Medical Specialties - The Pays and Competiveness

1pm, lazy cloudy Friday. Today all the lecturers and staff at uni have gone to Shanghai for their annual holiday trip, so declared official holiday.

Just finished Surgery clinical exam yesterday. Got Mr.MTC for exam, wah, very bad if get academician for exam, cuz his basics are dem strong, can question u anything under the sun. Case was a perforated gastric (or mebe duodenal) ulcer, post-op with long laparotomic scar runnin down the middle of his six packs. Chinese gentleman, 44 year old, presented with acute and worsening epigastric pain. Couldnt speak english, me no understand chinese, tried to ask for pt change but was told to 'try' and clerk in Bahasa Melayu. So I stammered in mix of Mandarin, Cantonese, Malay and even abit of Hokkien. Very disabling to take history from pt who can only speak Chinese, some more in 20 minutes, den rush thru physical exam. Presented a poor history. Missed out alot on the investigations and post-op management/follow-up since wasnt given time to prepare b4 presenting. Totally stunned when Mr.MTC asked about stomach acid physiology, completely left dat behind in Bukit Jalil.

Mr.MTC invited us down to the cafeteria to breakfast with him after our class, the day b4 our exams. He mentioned about continuously developing urself as a doctor, which is why he came to our uni, but found dat there was not much development option for him here. I agree with dat. To become stagnant in ur medical education after uv qualified wud mean a boring life, so must continue to study. He also talked about getting into the masters program in Malaysia. Yup, British FRCS is still not recognised in Msia, so have to take local surgery training.

Acceptance into the local program at either UKM, UPM or UM (i think some are phasing out post-graduate programmes edi, couldnt remember what MCT mentioned) requires u to, in addition to passing an entrance exam, show alot of initiative in wanting to take up surgery. Electives, CMEs, psotings, doing well in exams, taking other degrees etc. all show ur interest. Dat, with a good letter of reference from ur senior consultants, would clinch ur entry into the 5-year program, but only after uv finished ur 2 year HO and 3 year MO in the ministry of hell (MOH), so by the time ur a surgeon, uv past ur 30s. Which is why in medicine and other fields, MOs quickly go for MRCP and their specialities abroad, which is recognised in Msia.

Borrowed the Lange medical specialty book. It's based on US statistic, but i think they would reflect the medical scene here abit. They call post-gradutate training in the US as residency if im not mistaken, and HO training as internship.

Here are the competitiveness of getting into a residency program based on the rejection ("unmatched") rates (in % of applications) in the US in 2002. Cant find the latest one online. It shows the difficultness of matching into that programme, oso reflects the number of doctors rushing for it.

Extremely Competitive
Plastic Surgery - 23.5
Opthalmology - 22.0
Urology - 20.0
Radiation Oncology - 17.9
Dermatology - 16.1

Very Competitive
Neurosurgery - 15.0
ENT - 15.0
Orthopedic surgery - 14.9
Radiology - 11.1
AnE - 6.5

Competitive
General surgery - 5.4
Anesthesiology - 5.2
OnG - 4.3
Psychiatry - 4.3
Neurology - 3.0

Less Competitive
Rehabilitation - 2.7
Pathology - 2.1
Family medicine - 1.9 (wah, so not competitive meh...)
Internal medicine - 1.6
Pediatrics - 1.3

Everyone loves to know how much a specialty earns (money makes the world go around), so I've oso extracted the median compensation (which i assume is the annual average salary in US dollars, since its the only money thingy of each chapter) for each specialty based on 2002 statistics and re-arranged em.

But remember, medicine in the Us is mostly a private thingy, whereas in Msia, everyone in the government gets about the same amount of pay. If u want to earn this salary, go into private practice. Oso, they got more plastic surgeons over there than here, so of course, the pay here could be much higher. And this is US pay, not directly proportionate to Msian pay, which explains why med students abroad dun wan to come back after qualifying.

I din include some really sub-specialties (retinal surgery, endocinologic gynecology etc.) cuz i dun tink they exist in Msia yet, but their pay is much higher than what the general specialty gets.

Spinal Surgery
$420,660.

Cardiothoracic Surgery
$401,440.

Joint Replacement Orthopedic Surgery
$400,017.

Neurosurgery
$391,250.

Interventional Radiology
$356,000

Orthopedic Surgery
$324,754.

Radiation Oncology
$303,750

Diagnostic Radiology
$302,704

Cardiology
$287,163

Vascular Surgery
$286,286

Plastic and Reconstructive Surgery
$282,825

Anesthesiology
$278,964

Urology
$276,798

GI Surgery
$277,441.

Pediatric Surgery
$270,593.

General Surgery
$255,304.

ENT
$253, 971.

GI
$246,663.

Opththalmology
$240,265.

OnG
$230,804.

Pathology
$221,242

Dermatology
$220,766.

Pulmonary Medicine/Critical Care
$213,483.

Hematology/Oncology
$210,000.

Nephrology
$205,000.

AnE
$204,519.

Neonatology
$201,702.

Neurology
$181,689.

Child Psychiatry
$172,107.

Rehabilitation Medicine
$171,549

Rheumatology
$167,007.

Endocrinology
$166,929

Infectious Disease
$166,156.

Psychiatry
$158,275

Geriatrics
$152,260

General Internal Medicine (i tink its with ur basic MRCP)
$150,534.

Pediatrics
$149,429

Family Medicine
$145,675.

Msia government pay doctors based on their U levels. HO start off at U41, which is about RM2,800 and add all the on-call and some weird allowances (entertainment allowance?), it totals to about RM4,000. MOs now get RM6,000 based on recent news. Specialists go to U48, whereas consultants are at U52 and HODs at U54. Highest u can go is around RM10,000 i tink, with extra pay if ur datuk, do extra admin work, research and etc.

Thus everyone gets about the same pay in the gov, whether ur a cardiothoracic surgeon who's half-dead in the OT at the middle of god-knows what time in the morning, or a radiologist sleeping with the cardiothoracic surgeon's wife in the on-call rooms in the opposite block.

Not very attractive when u know that an ortho surgeon in private practice can earn around RM120,000 a month. Even a "retarded" one can earn about RM80,000.

But i think in the end, it depends on where ur interest lies. U can be making millions a year and giving the tax-collectors a field day, but if u hate ur job, u can be the unhappiest person on this planet. The list is to show u whether u think the job is worth the amount of effort u put in, which u must then applaud the doctors who stay back in the government to work for the sake of the patients who cannot afford private medical care.