MPS-MMA Seminar 2010: Doctors and Pharmacists: Partners in Health Care

MPS-MMA Seminar 2010:

Doctors and Pharmacists: Partners in Health Care

Summary Points of Health MInister's Speech during the MPS-MMA Seminar 

by Dato' Sri Liow Tiong Lai:

1. Doctors and pharmacists are integral players in the healthcare team and have complementary and synergistic roles to play in ensuring that patients get optimal medical care – doctors, by virtue of their in-depth knowledge of diseases and treatment modalities; and pharmacists, by virtue of their in-depth knowledge of medicines. They must therefore be able to support each other in their important roles.

2. In the public sector, doctors and pharmacists, each with their distinct roles in prescription and dispensing, have long been collaborating and working closely with each other in patient care, often going on ward rounds together. YBMK hopes that this culture will also spread to the private hospital and community settings.

3. As of Dec 2009, we have a total of 7,298 registered pharmacists in the country (i.e. 3,716 in the public and 3,582 in the private sector), giving a pharmacist to population ratio of 1:3,878.

4. With regard to the medical profession, we have 20,929 registered doctors in the public sector and 10,344 in the private sector, giving a total of 31,273 doctors, i.e. a doctor to population ratio of 1:905.

5. In other words, as at the end of 2009, we have 1 pharmacist to every 4.3 doctors in the country.

6. In terms of private community facilities, we have 6,672 registered General Practitioner Clinics against 1,830 Community Pharmacies in the country. In other words, we have, on average, 1 Community Pharmacy for every 3.6 General Practitioner Clinics in the country.

7. The Pharmacy Division, in collaboration with the Malaysian Pharmaceutical Society, has already embarked on a geo-mapping project to see if the Community Pharmacy to General Practitioner Clinic mix in the country is sufficient for the community pharmacies to adequately serve the needs of the rakyat vis-a-vis the GP clinics, particularly in the rural areas.

8. I have also instructed the Ministry to study if the ratio of 1 doctor to 600 population and 1 pharmacist to 2,000 population, as recommended by the WHO for developing countries, or a pharmacist to doctor mix of 1: 3.3 as implied by these ratios, are adequate for the needs of this country, bearing in mind the increasing trend towards specialisation and sub-specialisation of services.

9. With these in mind, it is timely for the two professions to sit down together to discuss these issues and all other matters of mutual interest, such as the placement and distribution of this manpower, and the separation of prescription and dispensing roles, in order to serve the rakyat and the nation better in the spirit of 1Care for 1Malaysia. We look forward to their proposals.

1Malaysia clinic: is the Health Ministry above the law?

Letter
By RS
From Lim Kit Siang's Blog 

It is distressing to learn from Dr. T. Jayabalan, the health adviser to the Consumers Association of Penang that medical assistants are giving out prescriptions for the wrong medicines or prescribing medicines which they are not allowed to prescribe and they have also been found to have wrongfully diagnosed patients at a study conducted at Kampar, Perak.

And feedback thus far, from the MOH regarding the validity of MCs (Medical Certificates) issued by 1Malaysia Clinics have been unsatisfactory. The explanation issued by the Health Ministry’s Medical Practice Division officer, Dr Noraini Baba, stating that according to an internal MOH circular, MAs are allowed to issue MCs seems to suggest that she either doesn’t know the law or thinks she can actually circumvent a law through a department circular.

But perhaps CAP too should share of the blame for this vague situation. The last time they made so much noise, it resulted in ignorant officers at the Health Ministry rushing to pass an reckless legislation called the Private Healthcare, Facilities and Services Act (PHFSA) which was conjured up in the dark corners of the Health Ministry and stamped with the Official Secrets Act (OSA) effectively excluding the stake holders from taking part in the discussions. The Act is surely unconstitutional.

A doctor today with an Annual Practicing Certificate (APC) is legal under the Medical Act 1971 but becomes illegal if his premise is unregistered under the PHFSA 2006. But a Hospital Assistant (HA) working in a presumably legal PHFSA premise, 1Malaysia Clinic, becomes immediately illegal as he has committed a felony under the Medical Act 1971 since under this Act only registered medical practitioners are allowed to work in medical clinics.

This is the end result of people like SM Idris who give half-baked ideas to our poorly trained civil servants who then create silly laws in a knee-jerk unthinking fashion, which ultimately not only endanger people’s lives but place the government eventually in a legal quandary. Worrying statistics of wrong prescriptions and misdiagnoses seeping out of 1Malaysia Clinics maybe just the tip of a disaster waiting to happen.

If we keep making up unending rules and regulations for the delivery of healthcare in this country, the whole of Sabah and Sarawak will soon be paralyzed as HAs there run many of our rural clinics and even provide anesthesia for many of the rural hospitals there. And anesthesia is no child’s play as even propofol; supposedly a very safe anesthetic can kill as it did the late Michael Jackson. In a country with limited trained medical human resources we have to initially stratify the levels of care that we can offer and much depends on both the quantity and today, the quality of medical professionals we have at hand.

Our rural health clinics are still run by midwives termed “Jururawat Desa“ while our health clinics are run by a combination of staff nurses, medical assistants and doctors. Our hospitals are run by all of these people and specialists. But specialists alone are not good enough if we want to deliver quality care as we need the help of physiotherapists, lab technologists, radiographers, biomedical personnel, critical care nurses, operating room technicians, anesthetic technicians and a whole gamut of other health personnel.

Some of the monster hospitals that this government has built like Sungai Buloh, Ampang and Serdang are today nothing more then glorified nursing homes. Patients rush in thinking they are in for high-tech care, but a quick glimpse of the ICU will show 20 beds with 5 junior nurses trying desperately to man the 20 beds with no respiratory therapists, technicians, doctors or even the critical care specialists or anesthetists around.

A great many of the Malaysian population, especially in urban areas are very dependant on the General Practitioner who are the lynchpins in healthcare both in the UK and Australia . In the UK , GPs are today credited in reducing smoking in the general population, monitoring and preventing strokes and heart attacks from modern day epidemics such as diabetes mellitus and hypertension.

In Mexico , Singapore , the US and in Europe , GPs were in the forefront in stopping the spread of the deadly influenza virus H1N1. GPs there were provided training, test kits and eventually Tamiflu to check the disease. Amazingly, in direct contrast, the MOH in Malaysia decided to bypass the resourceful neighborhood GP and instruct likely infected patients to rush to the Sungai Buloh Hospital with disastrous results where hundreds of patients mulled around at its lobby with staff stretched to their limits. Only after a huge public outcry in the face of mounting unacceptable mortalities did the MOH rescind and supply the generic version of Tamiflu to GPs.

For chaps like Idris, GPs in Malaysia are there only to make money and must therefore be shackled with draconian laws and treated as common criminals if they cross the line. They should be jailed or fined if their premises are unlicensed. In fact one doctor, Basmullah Khan, was needlessly jailed for three months just because his premise license was technically “not approved”. Only a malicious government would close down any health facility where hundreds of patients have been depending upon the expertise of the doctor for treatment and follow-up simply based on a bureaucratic edict.

No country in this world treats its doctors this way except for Malaysia , another Malaysian first I guess.

But what are the repercussions of this sought of enactments on medical practitioners? A GP in Sungai Pelek, who once used to put up a drip for a dehydrated patient suffering from diarrhea due to food poisoning, refers the patient because he doesn’t want to take a risk under the PHFSA. He has even been told to remove the two beds he always keeps for such emergencies at this remote town. A GP in Triang seeing a dengue patient, lethargic, nauseated with a platelet count of 80,000 decides to refer when previously he would have asked the patient to come for a daily course of IV fluids and monitored his clinical features and platelet counts. And a GP out in Gemas refuses to deliver a full-term patient in labour with an almost full cervical opening for fear the baby may be born ‘flat’ and he would have to face the draconian PHFSA. So he decides to be safe and call for the ambulance to Segamat, 20 miles away. The baby is of course born in the ambulance.

And right here in Penang, a GP sees a diabetic patient suffering a coronary, lies him flat and places a couple of GTN tablets under his tongue when previously he himself would have administered crushed aspirin to the patient and given him a bolus of heparin which he always keeps for emergencies of this nature and perhaps some morphine. Of course he could have administered all of this and nothing would have happened if everything went well. But if the patient developed a complication, lo and behold he would be criminally charged and the MOH would tell him to speak to the judge if he wanted a lesser sentence.

The GP doesn’t need this. It’s better to play safe. Is there any wonder why our government hospitals and their outpatient departments are overflowing. This is the type of defensive medicine that placed America into trouble.

The Prime Minister may have meant well in wanting to provide free outpatient care for poor urbanites. And the MOH could have advised him of a multitude of options including opening their own current urban health care clinics, even for 24 hours using their own doctors or outsource the service to GPs for an appropriate price.

Why did the MOH choose to break the law by allowing unregistered medical practitioners to treat patients when surely they know that this is wrong? Were they politically pressured or were they plain ignorant. How would the Ministry defend itself in the event a patient sues for malpractice?

It is an irony in itself that the MOH goes around closing clinics run by registered medical practitioners while they themselves use unregistered medical practitioners to run clinics in urban areas where there are an abundance of doctors. Is the Ministry of Health above the law?

The Star: Promotions for 9,698 doctors, dentists and pharmacists

Promotions for 9,698 doctors, dentists and pharmacists

The Star, Saturday March 13, 2010

KUALA LUMPUR: Nearly 10,000 health officers, including specialist doctors, dentists and pharmacists, have been promoted and will be getting anything between RM900 and RM1,800 more depending on the grade they have been moved to.

A total of 2,554 doctors who were previously under Grade UD44 have been promoted to higher grades ranging from UD48 to UD54 last Tuesday - the day Prime Minister Datuk Seri Najib Tun Razak announced the comprehensive career advancement plan for the three services under the Health Ministry.

Chief Secretary to the Government Tan Sri Mohd Sidek Hassan said from a total of 9,698 health officers promoted, 8,521 were clinical/administrative medical officers, 650 were dentists and 527 were pharmacists.

“For a start, 2,554 doctors who were on grade UD44 have been promoted to higher grades ranging from UD48 to UD54 effective Tuesday,” he said in a Bernama report yesterday.

“The promotion of medical officers and all eligible dental and pharmaceutical officers will be implemented in stages based on this career advancement plan,” he said.

He said the medical officers concerned could check the plan via the ministry’s website at www.moh.gov.my.

He said the Government’s decision was in recognition of the contributions of the medical officers in raising the country’s health service level, and to motivate them to continue providing quality service as well as to maintain their interest to serve longer in the public sector.

Health officers under grade UD44 will now receive RM3,358.68, up from RM3,028.90, while those promoted from UD44 to UD48 will now get RM4,871.25 from their old scale of RM4,431.54, while those under grade UD52 will get RM5,465.42 from RM4,492.31.

Those under the highest grade, UD54, will get RM5,722.85 from RM5,258.09.

Meanwhile, SHAUN HO reports, Cuepacs president Omar Osman as saying that the pay review was timely and hoped that similar wage reviews could be applied to other civil servants with particular skills.

“Professors and lecturers should also receive new wages. This would be in line in the Prime Minister’s call for citizens to be innovative and creative,” he added.

Bernama News: Career Advancement Plan Will Help Retain Doctors In Public Sector

Career Advancement Plan Will Help Retain Doctors In Public Sector

Bernama March 10, 2010 22:13 PM

KUALA LUMPUR, March 10 (Bernama) -- The Malaysian Medical Association (MMA), the country's premier organisation representing doctors, believes that the newly-announced comprehensive career advancement plan for doctors, dentists and pharmacists will help retain the doctors in the public sector.

Its president, Dr David Quek said this was also a vital move to maintain the number of doctors in the public sector, which currently was declining.

"It would certainly encourage more doctors working in the government hospitals and clinics to remain in the service rather than consider venturing out into private practice," he said in a statement here, on Wednesday.

The comprehensive career advancement plan was announced by Prime Minister Datuk Seri Najib Tun Razak yesterday.

The initiative, which involved an additional annual expenditure of RM200 million, was aimed at improving career advancement by giving them the opportunity to move up to Grade 54 within two to five years.

Dr Quek said MMA had been working closely with the government to improve the service, training opportunity, salary, allowance and other perks and benefits for the doctors in the public sector.

"Over the past many years, we have, through our Schomos (Section Concerning House Officers, Medical Officers and Specialists), liaised closely with the Health Ministry and the Public Service Department to improve the conditions of service.

"We are therefore very delighted that most of our requests have now been answered, and that so many doctors would now benefit from such upgrading service," he said.

Meanwhile, Malaysian Dental Association (MDA) president Dr Lee Soon Boon also agreed that the plan would stop the exodus of dentists from the public to the private sector.

Besides, he said, the initiative was also deemed appropriate due to the current situation where most doctors were also entrusted with heavier responsibilities.

At present, he said there were 3,606 dentists in the country, 53 per cent of whom were in the government service, while the rest were in the private sector.

Malaysian Pharmaceutical Society president Datuk Nancy Ho, on the other hand, said that the initiative clearly showed that the prime minister was serious in promoting the 1Malaysia concept.

"We appreciate the recognition from the government to pharmacists for doing a professional job. This also shows that they are concerned about the people and the professionals," she explained.

She also believed that the initiative would encourage pharmacists nationwide to discharge their duties to the best of their ability.

Meanwhile, Cuepacs president, Omar Osman said Cuepacs lauded the career advancement plan for the medical and education sector, but believed that the government should consider similar initiative for other sectors too, especially for workers of lower grade and those in the rural areas.

"Attention should also be given to those working in the rural areas because they are closer to the people," he said.

-- BERNAMA

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MMA Statement on Promotion Exercises for Doctors (10 March 2010)

The MMA welcomes the announcement of YAB Dato' Sri Prime Minister, which has made the remuneration scheme for doctors in government service that much more attractive.

The quicker approach to promotion to higher grades of service and salaries is certainly welcomed, and would certainly help encourage more doctors working in government hospitals and clinics to remain in service rather than consider venturing out into the private practice. This will be one important move to help retain doctors who are quite in short supply at the current moment in public health sector.

The MMA has always been working with the government to improve service conditions, training opportunities, remuneration and allowances, and perks for public service doctors.

Over the past many years we have through our SCHOMOS (Section Concerning House Officers, Medical Officers, and Specialists) liaised closely with the MOH, through its Director General Tan Sri Dr Ismail Merican and the JPA to improve these conditions of service.

We are therefore very delighted that most of our requests have now been answered, and that so many doctors would now benefit from such an upgrading exercise. In fact just by the end of last year, more than 6000 doctors also received automatic promotion of their service grades as promised earlier by the Ministry, i.e. from U41 to U44.

We hope that with these new perks, more doctors would remain in service and work harder and more conscientiously, to help provide better and more caring service to the rakyat. In view of various concerns brought up of late, we also hope that these perks would help encourage greater commitment to excellent services to help reduce waiting times and certainly improve quality of care for all.

We also take this opportunity to congratulate Tan Sri Dr Ismail Merican for his reappointment as DG of the MOH for another term. We have worked very closely with Tan Sri and know his passion for quality care and service, as well as his continuous efforts to help upgrade doctors' welfare and perks in the public health sector. We also thank the Minister of Health and the JPA for supporting these new initiatives at enhancing service conditions for the doctors.

Although we sometimes differ in approach, we believe that through better dialogue we can make our health services even stronger towards greater excellence.

We of course urge the MOH to now also consider more seriously, efforts to improve the lot of private doctors too, who have faced mounting challenges of late.

Just early this week, we receive official notices from the MOH to invite private doctors to register with the MOH to serve also in the many Klinik Kesihatan (health clinics) around the country. We are in the midst of sending this out to all our branches nationwide, and urge all our private doctors who would like to contribute to helping out in these clinics to quickly respond to this gesture of collaboration. The offer of RM 80 per hour for such services would be most appropriate and would stimulate interest for many of our doctors.

We are especially thankful for the DG and the Minister with whom we had discussed these issues of greater partnership earlier in a dialogue in January 2010. We will work in greater collaboration and dedication to ensure that private doctors continue to improve their service status, medical professionalism and standards of care, as we march on in this new environment of partnership.

Dr David Quek
President, MMA

Bernama: Hospital ward fees for civil servants and pensioners abolished

Hospital ward fees for civil servants and pensioners abolished

Mar 10, 10 5:28pm

 

The government will abolish ward charges for public service officers and pensioners in government hospitals effective April 1.

Director-general of the Public Service Department (PSD) Ismail Adam said via a PSD circular the abolishment was also applicable to the family and parents.

"The abolishment does not affect the eligibility for ward as set for officers based on their grade," he said in a statement here today.

He said the eligibility for high ranking officers Grade 45-54 was First Class (single room); Grade 31-44 (First Class twin-sharing); Grade 21-30 (three to a room) and Grade 1-20 (Second class).

The eligibility for family and parents is based on the eligibility set for the officer concerned, he said.

Ward eligibility for pensioners and family members is based on the last grade of officers before they retire.

Higher class wards

Ismail said if public servants, pensioners, family members or parents request to be admitted to higher class wards from their eligibility, civil servants or pensioners need to pay the ward charges as per members of the public.

"Officers and pensioners are also to place a deposit before admission to a higher class ward according to the rate set," he said.

He said with the enforcement of the circular, the C2 clause related to eligibility and payment rate in appendix C8 of Service Circular No. 4, 2002; clause 11 related to daily ward charges in Appendix 0 Service Circular 10 1991; and Division J related to spending application for treatment abroad in Appendix B of Service Circular Clause 21 2009 were cancelled.

Ismail said the circular issued also applied to state public services, statutory bodies and local authorities.

- Bernama

Bernama-Health Minister: No Surplus Of Doctors In Public Sector By 2015

No Surplus Of Doctors In Public Sector By 2015

Bernama, January 15, 2010 19:58 PM

PETALING JAYA, Jan 15 (Bernama) -- There will be no surplus of doctors in the public sector by 2015 as there is still a shortage of between 14,000 and 15,000 doctors from the 25,000 needed, said Health Minister Datuk Seri Liow Tiong Lai.

While some 3,000 new medical graduates enter the workforce yearly, an average of 300 to 400 doctors quit the public sector for greener pastures each year.

Liow said that as at September last year, only 63.7 per cent of the 24,241 posts for medical doctors in the ministry were filled while only 58.5 per cent of 3,800 posts for specialists were taken.

"We view this situation seriously, so various efforts have been made, including cooperating closely with the Public Service Commission and Public Service Department to expedite filling the vacancies for doctors in the public sector," he told reporters at Universiti Tunku Abdul Rahman (Utar), here, Friday.

He said the ministry would continue to find initiatives to improve the situation such as offering better incentives like promotion opportunities to keep doctors in the service.

He said considering that Malaysia was still a developing country, the fear of some quarters including professional bodies of a surplus of doctors by 2015 was not fully justified.

"As Malaysia advances and becomes increasingly developed, the ideal doctor to population ratio for the country will shift lower to accommodate the expected higher demand of the population for more personalised and better quality medical care.

"The doctor density will also need to increase to accommodate the increasing specialisation and sub-specialisation of medical practice," he added.

Liow said Malaysia was also expected to achieve the one doctor to 600 population ratio by 2015 from the existing 1:1,105, an improvement from 1:8,229 in 1957 when the nation gained independence.

-- BERNAMA

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Thanks to dranony, who pointed out that in a Bernama release, our Health Minister defends the claims of severe shortage of doctors in the nation:

Dranony:

On Jan 15th, 2010, the Health Minister Datuk Liow Tiong Lai had said that "No Surplus Of Doctors In Public Sector By 2015."

He further gave figures on number of percentage of filled posts, and the number of doctors entering and leaving the government service each year.

Do the math -
63.7% of 24,241 MO posts filled
i.e. 36.3% of 24,241 MO posts vacant = 8800 MO vacancies
58.5% of 3,800 Specialist posts filled
i.e. 41.5% of 3,800 Specialist posts vacant = 1577 Specialist vacancies
Total vacancies = 8,800 + 1,577 = 10,377 vacancies.

Also,
3000 enter workforce annually, 300-400 leave annually.
(Let's assume average is 350)
Nett gain is 3,000 - 350 = 2,650 annually.

(*actually this number may rise even further to around 4,000 per year, if many are not frightened away by Datuk Murugiah's idiotic pronouncements on extending compulsory service to 5 or 10 years! The MOH estimates that some 3,300 would start of as HOs in the year 2010)

Therefore, solely going by these figures which the Minister had provided, in only four years, the nett gain in doctors to the medical civil service, will be 2,650 X 4 = 10,600.
 

Since there are only 10,377 vacancies (as of Sept 2009), this nett gain of 10,600 doctors over four years, would already have resulted in a surplus in 2014, NOT even 2015!

This is despite the Health Minister's claim that there will be no surplus in 2015.

Perhaps in a way, he is right - the surplus will instead occur in 2014, and NOT 2015.

Or is he basing his conclusion on figures other than that which he had provided himself during that very press conference?

My Comments (DQ):

During our dialogue with the Minister on 8 Jan 2010, Dato' Sri Liow maintains that there will be no surplus of doctors even by 2015. 

Even if we then have 50,000 or 60,000 it would be good for the nation! This is the perception of the MOH that we need more and more doctors to fill the chronic 'shortage' in the public service sector! Hence too, you can see the rationale of the ridiculously high number of medical schools (25 as of now) in the country with no limit as to how many medical graduates each is allowed to produce annually. 

We appear to be bent on simply churning out medical graduates as if a third world paper mill, with no long term plan as to what might happen in just a few short years, when the production would seriously exceed the demand, what then?? Quick knee jerk reactions, quick-fix approach which even now looks alarmingly catastrophic in the near term! God help us!

And what about adequacy of the teachers? the quality? the experience? the quality of the entry students? or is it simply the fees that matter??

Consider the fact that for the entire UK, only some 1,100 to 1,200 medical doctors graduate annually, and from such established and solid medical schools at that!! In fact many schools are merging to save on costs and efficiency as well as to consolidate teaching faculty and strength!