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Becoming a medical officer in Malaysia: Are you still a real doctor?

To recap from my previous post, a person must completed 5-6 years study in medical school, pass their professional exam, enter 2 years house officer training program, pass their exam and completed their logbooks, then a person can now be called a fully registered Medical Officer / Medical Doctor.

A Journey of a Junior Medical Officer

After 7 or 8 years experience, a house officer will be given a full registration under Malaysian Medical Council. This registration process is a lengthy process which takes up months before it will be completed. Most doctors will apply for full registration 4 months before they finish their house officer training program. The registration will be processed only if all the criteria has been fulfilled by the house officer which includes log book, review by a board of specialist, no disciplinary action recorded, and other paper work stuff that need to be settled. A full registration means that the doctor now can practice as a doctor independently. They can work in government, they can open up a clinic, they can join private hospital or clinic, whatever they wanted to be. Thus, all private practitioner (medical officer) in the clinic you saw when you had a common cold, was not only completed medical school, but they also have their named fully registered after completed their 2 years training.

The registration is public, you can look up in Malaysian Medical Council official web page for any doctor you have in doubt to be a real doctor. If his or her name turn up in MMC database, they are real. Other than that, report him or her to the nearest police station available ( I am just kidding but I am serious).

All the doctors that has been given full registration (to contradict my previous statement) can not practice in private sector yet. At this point, they will be referred to as a Junior Medical Officer. After given full registration, a medical officer need to serve a 1 year compulsory services in government hospital before they can go to private sector or open up their own clinic. This 1 year compulsory service is necessary to make sure that a medical officer is truly safe to practice. Anything happen within this 1 year period will affect their career forever. No mistake can be done within this monitoring period. However, at this moment, a medical officer is fully responsible for his or her own action.

During house officer training, any mistake done will be answered by the specialist or medical officer in charge of that house officer. After becoming a medical officer, that doctor need to answered to any problem by himself or herself. If they wrongly given wrong medication to any patient, they will be sacked from their job, they can be sued in court, they need to answer to Health Department Director themselves. Basically, they are responsible for whatever they do. Commonly, during my time, a house officer will be sent to district hospital to practice. This will make sure that they brush up all their clinical skills and acquired more experience without having specialist to take care of them all the way.

However, some medical officer now have the luxury to directly enter a specialist hospital or directly enter their department of interest. I do not agree partially on this as for me, experienced is important. However, by doing that, a medical officer can progress towards another step of their career to become specialist quicker than the others. It is a matter or opportunity. For a medical officer that have not decided on which area to specialise, they will serve the community until they decided.

I will continue on this story on the perspective of a medical officer that was sent to district hospital, which I did. In the way, I will also tell a brief story on the other perspective where a medical officer directly enter their area of interest. In district hospital, depending on how big that hospital are, a medical officer need to be in charged of all discipline. This include obstetric and gynaecology, medical, surgical, orthopaedic, paediatric, psychiatric and perhaps whatever disease are there out there in the community. A hospital in district setting was never designated to receive only one kind of patient. Unless a tertiary hospital such as Women and Children Hospital or National heart institure, almost all hospital received all kind of patient. Some district hospital have their own small unit to handle a particular cases, eg; paediatric and labour room, but the doctor handling all this unit usually is the same doctor. The doctor you met in emergency department in a district hospital, might be the same doctor that will treat you when you are admitted in the ward.

Yes it was very busy working in district, not like what people always say " district doctors shaking their leg only everyday, no patient what..". Not when you offer free healthcare, all sort of people will always like to go to hospital, plus the people in a very district area will only come to hospital when they were severe enough. A severe patient will take hours to be taken care of compare to a simple common cold patient that only started a day before.

All the experienced acquired during house officer training will be very valuable now. The logbook they asked to complete during house officer time now feel relevant. In district, you will insert your own chest tube, you will do your own caesarian section, you will intubate and resuscitate on your own, everything is on you. If you cheat your way during housemen time, then it will be a perfect time to cry and quit. Life not getting better after house officer. A medical officer in district, work harder than the house officer.

Nevertheless, any cases in district setting which need specialist consultation need to be discuss with a specialist in tertiary or referral hospital first. So it will be a mistake if you think a medical officer is doing that surgery for his own fun, or giving you medication simply without giving a thought. Most of the work of a medical officer in district setting is recording all their observation and finding, and talking on the phone with specialist. Discussing a patient with a specialist is necessary to make sure the right treatment is given and this will also protect the medical officer from any medico-legal action in the future. For example, a pregnant lady who came with a fetal bradycardia which mean the baby in the womb heart rate is slowing down. The baby maybe in distress, as so the medical officer attending that. The baby need to be taken out immediately. An emergency caesarian section need to be done. As you observed the nurse running here and there preparing the patient to be sent to operating room, you will see the doctor sitting on the table like he or she never give a damn about anything. Plus you can see him or her looking at their smartphone and sometime texting. You feel mad. You post in social media that this doctor is useless. Pause for awhile, you might be wrong. At that precise moment (I recall from my experience), the doctor is sitting on the table recording whatever finding he found on that pregnant mother, the heart rate, any medical illness, allergy, indication for surgery and such. He then will call the specialist in tertiary hospital relaying the information he has. The cases will then be discussed intensively and in a very details manner. It will not take more than 10 minutes to do that as the baby in the womb is suffocating, however the details on that discussion must be very structured and clear. (This is what they taught in medical school, on how to present a case to the examiner).

The specialist will then give it a go or a no. If it is a go, the medical officer will then run to the operating theatre to do the operation.

Not just during emergency operation like this, most of the time, all the cases other than simple common cold and a few other simple cases, will be discussed in details with a specialist before any further action taken. This two layer system will make sure that patients safety are not compromised. Whatever treatment you get in the district hospital, will be equals to what you get in a big tertiary hospital. If the treatment is not available, then usually a patient will be transferred to a tertiary hospital.

Other than treating sick patient, medical officer also need to prepare medical report for insurance claim, or medical check up, giving continuous medical education to hospital staff, attend meeting, sometime went out to public to give health education. Medical officer also need to complete their logbook of procedure. The logbook will be assessed by hospital credentialing and privileging committee which usually include hospital director and a visiting specialist. This means that medical doctor are still need to be performed certain amount of procedures to be certified competent.

Medical officer also required to attend courses to make sure that their yearly license can be renew every year. A full registration is one useless paper that usually be kept in a dusty file or box and only to be taken out if necessary. What is more important for a medical officer is that yearly license to practice. It is called Annual Practice Certificate (APC)

A doctor can boast anywhere about them being a doctor, have that medical degree and completed their 2 years house officer training, but without APC, he is useless like a driver without a driving license. When a driver without driving license hit a cow that cross a road without looking, do you blame the cow? No. You blame that driver. If that driver has a license and hit that cow, you will then consider that the cow maybe the cause of the problem. Same goes to doctors without APC.

So when you meet a doctor, instead of asking for his medical school degree certificate, you can just ask for his or her APC. Unable to show their APC is a serious offence and can cause that doctor to be taken disciplinary action. I am serious on this. That is why, when there are bureaucratic problem causing our APC to be unavailable for that year, we will not touch a patient at all. We will rather sit and write a medical report or just hanging around doing nothing. It was rare. APC usually will be available after a doctor applied for it. Just to make sure that doctor attended courses, and not getting any disciplinary action, APC usually will not be a problem. Medical officers usually renew their APC a year before it expired. So usually will not be a problem on obtaining that. This means, a doctor that do not have APC, that doctor is either fake doctor, or a doctor with disciplinary problem...(or bureaucratic problem, not to forget this as my friend had his time hanging around unable to practice because someone lost his APC application).

For those who directly enter their field of interest or work directly into a specialist hospital without going to district, they will have better opportunity to get a shot to become a younger specialist. However, the work load is the same. As working in district cause you headache because no one is there to help, working in tertiary hospital also have their own headache. With a lot of patient, proper guidance from specialist, and ability to perform procedure that only available in hospital with specialist, these group of doctor will get their experience in their own way. District is like working in a small restaurant with thousand customers to be feed, and tertiary hospital is like a fancy restaurant with michelin star working under a famous chef. Both restaurant will serve good food to their customers.

After a year of serving as medical officer, a doctor then can now choose whether to stay in the government or go out to private practice which offer better salary than government.


Stay or not Stay

This will be the first big decision for a medical officer. Stay or not in the government. They have serve for at least 3 years in the government ( 2 years training + 1 year medical officer), so now it is all about building up their future.

They will be pro and cons and either decision is not wrong. It depend on the individuals. The pro of staying in the government is you can get your grade up easily by serving for another 2 more years. A medical officer will be graded UD44 and after 5 years serving in government they will be UD48. The monthly salary will go up of course but not as much as a private sector can offer. The importance of getting your grade up is to make sure that you gain enough experience, of course, and also to make sure you will not stuck forever in your UD44 grade. If you went out to private sector, you will not be graded like what they have in government, you will only be known as medical officer and perhaps you will be registrar after years and years applying to your boss. And I doubt someone will be rank up to registrar simply by applying.

Staying in government means cheaper salary, and years and years of labour and services. A friend of mine who work in private can already buy a house if not two house while I am still struggling to pay the loan of my medical study. Sometimes, grade is not important as what you think. Although, I stay in government for one reason, this is important...the ability to continue further study to become specialist.

As a government doctor, you have the opportunity to further your study and sponsored by the government. I will not talk much on this as I already dedicated a few post in my blog regarding how to apply for a master program sponsored by ministry of health. You can check it here.


So let us proceed. As I mentioned above, you will be promoted to UD48 after 3 years serving as a medical officer ( total 5 years serving in government. 2 years house officer, 3 years medical officer). By getting that grade, you will be known officially as a senior medical officer. A senior medical officer have a higher price in the market compare to junior medical officer (UD44). Even private clinic usually like to higher junior medical officer because their starting price will be lower. Do not confused the grade with skills and experienced. A medical officer grade UD44 can be as good as UD48 and UD48 can only be good as UD44. Grade is only a matter of how long have you serve in government. As I describe in length, a medical officer you find in a private clinic has serve his or her term for 3 years intensively in government hospital. They are not a low class doctor as you like to think. They were survivor. They only choose different pathway because in life, in a direct way to success, sometime you need to change your direction to be successful.


Up until this point, we have covered all the way of a journey of becoming a doctor. From Medical student, to house officer, to junior medical officer, to senior medical officer. I can go a little further but talking about what beyond UD48, I shall reserved to when I already reach that point myself. I hope that people will understand, if you see a doctor in front of you with their APC, they are almost certainly experienced and went through what I have discussed in my post here and before this. 

Medical doctor is a noble profession. It was not easy to achieved that status (I only discussed here until the point someone become a senior medical officer). If we talk more on the journey to become a specialist, you know how hard someone to get that title. The experience, the knowledge, the time spend on work, the family that left behind, everything is what make a doctor a real doctor. I am hurt if someone self proclaimed himself or herself a doctor but never experienced what I have discussed in length here. We can't stop these self proclaimed, bogus doctor, but we can educate the public on how to recognise them. 

Salute to those who have reach this point of becoming a real doctor.


Continue to next chapter on House officer.

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