Interestingly, I have received several messages the past few weeks from final year medical students who were already thinking about their housemanship. Should I do my housemanship (or internship) in Malaysia or continue abroad?
Most of these messages came from students who were already abroad and were hesitant in starting their housemanship in Malaysia due to many factors, but mostly concerning the work culture. I suppose the healthcare scene in Malaysia is notoriously known for the workplace culture, i.e bosses bullying house officers, asking them to get their GRAB food and not say thank you (whatever), bosses who aren’t thoughtful, considerate or helpful. Well, it is true there are some bosses who are notoriously known for their attitude, particularly prevalent in a certain department than others, there are however exceptions to superiors who are helpful, nice and very approachable.
Workplace culture differs from teams to teams, departments to departments and hospitals to hospitals. I suppose researching the hospital departments should aid in your decision-making process before applying for housemanship. Never apply to a hospital for logistic reasons. Housemanship is a difficult time period, choosing the right hospital is important and necessary to safeguard your wellbeing for the next 2 years.
While a lot of talk is about the workplace culture, housemanship in Malaysia generally gives you a lot of practical experience compared to overseas. I mean, how can you not do more? You literally mend the whole cubicle with 10-12 patients every day, and sometimes you are put alone in the ward with 28 patients, so how can you not learn to work strategically? But bear in mind, learning in these conditions are not always optimum and your learning may not always be right, seeing as how you need to manage all 28 patients quick and fast, otherwise, you’ll never be able to finish working and be able to leave on time. So even though you’d learn how to work fast, it may not always be using the right methods. Your hands may not always be as sterile as it should be.
And of course, on top of that heavy workload, your superiors may expect you to know all the cases, be able to manage everything a house officer is expected to do. Malaysia still has a lot of these unreasonable settings due to a lack of manpower, inefficient/ineffective hospital admins and lack of helpful/thoughtful colleagues. Nice people can be hard to come by.
Culture, skills and workload, when you add all of these up, it’s left with time management. You will almost always never leave on time. How can you? When you have to manage the whole cubicle/ward, on top of all the IV cannulas that aren’t working, and all the additional morning bloods you have to take, the requests and referrals you have to make, the AM, PM reviews you have to write, the lunch you have to pick up from the main entrance that your superior never got for you (sorry, sarcasm), how could you ever finish your work? And there isn’t a culture of passing over such to the oncall house officers either, so all you could do is finish up your morning plans before you go back, otherwise it’d be deemed “passing over shit”.
Malaysian housemanship is a lot to handle. It’s less enjoyable, but you see a whole different side of a dysfunctional healthcare system made up of bones that are trying to hold it together. Sometimes, it cracks a little, but it will stay and it won’t fall. The amount of learning depends on the individual. Some people learn a lot, some just don’t. Personally, it’s hard to learn when your every day is stressful. So learning, depends.
Given the recent announcement of more permanent positions and the eligibility of contract doctors to pursue masters, specialising isn’t really a huge problem in Malaysia. There is still a strong bottleneck for only those elite + those with connections can enter a master’s program. Given my time in Australia, training over there seems to be better, more tolerable, more research-oriented, more independent, more goal-oriented, but harder to level up. Hence, it might take years and years before you could become a consultant. But training in Australia is generally better (and the pay is great).
Should I do my housemanship in Malaysia or abroad?
There’s a few things to consider. Remember, Malaysia’s housemanship is brutal. 2 years of service makes you a competent MO. Internship training abroad unfortunately doesn’t give you that level of experience as it is here. Hence, most internships aren’t recognised in Malaysia. So if you were to do your internship abroad, coming back might mean you will have to restart your housemanship.
The other option is completing your housemanship here, then going overseas. There’s always this glimmer of hope that perhaps being a doctor in Malaysia is not that bad, if that’s the case, try starting your career with being a house officer in Malaysia then decide from there onwards. At least you’d be able to get your license at the end of it.
But of course midway through your housemanship, if you feel strongly about the need to quit because of bad mental health, bad work ethics, bad work culture, bad superiors, then tender your resignation. Your own personal morale should take precedence. Proceed with your plan abroad.
Can I return after my internship abroad?
You can return anytime but be prepared to restart your housemanship. There’s this saying whereby if you were ever to return, always return as a specialist. It’s just easier that way than to come back just to restart the process of being a doctor.
My main concern is my family, what should I do?
An honest discussion with your family should allow you to decide on what’s next. If you can’t go abroad, then your best option is to pick a hospital that’s good for you. Alternatively, an MBBS degree doesn’t always mean being a doctor. Lots of people end up in other successful careers, they earn better too.
I hope this helps.