Malaysia
Population (2017): 31.62 Million
Income per capita (2018): 11,521.45 US
Percentage of GDP on Healthcare (2015): 4.00
TRAINING
Type of Training –Master of Family Medicine, Vocational Training Program, Diploma
Length of Training – Master of Family Medicine (4 years), Vocational Training Program (2 years), Diploma (2 years part time)
Year Family Medicine established – 1989
Number of family medicine residents graduating each year – unknown
Number of institutions that offer family medicine – Master of family medicine – 3 universities
PRACTICE
Number of family doctors – unknown
Physician to population ratio – unknown
DALY: 14,616/100,000 individuals (due to all causes).
Life Expectancy:
Females 2017: 77.0 years
Males 2017: 73.0 years
Mortality rate 2017:
Males: 155 per 1,000 male adults.
Females: 83 per 1,000 female adults.
Infant Immunization-HepB3: N/A
College of Family Physicians (Y or N):
Yes: Academy of Family Physicians of Malaysia
Healthcare System
Previously, Malaysia had a comprehensive rural type of healthcare system that was comprised of main and subsidiary health centers (Family Practice, 1984). These centers provided primary care, midwifery, and maternal-child healthcare (Family Practice, 1984). The government focused on curative services instead of preventive medicine (Family Practice, 1984). Currently, Malaysia has a mixed healthcare system with a combination of public and private (Abdul Samad et al., 2014).
Healthcare service is comprised of government-run public health clinics and hospitals, and private medical services that are offered by private health clinics or general practices and hospitals (Chew et al., 2016). The ministry of health administers the public sector health service through the central, state and district health offices (Chew et al., 2016). General practices are mostly solo practices that are run by non-specialist doctors (Chew et al., 2016). Both general practices and private hospitals are located mainly in urban areas (Chew et al., 2016). Patients pay directly or have a private health insurance when receiving care through the private healthcare system (Chew et al., 2016).
The public primary care practices offer patient care with multidisciplinary team approach (Chew et al., 2016). This multidisciplinary team includes a nutritionist, pharmacist, physiotherapist, occupational therapist, and paramedic (Chew et al., 2016). The public health clinics are evenly distributed, with smaller clinics in remote areas (Chew et al., 2016). Family medicine specialists manage the bigger public health clinics and have all required facilities like medical laboratory tests, x-rays, and pharmacies (Chew et al., 2016). The clinics are linked to public hospitals with a fully developed referral system in place (Chew et al., 2016). Family medicine specialists work with specialists to provide patients with secondary or tertiary care (Chew et al., 2016). Patients pay a nominal fee to receive comprehensive care from public clinics and hospitals since the public health system in financed through general revenue and taxation, which are collected by the federal government (Chew et al., 2016).
Previously, there were inequities to access medical care in urban and rural areas (Family Practice, 1984). The government services and rural health centers offered primary care within the outpatient departments of hospitals and in urban polyclinics (Family Practice, 1984). Government employees and people with lower income accessed these services (Family Practice,1984).
TRAINING
Undergraduate medical students are not aware about family practice and doctors usually start general practice by default rather than by choice (Family Practice, 1984).
There are 2 different ways to become a family physician, first is by completing the Masters of Family Medicine 4 year program, and second is by completing the two year vocational training program in family practice offered by The Academy of Family Physicians, Malaysia (Malaysian Medical Resources, n.d.; Family Practice, 1984).
In 1989, the University of Malaysia started a four-year full time Master of Family Medicine Programme (Arya et al., 2017). Over 250 family medicine specialists (FMSs) have graduated from the three main universities that offer the program (WONCA Europe, n.d.; Arya, et al., 2017). The training received is structured, the first three years involves clinical postings and the last one-year involves training in a PHC Center (WONCA Europe, n.d.). Those who complete The Vocational Training Program (VTP) can sit for the conjoint examination with the RACGP in the third year (WONCA Europe, n.d.). Successful candidates receive the MAFP/FRACGP, these candidates can then practice at an enhanced level, become an academic staff at a University or migrate (WONCA Europe, n.d.). The VTP curriculum is composed of 20 modules that cover the entire spectrum of family medicine and workshops that cover research methodology (WONCA Europe, n.d.).
In 2007, a proposal was put forward to start a two year long 2 tier-training program called a Post-Graduate Diploma in Family Medicine for all those entering General Practice in Malaysia (WONCA Europe, n.d.). This program is then followed by a two year Intense Clinical VTP that is facilitated by The Academy of Family Physicians, Malaysia for those interested to become Family Medicine specialists (WONCA Europe, n.d.).
The Academy of Family Physicians of Malaysia (AFPM) offers a two-year part time Diploma in Family Medicine. Upon completion of this training, students could continue with the Vocational Training Scheme (VTS) and take the MSFP/FRACGP Malaysian/Australian General Practice, which provides certification in Australia (Arya et al., 2017).
The Academy of Family Physicians of Malaysia (AFPM) was initially established as the College of Practitioners of Malaysia in 1973 (Academy of Family Physicians of Malaysia, n.d.). In 1996, it was renamed to its current name after being approved for registration by the Registrar of Societies (Academy of Family Physicians of Malaysia, n.d.).
PRACTICE
Three quarters of the family medicine specialist’s work with the MOH, while the remaining work both in the public and private practice (Arya et al., 2017). Currently, family medicine graduates work in only 15% of the health clinics; hence the MOH has a goal that there should be at least one specialist working at each health clinic (Arya et al., 2017).
Previously, there was no gatekeeping role for the family doctors, which allows people to visit multiple doctors (Family Practice, 1984). This was a barrier in achieving continuity of care (Family Practice, 1984). Currently, private practices don’t have a referral system but the public practices do have a referral system (Chew et al., 2016).
Currently, continuous professional development is voluntary for doctors (Abdul Samad et al., 2014). The primary care doctors working in the public health sector have plenty of opportunities to advance their understanding about the latest medical evidence (Abdul Samad et al., 2014). The doctors working in a private setting would run solo practices; hence they do not have the time to keep up with the advances in the field (Abdul Samad et al., 2014).
References
Abdul Samad, N., Zain, A., Osman, R., Lee, P.Y., & Ng, C.J. "Malaysian Private General Practitioners’ Views and Experiences on Continuous Professional Development: A Qualitative Study." Malaysia Family Physician, no. 2 (2014): 34-40. https://pdfs.semanticscholar.org/da8d/204768ed7ef215b689a57bd6867621c60e39.pdf.
"Academy of Family Physicians of Malaysia | Education." Academy of Family Physicians of Malaysia. Retrieved from https://www.afpm.org.my/education.
Arya, N., Gibson, C., Ponka, D., Hansel, S., Dahlman, B., Rouleau, K., and Haq, C. "Global Family Medicine." The Centre for Family Medicine. http://family-medicine.ca/global/#asia.
"Career in Family Medicine." Malaysian Medical Resources. Retrieved from https://new.medicine.com.my/2013/07/career-in-family-medicine/.
Chew, B.H., Cheong, A.T., Ismail, M., Hamzah, Z., Mohd-Radzniwan A-Rashid, Mazapuspavina Md-Yasin, Norsiah Ali, Noridah Mohd-Salleh, and Baizury Bashah. "A Nationwide Survey of Public Healthcare Providers’ Impressions of Family Medicine Specialists in Malaysia: A Qualitative Analysis of Written Comments." BMJ Open6, no. 1 (2016). doi:10.1136/bmjopen-2015-009375.
"Family Practice in Malaysia." Family Practice1, no. 4 (1984): 197-98. doi:10.1093/fampra/1.4.197.
WONCA. "VOCATIONAL TRAINING IN FAMILY MEDICINE IN MALAYSIA." Retrieved from http://www.woncaeurope.org/content/vocational-training-family-medicine-malaysia.