Recently, much has been mentioned about the number of med graduates being produced and released back at 'ze motherland', subsequently affecting the quality of the compulsory housemanship training these fresh meat undergo before becoming a full-fledged medical officer (the actual competent and self-able doctor). Which isn't really a surprise judging by the sheer number of medical schools back home (today itself a new medical school has officially opened its doors to its first batch of med students. There are at least 2 more that have been confirmed to be on their way - and will be opening soon enough).
New private colleges/universities offering medical degrees, other privates creating their own medical courses, and batch sizes that seem to be growing each year are collectively a testament to how this once prestigious (not meaning to sound pompous but there *is* a reason why many parents have actively encouraged/pushed/forced their kids into the medical field) course has now been reduced to a mere cash cow. Dissecting further, one would discover how exorbitant the fees could be in a private medical school just to have the students learn most things on their own (which is generally the direction most modern schools are leaning towards these days) and show up to school only to be tested/questioned. You could probably argue that traditionally, medical schools have always been expensive. However, back then there were lectures whole day everyday, fresh cadavers for students to explore etc. So where do all the money paid today actually go to? This most likely end up as insurance fees (just in case a patient sues - more on this next time) but this would only be logical if the student is in his/her clinical phase. If a student is only cooped up at home with their books, attending uni for a few hours a day, with zilch interaction with real patients, what actually happens to all these money? Sure, there is the occasional library update and renovations for a more comfortable (both physically and to the eyes) space, but there is only so much that can be bought. Would it really be a surprise for a sizeable amount of money to end up in someone's pocket?
A few years back, there was already an awareness about the exponentially increasing number of medical trainees. A famous (or infamous) politician who was a medical doctor himself once put it this way, 'if you throw a rock out a window, you would not hit a doctor but five' (well, something along that line). Generally, developing (and even developed) countries have always had a shortage of medical professionals. Doctor:patient ratios in town areas usually are comparable to what WHO deem as ideal whereas the situation is not that optimistic rural-ly (note that we are using ratios instead of actual numbers - there would be more doctors in urban areas as the number of patient intake is much higher). Logically speaking, who would want to venture out into uncertainty; where help would be harder to access should he/she encounter difficulty, fewer colleague support to fall back on, and technology enough to just survive. Not forgetting, these doctors are more likely than not, pure urban, having been raised in the luxury of hygiene and comfort. It was probably the honest intention of wanting to improve the ratios in rural areas that have lead to the encouragement/approval by the government/medical council in any steps that would lead to more medically trained students, especially considering the brain drain problem that has been plaguing the country. But really, who would blame the soundminded people who have tasted (ie in Western countries) the sweetness of real democracy (at least relatively to back home), the culture of celebrating and sharing knowledge, the more humane working conditions; and all these on top of the better remuneration. Flooding the market with doctors in such a short period of time with hopes of keeping up with the rate of this drainage may soon backfire. We are currently just starting to feel the burden of congesting the wards with students and junior doctors.
Junior doctors/housemen/interns are on paper, doctors, but not quite there yet. With the year of housemanship (proposals/decisions to increase this to 2 since it was deemed 1 year was not enough - and this goes back to the main point of this post), these juniors are further trained; with them adjusting to their new-found responsibility, easing up to their capabilities, as well as identifying and fixing their own weaknesses. Each junior would be assigned to look after a ward, thus optimizing the variability of disorders/illnesses they encounter and teach em skills eg time management, patient/procedure-prioritising (perhaps the phrase 'working better under pressure' is appropriate here). That was how the system worked, or at least how I've always thought it was. Imagine the horror having a senior doctor expressing his concern regarding the crowding in the wards by junior doctors, how each junior is allocated to just 4(seriously?) patients each and there aren't enough senior doctors/consultants to conduct teaching thus compromising their learning. In the blog by this particular doc, terms such as 'pasar malam' were used and it just seems all too worrying. Of course, the fact that the hospital this doctor is working in is one of the main teaching hospitals is a justifiable reason, but with over 30 medical schools in the country churning out junior doctors by the factoryload and the homecoming docs (from the world over), where do these freshfaces go for training? We can't just dump them at a small hospital with no senior docs to guide them - where's the training?.
Having said all that tho, one good thing about having many doctors is the shifting system could then be tuned as such that work would now be less taxing on doctors and thus a possible reduction in complications associated with having overworked docs. And we could always roster out the junior docs who have finished their training (or towards the end) at a teaching/bigger hospital to the rural areas, and therefore (hopefully), achieving the dream to have a better doc:patient ratio.
Personally, I would agree with any arrangement that enables me to learn and get the valuable (and much needed) exposure before I put my license to kill to use. Crossing fingers that things would get sorted out and there would be an efficient organization by the time I enter the system (I won't even enter a sarcastic comment to avoid jinxing it).
(Here I did not mention: prospects of having more doctors going into specializations and meeting the high demands in the country, liability and the culture of suing, med jobs or lack thereof in other countries)
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