So, how are the new doctors able to afford their education?
How are the medical schools funded?
Discussion
we have :
1. local government medical school
2. local private medical school
3. overseas medical school.
now before i go into funding, the biggest issue is not even the funding. it is the autocratic rule which makes it compulsory for any new doctor to serve the government for at least 5 years (2 years of housemanship / residency + 3 years post housemanship). otherwise your local medical license will be revoked. this is where alot of issue being put forward as government are not giving permanent post for this, only contract jobs for 5 years.
ok funding.
government medical school cost MYR235k / 50.5k USD for 5 years of study, but students only need to pay 500usd for the 5 years. its heavily subsidized but entry is super competitive.
private medical school cost MYR350k / 75k USD for 5 years of study. students either need to take a student loan, pay out of pocket by parents or get a government scholarship which they will bond you for 10 years (and unfortunately still give you a contract post!).
overseas is a bit cheaper. middle east school cost approximately 48k USD but that too would need out of pocket or other loans / scholarship.
How do you think the pay would change if you were not forced to fund government schools?
mind rephrasing your question?
i dont understand it
If you and your fellow citizens were not forced by your government to fund medical education, (and new doctors were not forced to work years for low government forced pay), how would the Malaysia doctors’ pay scale change?
there will be a lot of brain drain. people would have join the private sector in masses or move overseas way earlier. even now, people are leaving government service right after the 5 years of service
the pay in private sector may start of low but the wage will rise exponentially. even more so overseas
but the biggest setback is becoming a specialist. in my country, there are very little opportunity to become a specialist if you join the private sector.
this is where my sacrifice left me. join government sector, enroll in master program study, get paycuts, pay for my own fees. haha
If your citizens were not forced to pay for government medical schools, hospitals and their bureacracy, would they not then be able to use the saved money to pay the doctors in the private sector more?
the govt & the private sectors are different entity. in fact, when more govt doctors leave, the private sector has more supply and wages in private sector goes down too.
maybe its a bit hard to understand because in malaysia we dont have social security insurance. govt hospital is heavily directly subsidized. but you cant really stretch that far so facilities are getting worse and service are not that optimum anymore.
but our private insurance policy are not that comprehensive. lots of exclusions, obstetrics not covered
plus, our overall wages to cost of living ratio is small so people cant afford expensive healthcare . it is for that reason why private healthcare in malaysia are favorite tourist activity for foreigners
If government doctors were not forced into indentured servitude for 5 years, would not more of them leave the system entirely for higher wages overseas, and decrease supply of doctors to private sector?
If your citizenry cannot afford expensive healthcare, how could Malay doctors have wage equity with luxurious pay provided overseas?
1. well yes. but going oversea is not easy for professional field. not all local graduate are eligible to practice in other countries
2. locals can afford to pay, but oversea citizens have different rule entirely. in countries where social security is compulsory, whatever fees they endure is going to be paid by the insurance.
1. Ok, so then would overall healthcare system costs not be lower, because you would save what you pay for government bureaucracy waste?
2. Insurance is a voluntary concept. Is compulsory government medical “insurance “ not just another tax and another expensive bureaucracy?
(Europe and others have that; yet their doctors’ pay is not luxurious, given their cost of living.)
Seems the same as the tax funded medschool and hospital system you have now. No?
2. this. i agree. just like how we pay road taxes and yet we have to pay lots of tolls because most of the road in the city are not federal roads 😂😂
1. i doubt we can reduce healthcare cost in this country any lower. its practically impossible because we are net importers of a lot of medicine and consumables and their price are controlled by international factors (which is up only).
in terms of wages, there were a lot of movement for fairer wages for govt doctors now (they are not even demanding for higher wages, they are just asking for rightful wages.
for example a doctor who are paid MYR5000 a month should he translated to a MYR27.77 per hour wage. yet when doing oncalls they are only paid MYR10.40 an hour which is an outright theft) and yet the government dont even bother.
Maybe i don’t know English well enough: what makes a wage fair or rightful?
Where is line that makes it theft?
Since government everywhere is just the largest local armed gang, funded entirely by coercion, how can anything but theft be expected of them?
Well if you promise to pay someone 20 usd an hour but you only pays them 10usd then by law that is a wage theft.
Only problem is govt servant is my country are not bounded by labor law. So it cant be trialed in court.
If this is a case that falls under the purview of labor law, the doctors would have definitely win.
In fact, under our labor law, overtime should be paid double of actual wage
Yes, that certainly sounds like fraud, but I have never visited a territory where government doctors thought they were “fairly” compensated, including in EU, UK and US.
Seems that the whole problem in your territory stems and revolves around government involvement in medicine education, operation and compensation, because they distort fair price discovery.
Maybe government and medicine are not compatible, and government should not be allowed to meddle in medicine?
that is what health comission and health white paper is all about. the two policies that were supposed to be tabled but now get hold off.
in another vein,
tobacco policy in my country is highly regulated and the council is managed by a Special interest group (SIG) group which involves multiple parties like paediatric doctors association, smoke free NGOs. now the current minister just vetoed one of their decision when in fact there is a limitation to her power when it comes to tobacco. she is being sued in court for undermining the council advice. will see how it goes.
compare to Legal and Education industry in my country, which is more "liberated", healthcare is somewhat fixated to government policy, funding and decisions.
Yes, seems a political issue.
I heard and read that more and more American doctors - particularly in General Medicine and Surgery - are refusing government and commercial insurance patients in favour of a subscription insurance model.
The patient pays a monthly subscription, and when care is needed, no further cost is involved.
Is anyone in your territory trying that?
none. we dont have that kinda thing here
No doctors in the world are compensated as well as American doctors in private practice, and these self-insurance practices are reported to be most lucrative.
Why would Malay private doctors not try this concept and charge as equitable and fair a wage for themselves as they wish?
They would pull even the government doctor payscale higher, and without government coercion.
Is that illegal?
i think subscription based healthcare would be illegal in my country
dont think any legal framework to allow it. for now that is
ps : People of Malaysia are called Malaysian. malay is in fact one of the ethnic in my country
Ok, thanks for correction.
How do you think your doctors being paid an equitable, rightful, fair or luxurious pay would have affected your wife’s recent medical treatment?
😔😭
😔😢😐
you hit a sensitive spot. if i got enough money i would have surely and definitely pay for a second opinion in another hospital, probably a private one.
but i cant afford it.... i barely cant even afford her duphaston and pantoprazole which i am paying out of pocket.
even with the so called decent healthcare we have now, but because of the wage gap, it felt like a burden.
but if the decent healthcare does not exist i dont even know how to treat my wife :(
its like a chicken and egg situation for me since i am in healthcare and people like my wife needs healthcare.
funny is, even if i can afford insurance (which my wife actually has) but because the gap in insurance law in malaysia, they wont be paying for her treatment since it falls under obstetrics cases.
damn it 😢😭
To me seems that it all leads to government distorting the healthcare market to the point that even healthcare workers can’t afford it!
Such distortion seems achievable only on purpose, through government policies, usually intended to benefit some powerful government cronies or for public vote buying.
US is the best example, where most patients cannot afford either good medical insurance, or the best care, if any, even though medical staff compensation and technology is second to none!
As i read, that was not so, until their government began limiting wages during WW2.
So, companies began to offer medical insurance to enhance compensation.
Then, when government began directly meddling in medical funding and pricing with their Medicare and Medicaid programs for low-income patients, and VA for military retirees, affordability for the middle class like you was completely demolished.
It seems the owners of your territory are following the same template, probably for same political reasons - enriching cronies and vote buying. :(
Is that possible?
in many ways, yes, though these misappropropriation does not directly comes from the healthcare organisation itself.
doctors, dentists, pharmacists alike are told we are demanding because we demand for permanent posts instead of contracts. we were hushed off when we request for claims when the doctors were transferred to remote areas only accessible by planes. we were minisculed when we demand fair oncall pays as mentioned previously.
yet, it was revealed that politicians are getting 60% pensions by merely working for 60 months (5 years) whereas civil servants are required to work a minimum of 360 months to get the same benefit.
and if a politician holds a parliamentary post and a ministry post and a state assembly post, he or she will received 3 pension, not one!
a parliamentary politician in office on paper get a relatively miniscule pay, but when review their allowance, its absurd.
basic pay : MYR16,000 a month
fuel allowance : MYR1500 a month
phone bill allowance : MYR900 a month
drive allowance : MYR 1500 a month
entertainment allowance : MYR2500 a month
special allowance : MYR1500
= MYR23,900 a month.
other perks
parliament / meeting attendance : MYR400 per attendance
handphone allowance : MYR2000 every 2 years.
laptop allowance : MYR6000 every 1 term (5 years)
formal clothing : MYR1500 one off + MYR1000 every 3 years.
note that the median Malaysian income is MYR3037.
yet, junior doctors are only paid MYR4000 month,
A senior doctor in the govt which 7 years experience get approximately MYR 6000 a month,
a government specialist get additional MYR2500 to whatever a regular non specialist doctor of his years get.
Yes, the politicians are everywhere robbing everyone they claim to “represent”.
Is there a doctors lobby group that can advocate for legal framework to allow this subscription compensation to cut out the government and commercial insurance bureaucrats?
Yup.
We have a few.
MMA the main one.
Hartal Doktor Kontrak is the left wing.
MMI & IMAM the others
Do you know which solutions they advocate to the problems you mentioned?
Nearly all of it, minus the politicians pay. They are quite united nowadays.
Including a legal framework for this subscription model?
oh no. we havent even discuss the social insurance model even yet. it was part of the national whitepaper for health but got postponed
Have you ever heard of Dr. Devi Sheti cardio hospital in India?
Does that exist in Malaysia?
None that i know of
That’s a model proven successful and lucrative over many years.
So, i can see why doctors are leaving and why they should: your lobby groups are stonewalled by bureaucrats and politicians into ineffectiveness. No legal framework exists to change the status quo through systemic innovation.
My associates and i are contemplating some small healthcare related investment, related to Dr Sheti concept.
When you are finished with studies and not so busy, perhaps details might be interesting to you.
cant*
nostr:npub18hqyxd8htzl2t2p039hhvuzhjsrmfxc6nueff5ldamrdr6wz2eesu46gu8 nowadays the risk reward of practicing medicine is not fun either.
the starting salary as housemanship officer is 1000USD per month.
at the fifth year as a doctor (the end of your compulsory service with the government) your pay may touch 1250USD per month. you get more money doing oncalls, but that means working up to 18 hours or more a day.
private life is so competitive as well. private doctors got paid as little as 1500 usd a month. with average pay ranges from 1720 usd to 2500 usd a month.
so the only way forward is to become a specialist. but that again will cost money, n time n pay cuts 😔