Materia Medica Malaysiana

May 10, 2007

Rural doctor shortage can be solved: MMA

Filed under: Uncategorized — malaysianmedicine @ 2:34 pm

Daily Express: Kota Kinabalu: The Malaysian Medical Association (MMA) supports the call by the Minister of Health to politicians to refrain from interfering with postings of doctors to rural areas.
“This gross disparity in distribution of doctors is not something that cannot be solved and we would like to share feedback from our members,” said its President, Datuk Dr Teoh Siang Chin, in a statement, Tuesday.
He said for the doctors who serve in East Malaysia, the heavier workload, more complex cases handled and more operative experience are seen as advantageous for their clinical training.
“Most of the district doctors are on alternate day call or at best one in three calls. Given that there is a chronic shortage, this situation exists for the length of time they serve which sometimes exceeds two years.
“There must be better support mechanisms for the junior doctors (fresh from housemanship training) who may be required to perform procedures that may tax all their abilities.
“The fear of making a mistake in an unsupervised situation is a constant stress. This issue certainly requires proper risk management by the Ministry of Health. We need more experienced doctors where the transfer of cases can take more than two hours,” he said.
“Unlike in West Malaysia, patients in Sabah and Sarawak do not bypass the district hospital to crowd the specialist hospitals because of transport issues.
“Economic reasons also preclude the ability for most to seek private care.
“Thus the outpatient, inpatient and operative workload of the doctor in Kudat or Kapit hospitals is much higher than in comparable sized hospitals in the Peninsula,” he added.
He noted that most district hospitals have less than a quarter of their posts filled.
Besides struggling to cope with daily workloads, it is near impossible to allow doctors to attend training courses.
“Similarly, it is difficult to get relief doctors even to attend required service induction and orientation programmes,” he said.
Many in their third year are still not confirmed in service, which renders them ineligible for postgraduate entry. Furthermore, the lack of senior specialists for training and motivating the new doctors creates a vicious cycle.
The MMA would advise that the solution is not to hire more foreign doctors. A comprehensive evaluation of the situation would show that there are aspects that can be improved.
“In the past 30 years, we have already submitted many proposals, including faster promotions and more credit points for postgraduate training,” said Dr Teoh.
However, these have not been uniformly addressed and the process is not transparent to all young doctors. The latest proposal by SCHOMOS (Section Concerning House Officers, Medical Officers and Specialist), is for instance in critical allowance for all doctors serving in East Malaysia. While the reception to this proposal has been encouraging, the authorities must expedite the implementation before going abroad to recruit more foreign doctors, he said.
He pointed out that the provision of significant financial incentives has been proven in many countries to improve the urban rural distribution of doctors and hoped that it will be implemented as soon as possible.
“We are confident that if these allowances are attractive enough, it will be more viable and practical to have our doctors to serve rather than casting abroad for foreign doctors,” he said, adding the total economic and social cost will also be much lower than employing expatriates.
Dr Teoh said there are other issues regarding work permits which need to be resolved with the State governments.
However, the relative lack of equipment and other supportive facilities also frustrate the clinician and allocating bigger budgets for these hospitals will hopefully be able to compensate in part for the shortfalls.
It may prove easier to move money than to move personnel, he said.
“We are confident that a meaningful solution is possible and necessary so that the people of East Malaysia can receive equivalent care after 50 years as a nation. Soon, perhaps a stint in East Malaysia will be privilege and essential for career advancements, such that the Health Minister, will have his fellow parliamentarians lobbying for doctors vying to serve in Sabah and Sarawak,” he added.

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