Housemanship : The Sweetest Nightmare

 I believe this is one of the hottest topic in town for the past one week after a new houseman "fell" to his death in Hospital Pulau Pinang. Following the incident, many (not-so-) dark secrets of our fraternity surfaced. Many had shared their experience being bullied during their training, and there are a number of public pages exposing the "malignant" medical officers/ senior house officer/ specialists/ consultants. (so we called, the fierce and scary ones, as this term simply means cancer - something bad and aggressive)

I am currently a medical officer. I have gone through my housemanship training.

In Malaysia, a 2-years housemanship training is compulsory for all medical graduate. We would be practising under provisional registration with the medical council. Upon completion of the training, we will get our full registration to practice as a medical officer, embarking on the future of more uncertainties, especially in the era of contract healthcare workers. (Only fully registered personnels can practice in private sectors)

How is Housemanship like? On paper; 

Introduction :

We will serve in one of the training hospitals (of our choice) for 2 year. We will rotate in 6 different postings/ departments, namely Internal Medicine, General Surgery, Obstetric and Gynaecology, Paediatrics, Orthopaedic Surgery, and lastly an elective posting depending on availability at your training hospital, but the selection consists of Anaesthesiology, Emergency Medicine, Psychiatry or Primary Care. Each posting will last for 4 months by default, however if deemed incompetent/ attitude issues, the houseman may be extended/retained in the posting for another 1 or 2 months. If one had not passed the posting after 8months, the HO will then be transferred to another hospital for training continuation.

For each posting, we are given a logbook as part of the assessment. Specific topics and procedures for each posting are listed in the logbook. As a houseman, (especially one in the current era), there are many procedures in the logbook that we are not allowed to perform, due to medicolegal issues. Most of the time we were only assisting our medical officers.

At the end of third month of each posting, the houseman will have to approach the specialist in charged/ assigned for end of posting assessments. These assessments are tailored and differs among hospitals and departments. Nonetheless, the aim is to assess the houseman's competency (basic, of course) in the particular department, before the houseman is allowed to move on to the next posting.

Working hour :

During my time, most hospitals had already adapted to the shift system for housemanship training. In general, we would have 3 different shifts -

AM/ normal day shift, 7am to 5pm

PM/ Extended hours, 7am to 9pm

Night shift, 8pm to 8am/ 10am/ 12am

(Every week, we have to do at least 2 PM and 1 Night shift, depending on the availability of housemen in the department.)

Of course again, all these working hours differs slightly among hospitals. On paper,  the housemen shall get one off day per week, which may or may not be on weekend. During housemanship, there isn't a Public Holiday. and we don't get replacement off/ extra claim for working on PH.

On paper (again), a houseman shall not work more than 65hours/week. But 90% of the time, this is not the case. A houseman will usually come at 5am (some busy hospital they come at 3am), finished up their work at 11pm, or even 1am. And our 1 off day per week is not guaranteed.

Salary:

"Overworked, underpaid" is not an understatement. As a fresh started houseman, our basic salary would be RM2947.00. Note i said "basic". Housemen are entitled to some prefixed allowances, meaning all HO are entitled for these without having to apply/ submit claim :- 

elaun perkhidmatan kritikal, Imbuhan tetap khidmat awam

elaun waktu bekerja fleksi - hence no overtime claim

elaun perumahan wilayah - depending on your state of origin and the state you are serving, the allowance may differs by about RM300

At the end of the day, after adding all the allowances and deducting for KWSP, SOCSO and Income tax, a houseman's monthly income will be about RM4500-5000/month. And while working for the government, we get a yearly increment of basic salary, by RM225/year.

You'd think, 4.5k for a fresh grad, sounds good what.

Think again, after 6-7yrs of tertiary education and the working hours/week, does it really pay okay??

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That's all about the concepts of being a junior doctor in Malaysia.

Next I'd like to share my journey of being a houseman back then.