The Doctors’ Dilemma

 

The ineptitude in the handling of the employment of young doctors in the medical service is mind-boggling. The healthcare system is collapsing in the face of the pandemic. Healthcare workers are being strained to the limit of their capacity. The daily count of infections and deaths does not put a number on the efforts of these valiant workers. Now, eighteen months into the pandemic, there is still no visible signs of when the pandemic will be brought under control. Instead, a danger looms of the system itself failing. Against this background, instead of treating the additional numbers of qualified doctors as a boon to the health system and the nation as a whole, decision-makers are embroiled in an unnecessary controversy about the tenure of these young doctors and their future careers. If matters are not quickly resolved the situation would alienate a whole generation of doctors and stifle their enthusiasm and motivations.

This country needs more doctors regardless of the doctor to population figure standing at 1:454 (2020). With a dispersed population and many living in rural areas, the WHO ideal of 1:400 does not say anything about whether public healthcare reaches those in remote and fringe areas. The ideal figures also say nothing about how these ‘ideal’ figures will cater for extraordinary situations like those created by a pandemic like that being experienced now. Total Covid-19 cases from March last year exceed 900 thousand. New positive cases reported daily exceed 10 thousand patients. The system is under great strain, not least because of the shortage of doctors. A sufficient number of skilled and motivated health workers is critical to the performance of any health system, particularly now in the COVID‑19 pandemic. Faced with similar situations, other countries, including OECD countries, have cut the bureaucratic red tape to press doctors who are outside formal systems into service to fight the pandemic.

Unfortunately, very often in this country, official decisions on important social matters as those now concerning the employment of doctors in the public service are often influenced by issues of race, religion, and political expedience. In the present case, an additional, widely held reason preventing a rational decision is that the doctors graduated from private universities. This is not based on the quality of their education but simply that they are the products of ‘money-making’ enterprises. For that reason alone, it is being proposed by some that the numbers qualifying from private institutions must be reduced in the future to prevent similar future predicaments. This is an untenable argument which, the sooner it is put to rest the better.

Private universities, including those with medical schools are the product of an evolution that was shaped by the unfulfilled demand for higher education. A large section of our population, at a critical moment in their lives, would not have had the opportunities for further education after school but for the offerings of private colleges. From around the 1980s, long before the law allowed the creation of private universities, private colleges in this country changed the very nature of higher education as traditionally defined to make it more accessible to learners. The innovations private colleges introduced (too many to repeat in this article), separated the substance of higher education from the physical trappings of the university and allowed a university-level education to be delivered outside the lecture rooms and even outside the country of its location. What followed was a historical transformation that democratized higher education and brought it within the reach of our school-leaving youth even as their growing numbers found them no place in local public institutions.

The private sector of higher education in this country must be respected for its contribution to higher education. Many of the owners of these private institutions are there not just to make money. They set up colleges and universities out of a commitment to providing education and with philanthropic motives. The development of the private sector of higher education, which now hosts more than half the tertiary education population in this country, no doubt, also played an important role in stilling potential social disquiet that would have arisen because of the unmet demand for higher education. Reviewing the sector in 2008, the EPU report entitled, Strengthening Private Education Services in Malaysia, 2009, described the private education landscape then as;

‘. . . a thriving sector widely recognized in international academic circles as one of the most innovative and progressive in the region. Education experts and investors consulted during the course of this project have highlighted Malaysia as one of the most “open” regimes and more “attractive” markets in Asia. Among its achievements are;

Split-degrees and international transfer programs, particularly the proliferation of ‘twinning’ programs with premier international institutions are often heralded as some of the innovations introduced by the private education entrepreneurs; Malaysia is the 10th largest exporter of education, catering to 80,000 foreign students or 2% of the global market share.

Most of the achievements reported by EPU were realized before the passing of the Private Higher Educational Institutions Act in 1996 (Act 555). The far-reaching policy changes implemented by the Act set the pace for the next big leap in the development of the private sector. The Act legitimized private education and assigned it an equal role with that of public institutions. It allowed, for the first time in the country’s history, for private universities to be established. The significance of that move was the government’s relinquishment of its long-held monopoly over universities. Because of this bold step and other reasons, Act 555 radically altered the landscape of higher education. The provisions on private universities also allowed foreign universities to set up branch campuses in this country. As a result of these changes the private sector of higher education today is so diverse that it represents all the main systems of the English-speaking world. The same factors that attracted foreign universities also attracted foreign students in large numbers into local universities and colleges. The stimulus for these radical developments was the presence in 1996 of a mature, locally developed, private higher education system that was recognized internationally. It was a system that was well prepared to build on the opportunities created by Act 555.

The private sector of higher education is subject to tight control by different regulatory authorities established by Act 555 and other legislation. An important part of the regulatory system is the accreditation of the courses which is by statute vested in an independent agency – the Malaysian Accreditation Agency (MQA). Under the MQA Act, medical and other professional qualifications can only be accredited with the approval of the related professional body. In fact, the relevant provisions of the MQA Act 2007 gives the MMA and the medical profession a greater say on accreditation than the Agency itself.

Many of the doctors at the heart of the present controversy would be graduates of the private medical schools established under the regime of Act 555. The predicament they face is not of their making but that of a failure by the Health Ministry to anticipate the increased output of doctors from the private sector. The doctors from private medical schools are entitled to the same treatment as their counterparts from public medical schools. Their absorption into the medical health service on traditionally established terms should not be delayed any further.

One final point. The first medical school in this country, the King Edward VII College of Medicine was established in 1905 only because of the persistence and funding provided by philanthropic businessmen of that era. Malaysia’s first university, Universiti Malaya now claims its ancestry to that institution.