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Malaysian Medical Council’s powers being usurped

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A turf war seems to have taken place between the Ministry of Health and the Ministry of Higher Education over who is responsible for regulating medical education in Malaysia. Dr Jeyakumar Devaraj highlights the issue.

Thank you Mr Speaker for this opportunity to debate the Bill (The Medical Act Amendment Bill 2012) to amend the Medical Act of 1971.

I support the proposal to increase the number of elected members in the Medical Council from the current 11 members to 17 as is given in section 3A subsection (1), (e), (f) and (g). In fact on the whole I have no objections to the changes that the Amendment Bill brings to the Act. But what troubles me, Mr Speaker, are the issues that are not dealt with.

Mr Speaker, the main purpose of the Medical Act is to ensure the professional quality of our doctors – to ensure that they possess the knowledge and the skills that are required of them. To do this effectively, we need to ensure that their education as doctors is wholesome. We have to start at the level of medical education.

This is even more pertinent now than it was in 1971, when the Medical Act was legislated. In 1971, there were only three universities awarding medical degrees, and all three were government-owned universities. Now there are 33 universities and colleges awarding medical degrees, and 22 of these are for-profit institutions. The face of medical education has changed drastically, and it is crucial that the Medical Council is given sufficient powers to ensure that minimum standards regarding student selection, the number and experience of lecturers, clinical exposure for the students, and houseman-patient ratios are maintained!

But with this new amendment, the power of the Medical Council to regulate medical education in Malaysia has been diluted further. Why? On Monday (11 June 2012), we were all given a blue booklet entitled ‘An Act to Amend the Medical Act 1971’. However on Tuesday we received a white sheet of paper entitled ‘Amendments at the Committee stage of the Medical Act Amendment Bill’. Amendments to the Amendment Bill, if you will.

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Let me take you through the three amendments brought by the white paper.

In the blue booklet, a ‘a recognised medical training institution’ is defined as one that is recognised and accredited by the Malaysian Medical Council (MMC). However, the white paper has this definition amended as follows – ‘a recognised medical training institution’ is one that is recognised under Section 2 of the Malaysian Qualifying Agency Act 2007.

Section 7 of the Act as given in Section 4A (2) (h) by the blue booklet specifies that among the powers of the MMC is to recognise and accredit medical training institutions. However the white paper has altered the same subsection to read “to recognise and accredit training institutions based on the recommendation of the Joint Technical Committee set up under the Qualifying Agency Act”. It appears to me, Mr Speaker, that the power of the MMC to recognise and accredit medical training colleges has been taken away and placed under a committee under the purview of the Ministry of Higher Education. The MMC’s function has been reduced to a clerical role – to merely recording and documenting the decision to recognise a medical school – that decision being made elsewhere.

Section 37 is even more revealing! Section 36 (2)(bb) is annulled by the amendment brought by the white paper. In the blue booklet that section specifies that the MMC should set up a committee to ensure the maintenance of high standards at all levels of medical education. The white paper relieves the MMC of this responsibility!

Mr Speaker, I might be wrong, but it seems to me that there has been a tussle between the Ministry of Health and the Ministry of Higher Education for the responsibility to regulate medical education in Malaysia. A turf war! And it looks as though the Ministry of Health has lost the tussle! I hope the Ministry will clarify this matter when he winds up the debate.

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I would like to inform the House why this is an issue we should be concerned about. Let’s take the example of Lincoln University College. In 2010, the LUC obtained permission to send 300 medical students to three colleges of medicine in Ukraine for a six-year medical programme there. The problem is that none of these three colleges have ever been recognised by the MMC. The MMC has recognised 373 colleges throughout the world, but these three colleges are not on that list.

There have been Malaysian students who have gone to these Ukrainian colleges. When they complete their education and return to Malaysia, they need to sit for a qualifying examination, which they must pass before they can apply to work as housemen. So far only a quarter of the 50 students who have returned from these Ukrainian colleges have cleared this examination.

However, the Malaysian Qualifying Agency has sanctioned LUC’s proposal to award LUC medical degrees to the students that LUC recruits and sends to Ukraine! The LUC medical degree has been recognised by the MMC. Interesting isn’t it – study in an Ukrainian college, under Ukrainian lecturers following their syllabus, but eventually receive a LUC degree that is recognised in Malaysia.

This is probably completely unrelated, Mr Speaker, but we should note that students who register directly with the Ukrainian colleges have to pay tuition fees amounting to RM120000 for the entire course. However if they go through LUC (to get a recognised degree) they need to pay RM190000. An increase of RM 70000! If we multiply it by 300 students per year, we get RM21m.

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This is the problem we are facing now in Malaysia – the problem of regulating medical education that is increasingly being provided by the private sector. We have 33 medical colleges for a population of 27 million. The United Kingdom with 67 million people only has 32 medical colleges. Years ago we had 1200 housemen. Today the number of housemen has increased to 3500, to the extent that their housemanship training is compromised.

The face of medical education has changed drastically. In 1971, it was entirely by the government. Today 22 out of the 33 colleges in Malaysia are private colleges out to maximise their profits. They each charge between RM300000 and RM500000 for the medical programme.

Given this changed scenario, it is imperative that the MMC be given further powers to assess and regulate the medical colleges. However the opposite has occurred. The MMC’s power has been reduced, usurped by the Ministry of Higher Education.

This isn’t something we can shrug off, Mr Speaker. The quality of our doctors is at stake. The quality of medical treatment of our population is involved. The current situation is worrying.

I intend to propose that this Bill is deferred and instead referred to a Parliamentary Select Committee to look more closely into the issue of the regulation of medical education. I hope Members of Parliament from both sides of the House will support my proposal.

Dr Jeyakumar Devaraj, the Member of Parliament for Sungai Siput, made the above address in Parliament on 14 June 2012

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