#HEALTH: Thousands of heart patients at risk due to critical shortage of cardiothoracic surgeons

THERE is currently a long waiting list for life-saving heart surgery at all seven Ministry of Health (MOH) cardiothoracic centres nationwide.

This delay will result in the death of one patient from each centre every week, said Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS) president Datuk Dr Basheer Ahamed Abd Kareem.

He said Serdang Hospital (now known as Hospital Sultan Idris Shah Serdang) and Penang Hospital each have more than 1000 patients on their waiting lists, with the waiting time for surgery expected to exceed a year.

Meanwhile, around 300 patients are on the waiting list of each of the remaining five cardiothoracic centres in the country and the situation is critical.

Among the key reasons for this are the lack of ICU beds and the post pandemic situation which has resulted in a huge backlog.

But a major contributing factor is the critical shortage of cardiothoracic surgeons in the country.

Cardiothoracic surgeons perform surgery on organs within the thorax (chest) including the heart, lungs and oesophagus and are also involved in the treatment of lung cancer among other conditions.

Dr Basheer said there are only 14 heart surgeons working full time currently at Ministry of Health centres (11 permanent and three contract officers), with some scheduled to retire soon, while the attrition rates of heart surgeons migrating to the private sector remain very high.

Besides Serdang Hospital and Penang Hospital, the five other MOH cardiothoracic centres are located in Johor Bahru, Kuantan, Kota Baru, Kuching and Kota Kinabalu.

"Some centres such as those in Kota Baru, Kuantan and kota Kinabalu are operating with only one cardiothoracic surgeon each, far below the number needed to meet demand," he said.

Given this dire shortage, MATCVS is extremely concerned that the Malaysian Medical Council (MMC) recently rejected specialist registration applications for the National Specialist Register (NSR) by four pioneer Cardiothoracic Parallel Pathway graduates, essentially disabling them from practising as cardiothoracic surgeons despite six years of training.

"This decision poses a great danger to the running of critical cardiothoracic surgical services within MOH, disrupting succession and workforce planning, and possibly promoting brain drain in view of the qualification being accepted globally but not in Malaysia," said Dr Basheer.

MOH initiated the Parallel Pathway Programme (PPP) in Cardiothoracic Surgery in 2016 in collaboration with MATCVS, Academy of Medicine Malaysia and its international partner, the Royal College of Surgeons of Edinburgh (RCSEd) UK.

Dr Basheer said the objective was to shorten heart surgery waiting times, provide care on par with international standards and increase the number of heart surgeons in all local centres.

This training programme was approved by the relevant competent authority and regulator at that time, including MOH, Academy of Medicine, and the National Heart Institute (IJN), with the government providing full scholarships with bonds attached for aspiring young doctors to do postgraduate training in cardiothoracic surgery.

The qualification awarded at the end of training is the Fellow of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery, a qualification fully recognised in Singapore, Hong Kong and Brunei Darussalam, as well as being acceptable and registrable in the United Kingdom.

A total of 33 surgeons have entered the Cardiothoracic Surgery Parallel Pathway Programme since 2016 with 22 of them under MOH sponsorship.

Dr Basheer said the Parallel Pathway Programme should be supported as it will help address the critical shortage of medical specialists in the country.

The Masters training programme for doctors conducted by local universities would not, on its own, be able to meet the critical demand for more medical specialists, he added.

MATCVS has always maintained that the Parallel Pathway Programme and local university Masters programmes should be allowed to co-exist based on acceptable standards and curriculum in order to cater for critical cardiothoracic surgery and the overall healthcare needs of the country.

"We need to increase the number of specialists and bring cardiac surgery to the common man. Both these training programmes can co-exist and flourish and the benefits will be reaped by the nation in terms of providing better healthcare for citizens," he said.

He added that it's essential for the specialist shortage to be addressed as soon as possible as otherwise, lives will continue to be lost and critical services come to a standstill.

As such, MATCVS fully supports Health Minister Datuk Seri Dr Dzulkefli Ahmad's recent statement about his commitment to solve problems involving the Parallel Pathway Programme.

"His determination in handling this serious problem should be lauded in view of the perils facing cardiothoracic surgical services in the country, particularly those within the Ministry of Health," said Dr Basheer.

MATCVS, on its part, remains fully committed to the Parallel Pathway Programme in Cardiothoracic Surgery as it's the only programme which is fully compliant to the National Postgraduate Medical Curriculum for Cardiothoracic Surgical Training, an initiative of the Medical Deans Council and a collective effort by the local cardiothoracic surgical fraternity via MATCVS and University Malaya and launched by the Director General of Health in April 2022.

Its goal is to ensure graduating cardiothoracic surgeons are of good calibre by international standards and able to provide safe cardiothoracic surgical care for patients.

"MATCVS therefore would like to make a strong plea to the Malaysian Medical Council to kindly reconsider its decision and facilitate specialist registration for our future surgeons to avoid grave implications for thousands of patients awaiting open heart surgery in the country, especially the B40 group," said Dr Basheer.

There are currently more than 70 cardiothoracic surgeons in the country but the bulk are believed to be in private practice.

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