Managing the oversupply of medical graduates

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Is the “revolving door” one of the main mechanisms of the “regulatory capture” that has led to the overproduction of doctors and nurses, wonders Jeyakumar Devaraj.

The Socialist Party of Malaysia (PSM) strongly advises the government to abstain from reducing the intake of medical students into public universities.

According to a news report (The Star, 9 November 2019), this is one of the solutions being considered by the Health Advisory Council to deal with the oversupply of medical graduates.

In 2018 there were 1,482 medical graduates from public universities, 2,509 medical graduates from local private universities and another 1,876 graduates returning from overseas medical colleges. We think it would make much more sense to reduce the intake of medical students into private universities.

We have been advocating highly subsidised tertiary education – and for a good reason. Medical graduates who have student debts of several hundred thousand ringgit will not be in the right frame of mind to go and work in East Malaysia, the east coast of Peninsular Malaysia or even in rural areas in the west coast. They would much prefer to work in urban centres so that they can do more work as locum doctors and undergo training to specialise as soon as possible so that they set up a private practice, earn big, pay back their student loans and save up to send their own children to university.

But is this why we educate our best and our brightest – so that they can get high-paying jobs and pay back their humongous debts? Shouldn’t we endeavour to motivate our educated youth to use their knowledge and training for the benefit of society, especially the disadvantaged?

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If so, we need to ensure that they are not smothered by huge student debts. If society subsidises tertiary education, then society would have the moral authority to ask these graduates to spend a few years in service in the more rural areas of the country.

We lose that moral authority to ask them to serve the disadvantaged in society if we require them to purchase their education at market value – the tuition fees for medical education in local private colleges are currently between RM300,000 and a million ringgit!

This is where the Pakatan Harapan government seems to be floundering. Its leaders come with lofty phrases such as “shared prosperity”, “no one will be left behind” and “caring society”. But at the same time the government is creating a macro-environment that increases financial insecurity for the bottom 40% of households and the middle 40%. It does not require rocket science to appreciate that financial insecurity will lead to more self-centred coping strategies among the public – the focus will be on earning as much as possible and not on building a more caring society!

Private medical colleges have mushroomed over the past 15 years. We now have nine public universities and 23 private medical colleges – producing far more medical graduates than the system can safely handle.

The most important phase of a doctor’s development is when he or she makes the transition from medical school to the real world – our crowded public hospitals. Our young medical graduates need close supervision and bed-side teaching so that they develop the right attitudes and skills. But the deluge of fresh graduates has overwhelmed the current system’s capacity to supervise, train and mentor the new generation of doctors.

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The solution to the problem of oversupply would be to rapidly (over the next two years) reduce the intake of the private medical schools by 40-50%. If this affects their economies of scale, several of these private colleges could be merged.

Flooding the system with poorly trained doctors isn’t helping anyone – including the doctors themselves. What would young doctors with four years of experience do if denied further employment in government service? Four years is not enough time to specialise in any field. Private hospitals only need a few non-specialist doctors in their emergency departments.

So the majority of the young doctors ejected from government service with four years’ working experience would have to open GP clinics and jostle with the existing 7,000-odd GPs, who are already finding it hard to make ends meet. A significant number would have to give up working as doctors. The level of competence in those remaining in the profession would also be a cause for concern given that their post-graduation training was compromised.

We would like the Health Advisory Council to get to the root of the matter. The council should honestly tackle this difficult but crucial issue – have the agencies that are supposed to oversee and regulate the education of medical personnel been able to do their job properly?

Or have they been compromised by “regulatory capture”? Upon retirement, many senior members of health departments and agencies approving courses, intake quotas and scholarships for private colleges are offered high-paying top jobs in the private institutions that they previously “regulated”.

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Is this “revolving door” one of the main mechanisms of the “regulatory capture” that has led to the overproduction of doctors, nurses, physiotherapists, etc? How can this be tackled?

Ordinary Malaysian should watch carefully to see whether this latest suggestion to reduce the intake of medical students into public universities (while remaining silent on the intake of private medical colleges) is yet another manifestation of regulatory capture at the highest levels of the Ministry of Health.

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