Where to go next?

At the second year of my housemanship, I should seriously consider what am I planning to do in the future. Although I have at least another 10 months before completion of housemanship, me and my colleagues have been discussing on where to go next. Among the questions:

  • After housemanship, where would I like to be posted? Am I suitable in another general hospital, a district hospital or Klinik Kesihatan?
  • Then there’s the question of location. I heard Negeri Sembilan and Pahang (Bentong especially) are high up in the list for those who did housemanship in Klang Valley. Some people chose Sabah and Sarawak because somehow it’s much easier to get into Master’s program.
  • If one chooses to be posted in a big hospital, there’s a question of which department. Some hospitals have good Master’s program or good path towards master’s program, large pool of specialists and consultants with good supervision. It’s essential to choose the right department as it will greatly effect the choice of candidate in a specialty program. It’s not uncommon for a candidate to be rejected from surgery Master’s program because he is posted in district and never worked in surgery department as a Medical Officer (MO).

Of course this is for our Health Ministry to decide. But still everyone needs to think of their own future path in their career.

As for me, I am still not making up my mind yet. I have interest in internal medicine. I have interest in surgery. Two basically different spectrum of specialty. I also might be interested in Emergency Medicine. But I know I have no interest in pediatric, bones, O&G, eyes, ears nose and throat, radiology, etc etc…

In medical there are lots of patients, also nicer supervisors to learn from. Managements in medical make more sense than management elsewhere. Cases are interesting. Procedures are quite alot too. Specialization in malaysia includes MRCP and masters program. There are oceans of options for subspecialization, good challenges, good growth and better prospects. Well accepted in public, private and overseas sector.

As for surgery, although the bosses are less nicer than medical, they are still approachable. Pathway to specialize in surgery in Malaysia is only masters program. MRCS cant be used because it’s only an entrance exam. Good challenges, as we mature, we get to do more complicated procedures. Working hours are very long, but that is a necessity to becoming a good surgeon. Although not as many as medical, chances of subspecialization are still there. By the time we become a consultant, it’s already in our 40s. The private sectors including from overseas are eyeing our surgeons.

I have never worked in accident and emergency department so I dont know how’s the work over there. I heard so far so good reviews from those who work over there, they enjoy it. Seeing all types of patients with different spectrum of illnesses. Must know the basics of each discipline, then refer to respective departments as needed. A lot of procedures can be done. Supervisors are nice. No need to remember cases, unlike in ward settings (I do have a short term memory problem). But as for prospects in Malaysia, so far that I know, the growth is fairly limited, subspecialization is rare. And I am not sure if the specialists in A&E are well accepted in private sector and overseas or not.

So there are pros and cons in each department. To search for criteria to being registered as specialist, please visit the National Specialist Registry website.

Why do I mention private sector? It’s an alternative to public sector lah of course. Most of our specialists who are very good at their jobs leave the public sector not just for the money, but most of them have already expressed repeated disappoinments with the system but somehow fallen on deaf ears. Doctors in Malaysia are not just overworked and underpaid, they are being bullied with no respect. Imagine a clerk or PPK with SPM level education can even bully or shout to doctors, especially the houseman, especially in Kuala Lumpur. I heard that people respect doctors more when they work in Sabah or Sarawak.

The other question is, are doctors being underpaid? As for me, I am grateful to the current remuneration I am receiving now. I can make a living, I can entertain myself, I can purchase a car and a property. Alhamdulillah. But please read the comparisons between the top jobs in countries in US, UK, CanadaAustralia, New Zealand, Gulf countries, Philippines, India, Singapore, Norway, the top and competitive jobs are doctors! They have more competitive remunerations. I guess it’s just fair; for the years spent on training to be specialists, long working hours and sleepless nights, sacrificing time from being with loved ones for work, physically and mentally stress works and a lot of workloads, skilled procedures done, risks of being exposed to communicable diseases, medicolegal stuffs, researches done, papers and journals published etc etc. Unfortunately, Malaysia is not onboard on making doctor’s salary more competitive.

It’s sad though. We undercharge our patients, patients not compliant to meds and medical advices, we treat a lot of complications of chronic diseases instead of preventing them, hospitals are always overloaded with patients who simply abuse the undercharge system. They pay few ringgits, they get full medical treatment. The needier ones are deprived because of these abusive patients. In the end, doctors are underpaid. I think we should charge our patients accordingly, especially the noncompliant ones, so that doctors receive more competitive remuneration.


4 thoughts on “Where to go next?

  1. I love how the flow diagram stereotypes the specialties! I see how surgeons are seen as pompous, arrogant individuals, but some of the nicest, most inspiring people I’ve met happen to be surgeons 🙂

  2. Well done young man! You have a natural flair for writing – very engaging. I agree with Anna 100%, one of my nicest and most humble colleague happens to be a cardiothoracic surgeon, but he is an exception, rather than the rule. Oh and also to point out one small mistake in your career pathway, to become a dermatologist, you have to do internal medicine/become a physician first, at least in Malaysia. And that will be a good career choice for you I reckon – dermatology is a hybrid specialty of medicine and surgery plus a few emergencies to keep you on your toes!

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