Patients waiting at Hospital Serdang, Kajang. This specialist qualification issue is an ongoing one. The good news is, it is being brought to light and solutions sought. — FAIHAN GHANI/The Star
THE process of specialist recognition within the medical practice in Malaysia is being called into question. It has become a hotly debated matter, making headlines.
What is all the fuss about?
It seems to have stemmed from a change in the law that placed the power with the Malaysian Medical Council (MMC) to decide which specialist qualifications entitle the holders to get unto the National Specialist Registrar (NSR).
Without being on the NSR, a doctor cannot call him or herself a specialist.
Historically, in countries like Malaysia, Singapore and Hong Kong, as former British colonies, postgraduate medical training was largely based on professional examinations and training set by the Royal Colleges in the UK.
In 2012, the MMC was corporatised and given further power to form the NSR. In 2017, an amendment to the Medical Act 1971 (Act 50) came into force that made the MMC the sole authority to make the determination of which doctors can become specialists, also giving the body the power to determine which specialist qualifications are recognised in Malaysia.
There are essentially two ways in which doctors can study to become specialists following their basic medical degree. One is through masters programmes in universities and the other through what is referred to as a ‘parallel pathway’ qualification, such as through the Royal Colleges in the UK.
Prior to the amendment to Act 50, such candidates needed to get their qualifications and experience approved by senior specialists in the country at government hospitals, after gaining sufficient experience.
Following the amendment, that verification and certification process was taken over by the MMC.
Also, following amendments to the Medical Act, several medical programmes, both from local universities and Royal Colleges abroad, have since been excluded from the MMC’s list of recognised programmes in the NSR, reports Code Blue, a Malaysian health news website.
Medical Act amendment
One vocal critic of the current situation is Senator Dr Lingeshwaran R Arunasalam.
Just over two weeks ago, Lingeshwaran asked the Ministry of Health (MOH) to clarify why the MMC had ceased recognising the Parallel Pathway Programme (PPP) for cardiothoracic surgeons involved in twinning programmes with universities in the UK.
The MMC had in December rejected specialist registration applications by four graduates from the cardiothoracic surgery PPP with the Royal College of Surgeons of Edinburgh (RCSEd).
As Lingeshwaran had pointed out, it doesn’t make sense for Malaysia to not recognise the RCSEd when countries like Singapore and Hong Kong continue to do so.
Lingeshwaran said the specialist course under the RSCEd parallel programme had been recognised until 2021 but after that, it went missing from the list of recognised postgraduate qualifications on the MMC website and no reason was provided.
So what does the Ministry of Health (MoH) have to say about the issue?
A week ago, Health Minister Datuk Seri Dr Dzulkefly Ahmad said that resolving this issue had become part of his 100-day Key Performance Index (KPI).
He said he had met almost all “feuding” medical entities and healthcare practitioners in relation to the issue, and that he is positive “an amicable closure” will be found.
His ministry then issued a statement suggesting changes to the Medical Act in order to resolve the issues related to the recognition of specialists in Malaysia, especially those going through parallel pathway training. It remains unclear with specific changes to the Act that the MOH is suggesting.
The health minister said given the critical shortage of medical specialists at public hospitals, MOH intends to request the Cabinet to expedite the proposed amendments, ideally in the next parliamentary sitting in June, for prompt implementation.
Calls for Transparency
Incidentally, it is not just foreign qualifications that are not being recognised by the MMC.
Code Blue recently reported that six pathology graduates in medical genetics from Universiti Sains Malaysia (USM) have initiated a judicial review against the MMC’s refusal last August to register them on the NSR as specialist doctors.
Skin Check Malaysia founder and medical director Dr Khoo Lee Seng equates not being on the NSR to professional ostracisation.
“Without you being on the NSR, the NSR holders will say that you are fake and dangerous, a pretend doctor,” he quips. “Without NSR also means inability or limitations to gain admission rights or operative privileges in private hospitals. There is also the issue of insurance claims by patients as insurance companies only accept NSR doctors,” he says.
Dr Khoo claims the restricting of doctors being recognised as specialists in Malaysia is akin to some form of protectionist behaviour, whereby it will result in less competition to specialists coming out of some local universities.
Meanwhile, Lingeshwaran has called for reforms to bring about more transparency in the MMC’s decision-making process for postgraduate qualifications from both local universities and the PPP. He says the MMC should be more transparent in explaining to the public on how it arrives at certain decisions which affect the wellbeing of everyone.
He also points out that even the elections of MMC council members should be more transparent as the process still uses methods such as postal votes, which have long been a bone of contention among many.
This specialist qualification issue is an ongoing one. The good news is, it is being brought to light and solutions sought. The minister of health is also keen to see it resolved for the betterment of the rakyat.
This article first appeared in Star Biz7 weekly edition.
