Too many new doctors and too few hospitals to train them

By Loh Foon Fong, The 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.