just enough to cope with the workload,” he said, reiterating the need for more psychiatrists.
Dr Suaran, however, said that more people were willing to take up psychiatry, which was quite a new medical discipline in Malaysia.
“The ministry is working to increase the number of psychiatrists in the country,” he added.
He noted that the country also had 55 private psychiatrists, but almost 45% of them were based in the Klang Valley.
On the public forum, Dr Suaran said it was organised in conjunction with Hospital Bahagia Ulu Kinta’s 100th anniversary to educate the public on coping with stress.
Perak executive council member Datuk Dr Mah Hang Soon, who opened the forum, said mental illness must be treated.
“People with such illnesses need help and there are a lot of new treatments available,” he said, adding that psychiatric patients also required good care and support from their family members.