Friday, March 22, 2024

MOH gazette of "illegal" FRCS in conflict with Medical Act 1971

FMT reported the Ministry of Health gazetted the "illegal" status FRCS International issued by the Royal College of Surgeons of Edinburgh (RCS Edin) under an NGO-initiated Parallel Pathway (PP) program. 

This gazettement is in conflict with the Medical Act 1971 and the last media statement ironically issued by the former Director General of Health, Tan Sri Dr Noor Hisham on September 22, 2022 prior to his retirement.

Only the Malaysian Medical Council (MMC) can certify any doctors as fit to be specialist and surgeon, and qualify for the National Specialist Register. This is over riding their authority and applying unprofessional political and government pressure on MMC to recognise a legally and technically unqualified diploma.  

The PP Program was endorsed and championed by Noor Hisham since the first batch of trainee in 2016. His successors pushed for its recognition, in which its application have been viewed to not met the basic criteria, required standards and duly rejected by the MMC. 

This move by MOH will attract abuse by those in administrative position and undermine the high standards and good reputation of the Malaysian healthcare practitioners. 

One can expect unqualified and insufficiently trained surgeons be allowed to perform surgery with serious implications to patients' safety and possibly lead to the rise of casualties on the operating tables.   

Guised with the intention to increase the number of Medical Specialist, the motivation to do so is suspected to come about out of  Noor Hisham's gratification to RCS Edin for being conferred with honour from the esteemed institution. 

It came with the commitment to bulldoze the PP program. In collusion with the Deans of local Universities (also gowned by RCS Edin), no local Masters in Surgery program would be allowed to take off. 

Already, trainee surgeons from local Universities have reportedly being blocked from getting training in government hospitals. 

In the latest move, it is heard that a senior lecturer in a Medical Faculty responsible for getting the approval from Malaysian Qualifying Agency (MQA) under Ministry of Higher Education was removed upon completion of the voluminous submission.

A pro-"illegal" FRCS lecturer to take over presumably to dump the submission or modify the Masters program to serve RCS Edin requirement.   

This PP program earlier described as a medical scam by this blog was rejected by the MMC. The reason being this particular RCS Edin diploma, FRCS International is not recognised for practise in the home country it is awarded. The accepted one is the Intercollegiate FRCS.  

More so, PP program is not undertaken by a University as required by the Malaysian law, but by the NGO, namely Malaysian Association of Thoracic Cardiovascular Surgeon (MATCVS). 

Any medical program to be conducted by local Universities should be approved by MQA and receive prior approval of MMC before the course could commenced. 

PP was a case of "start first and apply recognition later". In the course of the program, the training provided by RCS Edin to the PP program trainee were too basic, does not provide sufficient exposure and practical training, and does not qualify to be issued the Certificate of Completion of Training (CTT). 

Locally MATCVS could not commit to train the trainee and the plan for the practical training to be taken up by local University Hospitals are mere afterthoughts. 

By doing so, the PP program becomes local and require prior MQA approval for any conduct of programs at any local University. Either way MMC could not recognise the diploma.    

This fast track manner of putting insufficiently trained surgeon will put the lives of patients undergoing surgery at risk and give rise to more post-surgery complication or god forbid, death on the operating table. 

The FMT report below:

Health ministry okays UK college’s medical specialist cert

K. Parkaran

19 Mar 2024, 01:09 PM

Its special medical committee agrees to allow specialists trained at the Royal College of Surgeons of Edinburgh to apply for gazettement.

Dr RA Lingeswaran says the health ministry’s recognition of the Royal College of Surgeons of Edinburgh’s qualification is timely. (Wikipedia pic)

PETALING JAYA: Cardiothoracic surgeons qualifying from the Royal College of Surgeons of Edinburgh under the health ministry’s parallel pathway programme can now apply to be gazetted as specialists.

Also eligible for gazettement are family medicine specialists from the Royal Australian College of General Practitioners and Irish College of General Practitioners, as well as plastic surgeons from the Royal College of Physicians and Surgeons of Glasgow.

According to a letter addressed to heads of departments sighted by FMT, the ministry said the special medical committee that met on March 13 had agreed to allow those qualifying as specialists from these colleges to apply for gazettement.

“The affected medical officers will be given official letters to go through the gazettement process for a minimum of six months. They must also undergo an assessment at the end of the process,” said the letter signed by deputy director-general (medical) Dr Nor Azimi Yunus.

In an FMT report yesterday, Senator Dr RA Lingeswaran asked the health ministry and the Malaysian Medical Council (MMC) in the Dewan Negara why they had halted recognition of the cardiothoracic surgeon qualification from the Royal College of Surgeons of Edinburgh under the parallel pathway programme.

He said the move had put many doctors who had obtained a postgraduate qualification from the college in a tough spot, as they could not be gazetted as specialists.

Responding to the letter, Lingeswaran told FMT that the ministry’s recognition was timely, although the affected doctors could only start working as specialists after their gazettement.

He said MMC must enter their names in the National Registry of Specialists as soon as they become eligible.

“The ball is in MMC’s court now. It should speed up the process of recognising the cardiothoracic surgery parallel pathway training programme from the college again. There is talk that little Napoleons are stalling some of the processes.

“I urge MMC to register these deserving doctors as soon as possible, as they have all passed the rigorous parallel pathway training programme,” he said, adding that it must quickly reinsert the college’s name in the official recognition list.


Little Napoleans in MMC stalling the recognisation process? 

Why is a 5 month-member-instantly-appointed DAP Senator interfering in the technical and legal process of recognition when the law clearly stated that the power to recognise Medical Specialist lies solely with MMC?

There was a lawsuit made against MMC by trainee doctors for rejected their diploma. 

Apparently sources claim there have been a legal opinion given by the Attorney General Office and it is of the view MMC's decision to not recognised is legally sound and cannot be withdrawn.   

This irresponsible remark brought out a reaction from a vocal Cardiothoracic Surgeon:

Statement 9

Gazettement of Parallel Pathway candidates.  

Though it is well within the jurisdiction and discretion of MOH to gazette anyone within their system but there are SOPs that need to be adhered to. 

The justifications has to be clear.

Looking through MOH documents on gazettement as shown below;

This shows clearly that among the criterias for gazettement are:

1. A recognised qualification 

2. Endorsement by DG of Health 

3. Or endorsement by Jawatankuasa Khas Perubatan under MOH.

It appears that history may be repeating itself, and past mistakes not learned. When the late Datuk Dr. Jeyaindran in his capacity as Deputy DG, unilaterally gave an endorsement letter to allow General Surgeons to do Thoracic Surgery.

The initial intention was good, as an attempt to reduce the lack of surgeons doing thoracic surgery. 


This again as is now, was a misinformation. 

This decision has led to complications in terms of adequacy of training, audit, credential-ling & previlledg-ing and NSR certification of these surgeons as Thoracic Surgeons. 

They remain as General Surgeons with Special interest in Thoracic Surgery which encroach into the domain of the Cardiothoracic Surgeons. 

To reverse what was given away, is going to be a very difficult process. 

Incidentally and ironically, this happened during the tenure of one of the current advocate of the Parallel Pathway, who was then the Head of Cardiothoracic Surgery in MOH. 

I’m sure advise was given by him. The same people making another similar mistake again. 

This however, is another sensitive topic for another day. 

The point I’m making here is that, a precedent had been set by previous DG where such an important decision which impacted the outcome of care for patients, and the risk it has made without proper audit, endangers the public who undergo surgeries by unaudited and unqualified practitioners. 

Special interest in Thoracic Surgery is not the same as a fully qualified Thoracic Surgeons who can handle all matters in the chest including complications such as tumour invasion of the mediastinum which may require the use of cardiopulmonary bypass machine. 

As member of the MATCVS committee at that time, we heard about issues pertaining to General Surgeons doing Thoracic Surgery and were extremely concerned.  

But couldn’t do much as the DG at that time supported the arrangements. 

We wanted better monitoring and to include cardiac exposures as part of the training. 

So until today, Thoracic Surgery work is divided and not properly audited to the disadvantage of  the public. 

Now we have another Deputy DG, who unilaterally gave a gazettement order without the endorsement of the DG of Health for the Parallel Pathway candidates, which will lead to further future complications. 

The best part is that, these Deputy DGs were and are NOT specialist in the area of specialty that they endorse. 

This act will make a mockery of our DG and Minister of Heath. 

This is a direct defiance to a reasonable solution ordered by our honourable Minister. 

Again, this is an act to take a short cut around legal procedures and an abuse of power. 

Advise should have been taken from the Institutions that are authorities in these fields. 

However, upon checking the various documents regarding gazettement process, I can clearly see some irregularities going on here. 

On the surface, it look like they are helping these candidates, but it will actually complicate matters both in the medium and long term. 

1. These gazetted doctors still hold unrecognised qualifications. 

2. They can only work within the confines of MOH. 

3. This poses a threat to the public if any problems arise when they are not properly monitored and allowed to do surgeries independently upon completion of the 6 months period of gazettement. 

4. They will be given specialist allowances initially but may be asked to return it back in the future when found to be having an illegal qualification. 

5. They will not be able to get their NSR certification because their qualifications are not recognised in Malaysia. So will not be able to do private work or even leave for private practice. 

6. Those who are employees from IJN and UM will need to be gazetted within their own system and may have the same issues. 

For the short term, things may appear positive but the medium and long term effects can be detrimental. 

And again, I ask you, do we really what to set this precedent? 

This is akin to covering one hole with sand from another hole. 


This manouvre by the syndicate of self serving surgeons, public administrators and University Deans have will have serious consequences to public health. It will compromise the high standard of Malaysian healthcare practises.

It puts Malaysian healthcare on the slippery slope and over time when frequent complications and casualties arise, it will jeopardise the reputation of the industry. 

Most of the trainee undergoing PP program are likely destined for the better renumerated private hospitals. It is the segment that is pursuing patients from overseas, primarily within the region.

With this compromise, Malaysia can kiss its health tourism sector goodbye. Tiong King Seng will not know what hit his Ministry!  


Anonymous said...

Woof woof

RS said...

the article is factually wrong.