The insightful and passionate responses from Dr LF Ng ( Overseas training for doctors helpful ) and Dr Ida Bakar ( The sinister side of gov't policy for doctors ) to my previous letter carry pertinent messages which the director-general and health minister should perhaps take note of.
I write as one who has received most of my medical training up to specialist level outside of Malaysia without any government sponsorship. I also write as a doctor who has served in a wide variety of settings - from tiny East Malaysian hospitals and district and general hospitals, to teaching hospitals in West Malaysia and several major institutions in the UK.
I have not tried to raise concerns about the duties of doctors who have gone to foreign medical schools or into post-graduate training programmes without any form of Malaysian government sponsorship. These persons are free agents who are at liberty to participate in the global movement of medical personnel across borders.
There are no contractual or moral pressures bearing upon their career choices, although there may be a valid philosophical argument against first world countries poaching medical talent from third world nations which have subsidised their doctors' expensive training. That, however is a different issue.
In terms of post-graduate training, I reject the argument that a justification for Western training is to generate 'experience and critical thinking skills' for Malaysian doctors and to 'expose them to a globalised medical practice'.
No one can argue against the fact that exposure to clinical material is far greater in third world countries than in the West. Medical information now flows freely over the Internet and doctors now have myriad ways of gaining access to 'globalised' knowledge, whatever that may mean.
Globalised medical practice is not synonymous with Western medical practice. It is also somewhat patronising to insist that critical thinking skills are accessible predominantly via Western training traditions.
International-standard specialist training is now available in several outstanding postgraduate centres in Asian countries. The academic content of publications as well as conference papers emanating from good Asian centres is testimony to that fact. Doctors who are mostly familiar with Anglo-Australian systems may not be sufficiently aware of the details of these resources.
I stand by my argument that Malaysians need not be sponsored at great cost to expensive medical schools in first world countries to obtain basic undergraduate training. It is time that Malaysian healthcare planners stopped thinking merely along Anglo-Australian axis.
They should remove their reflexive biases and examine the options of more cost-effective centres with high standards that can be found in India, Taiwan and even Thailand and the Philippines.
Nobody will deny the fact that there are Asian centres that may be found lacking in standards. My UK experience has, however, told me that hidden behind the veneer of excellent-sounding institutional names, there may well lurk a cohort of incompetents! It boils down to ensuring careful research in the selection of training centres to send doctors too.
US healthcare statistics may say something about the quality of some of these Asian medical schools. For example, in 2004 there were about 38,000 physicians of Indian origin practicing medicine in the US.
About 12,000 Indians and Indian-Americans are medical students and residents (doctors in specialty training in teaching hospitals) across that country. Indians make up roughly 20 percent of foreign-trained doctors in the US and added to this number are Filipinos, Taiwanese, Pakistanis and other Asians. UK stats may convey a similar message.
Here is another controversial proposal to consider that Malaysian medical schools should only recruit academic staff who have had work exposure in public hospitals at the district or general hospital level for at least six months to a year.
This requirement may help ensure that their teaching of local undergraduates (who will later go out to serve the rakyat) will be contextually relevant.
