This email is in response to the query here.
Dear Captain Lim,
I just can't imagine how some people equate professions and professionalism with earning capacity? It beats me how this equation came about. I think he is confused between a profession and earning a lot of money.
Who is A Professional?
The Oxford dictionary defines a profession as any paid occupation, especially one that involves training and a formal qualification. If that is the case, can we include the paid occupation of unscrupulous business people and corrupt politicians who earn far, far, more than doctors or pilots? They simply become a millionaire within 1-2 years. They are probably one of the highest paid and richest professionals' in the world such as Bill Gates. Others include Chairman and CEOs of multinational companies. Are they classified as professional people?
Are big earners in some of these categories, professionals, or are they very professional in their jobs? Others use deceitful means to earn a living? Then what about bank robbers, gamblers, hired killers, and swindlers, some who are paid for doing their jobs. Are they professionals too?
In my definition, a profession is any job where one earns a living decently, ethically, honestly, responsibly, and caringly, irrespectively his salary or income. To me, that person is a professional. He did not be a pilot, scientist, engineer or doctor. Lawyers are considered professionals. But I think they are the worse of all the professions. They twist and turn, and argue with their tongues and lie in court to defend a criminal in court until the murderer / criminal is free, because he is paid to do this job. For instance, there was a very senior lawyer who brokered for the appointment of judges, went on holidays in New Zealand with the Judge, and who wrote out a RM 10 million judgment for the presiding Judge, is a very glaring example of public opinion of this disgraceful legal and judiciary professions.
Not All Doctors are Rich:
I also just wish to let you know that not all doctors are rich. Just read in the papers the numerous complaints doctors in Government Service are all voicing their dissatisfaction all the time about too much work and their very poor pay. This is not something new. It has been going on for many decades already, since the British time in the 1930s.
When I joined the Civil Service in 1969, a newly graduated doctor got only RM 750 per month. My entry salary at that time was a miserable RM 1050 per month only. I got a slightly higher starting pay merely because I got also a Master's degree. This is true for all graduates, not just medical graduates. It is a blanket salary scale for all university graduates including Arts graduates. My starting pay was only a tiny edge over other newly graduated doctors who only got a basic Bachelor's medical degree. No doubt, cost of living was very much cheaper then, and we were just comfortable. We were able to buy a car and small house then after just one or two years of saving.
Salaries vs. Cost of Living:
But look at the cost of living today in 2008. The cost of living has escalated so tremendously and a doctor's salary inclusive of all allowances in Government Service is still less than RM 3,000 per month. Is this a lucrative profession for doctors after spending some RM500,000 over 5-6 years in a medical school? Just to highlight further, a Government doctor, alongside with teachers, nurses, and the armed forces in this country are the lowest paid Civil Servants in term of hours put in, and the amount of work they have to do. They are the lowest paid civil servants in the country. If you start equating income or salary with amount of work, stress and time put in, I think the medical profession in this country is the worse of the lot.
Arts Graduates do Better?
An Arts graduate especially in Business, Administration, Management, or Economics or in any other non-technical fields, do much better. They need only spend 3 years in a university to get a degree, and their total tuition fees is only less than RM 100,000 for the entire course. But they come out to command a salary as a young executive or junior manager equivalent to that of a doctor, engineer, or a scientist. On the top of that, they have more time for themselves, their families, and friends. They also have the time to pursue other things more interesting and enjoyable, such as hobbies and things they love to do in life. I don't think doctors and pilots have time for these luxuries in life. I am lucky to have some time as I am retired, and I also get a Retention Consultant fee from drug companies without doing much work.
Not as Glamorous as Public Think:
It is very miserable life if a doctor or a pilot has a family. A doctor working in a big and busy hospital hardly has time for his family, let alone spends quality time together. It is a very stressful and unrewarding job. I guess pilots suffer the same when they have to fly here and there all the time, leaving their families behind for days or weeks.
Who is More Responsible?
Both pilots and doctors have highly responsible jobs. But I think the responsibility rest on a pilot is much higher. This is because if a doctor or a surgeon makes a mistake only one person - that is only that patient's life is affected. Others are not at risk. But if a pilot makes a mistake or is irresponsible in his job, the entire plane load of 100-400 passengers' lives behind him is at his mercy. So in my mind, a pilot responsibility in ensuring safety for so many lives is much higher.
Who Has Heavier Professional Responsibility?
But I once read in a medical journal that a medical researcher responsibility is tens of millions of times higher than that of a single clinician. If a researcher fabricates a research results and have it published in a medical journal, this will affect future medical teaching in all the universities around the globe. The decision on the method of diagnosis and / or treatment published in a scientific journal will affect the thinking of hundreds of millions of doctors around the world, down to the generations of doctors who are under training to use and adopting a certain diagnosis or treatment based on that certain study. I think that kind of responsibility is far, far serious than a single doctor or a pilot who makes a mistake that affects the lives of just a few.
Fortunately most doctors are too preoccupied, lazy, or academically not competent enough to understand highly academic literatures and highly specialized technical languages used in research papers. They cannot understand what's going on even in their own areas of medical sciences. Neither do they want to keep themselves up-to-date with the latest advances nor discoveries in medicine to change their mind set. So most of them still use standard, and out-of-date treatment procedures, especially those GPs in private practice in cities and towns. These GPs only listen to the drug salespeople who visit them once a month to stock up their medicines routinely. Being in this profession currently as a special medical adviser to a group of local drug companies, I know their mind set through and through.
Neither in Private Practice:
If you think that only a Government doctor salary is low, and the income of a private practitioner is high, think again. Let me tell you it is neither that lucrative for ordinary doctors in private practice. Do you know that a GP these days are looking for patients, instead of patients looking for them? I know of many former colleagues who opted out of Government Service to try private practice. Many of them told me they regretted that decision. Many of them struggled a lot. These days, especially in the city and urban areas, you meet one clinic at every street corner. There are so many of them competing with each other these days.
Some of my friends hardly got 5 patients per day. The lucky ones got 20 -30 patients per day. Only very, very, few managed to get over 40 patients a day. That depends on luck. They depend on others to spread the word round, or other potential patients see if the clinic is crowded with patients. If it is crowded, that doctor inside there must be good? A ‘good' doctor is only when it is crowded with patients. It is just like people searching for a good restaurant to eat. They only go in when they see a lot of other customers eating there. All the neighboring restaurants they would not patronize because nobody goes there. I think this is very unfair and very unprofessional judgment.
People Gauge by the Crowd:
If they don't get the crowd, their clinic will forever remain empty. So private doctors want the crowd to come, while Government doctors with their poor salaries, want the crowd to go away. Funny and highly unprofessional attitude of the doctors isn't it? Some doctor friends now in private practice told me they just break even, considering all the overhead charges, rentals, nurse(s) and other workers they have to pay. Many of them literally beg for contacts with private companies to work as company doctors.
Others engaged in direct selling to supplement their income. Government doctors who moonshine as locum after work get only RM 30 per hour. They stayed up the whole night long to get that RM 30 per hour, and when morning breaks, they have to go back to the mad crowded Government hospitals and continue with their real official work there with dissatisfied, grumbling, and abusive patients. They have to be there till evening. What kind of life is that? It is not easy as that, and life is not so professional and rosy for doctors as most people think. Life is not easy as that, which ever the profession or trade.
The Rich Doctors:
The private doctors who get the most in terms of income are those specialists who are on their own, or work in 5-star private hospitals. That also depends on which area of specialty. They also have to depend on referrals from other doctors. They can't work alone. Those who specialize in surgery, especially cardiothoracic and vascular surgery have the most earning. Others high earners are those in cardiology, O &G, pediatrics, and general medicine. These are the people who charge exorbitantly, leaving those specialists in psychiatry, dermatology, pathology, haematology (study of blood disorders), radiology, forensic medicine (hardly any in private practice), sports medicine, geriatrics, neurology, trauma and emergency medicine to fend for themselves with their professional specialty in sharing the financial cake.
But Does Charging High Fees Means Professionalism?
If these high income medical specialists are really caring, honest and noble in their professions with an earnest desire to heal the sick, relieve pain and sufferings as what the objective of the medical profession ought to be, then they should not work in 5-star private hospitals, and charge patients mercilessly. They should continue to work in Government and charitable hospitals, or become missionary doctors in deprived rural areas of poor countries, and charge nothing. If they can do that, then I can say, the medical profession is truly a very noble one. But they are far from being one.
But I do not think it is very charitable or noble if a doctor simply charges poor patients who cannot afford health care. Some doctors do give a discount, or waive their professional fees. But the private hospitals are own and run by businessmen, not doctors. So they still have to pay the hospital bills, even if the specialists working there have waived their professional fees. The doctors are just employees there. They don't own the hospitals. So the entire health care profession is just nothing but a huge commercial uncaring enterprise, doctors working hand-in-gloves with businessmen. Is this a noble and caring profession, or is it just some kind of money making machine?
Go Away if Can't Pay:
Almost all specialists working in private hospitals simply ask patients to go to a Government hospital if they cannot pay. In Government hospitals we get doctors, who are rude and grumbling all day long, and the patients equally abusive and impatient having to wait for hours, and getting the wrong diagnosis and rubbish treatment after that. I have experienced countless cases like wrong diagnosis and subsequent wrong treatment myself when patients sought a second opinion from me after getting some rubbish diagnosis and treatment in a Government hospital.
So I have no choice but to ask them to go to a private hospital to be properly investigated. There they have to empty their purse and get slaughtered. I am telling you this is the real state of affairs going on in the health care industry of the 21st Century. Medicine is no longer a noble and caring profession as it used to be. It is just uncaring business these days.
My youngest brother who is a United States Mayo Clinic trained Consultant Cardiothoracic and Vascular Surgeon, and a Professor of Surgery, and an Examiner for postgraduate doctors doing their surgery at the University of Malaya told me the same story. He told me not to trust doctors graduating from local public universities, and many of other doctors coming from poor non-commonwealth countries where students go to study cheaply. He told me their profession competency is far, far below par, and simply beyond belief. They don't seem to know anything even after graduation. They are far too many complaints about these doctors. It is a bare fact I am telling you.
What about Doctors in Research?
There are some doctors who only want to do research. That seems easier as they need not deal with stubborn and uncooperative patients in crowded hospitals. In Government Service, research doctors are not rich either. No doubt we receive special research allowances not given to doctors doing routine clinical work in hospitals. But that is just an additional RM 500 more, besides critical allowances and service allowances we got. These miserable few hundred RM extra does not make us richer either.
Researchers in Multinational Drug Companies:
However, a medical doctor, or any pharmaceutical scientist who also holds a doctorate, namely a PhD degree besides their basic medical or science degrees, and who are working as a researcher in a big multi-national drug companies in a foreign country, especially in United States commands a whooping US $300,000 per month. This is because, a medical doctor, or any medical scientist is engaged in a profession in a truly multi-billion dollar drug industry. But to command that kind of salary is not easy either. The researcher must also be armed with a doctorate degree, plus many years of research experience. His basic medical or science degree is far from being adequate to be a researcher.
Highly Expensive Job:
He would be involved in very expensive research and development (R & D). That kind of work commands very high end caliber academic competency. His professional responsibility is to formulate and develop new drugs for the medical profession. Bear in mind the development of a single drug is going to cost a drug company no less than US $500 million over 15-20 years to develop. That sum is the cheapest. To get a drug out into the market demands highly sophisticated and exceedingly complex and time consuming research. So whoever commands this job, must be very highly qualified, and very well tuned inresearch work. It takes years to develop a drug.
What Training is Needed?
Because of the horrendous cost of putting a single drug into the lucrative pharmaceutical market, a highly trained doctor or scientist working on this area MUST also be very highly paid. But he MUST also have at least a PhD degree, and not just a simple medical or science degree. Additionally, he must have years of experience with large volumes of peer-reviewed research papers published in international refereed scientific journals. This is not easy I should say. Some of my former medical colleagues could not even get a single paper out just to publish in a local journal even after 5 years of ‘research'. They just stared at the ceiling everyday. They just ride piggy-back on us in desperation as we are more senior and experienced researchers. That's when the Ministry of Health gave them warning letters after 3 years. After all they too received monthly research allowances like us which other hospital doctors are not eligible, and yet they cannot produce a single paper. So when they failed to perform, the Government transferred them back to the hospitals to do routine clinical work. There, their research allowances were withdrawn. Out of frustration they then leave Government Service and try some private practice which did not work out well either.
Professionalism vs. Income, or is it Dirt?
So if we back to square one. If we are equating profession and salary, then a drug medical researcher is probably the highest paid of all professions, far surpassing that of a clinician in a hospital or a pilot with a major airline. But that kind of salary is only available in advanced countries, and definitely NOT in Malaysia. Here we are treated as dirt no matter what our qualifications and skills. There is little wonder why the brain drain, and capable doctors and scientists trained and working abroad in advanced countries refused to come back to Malaysia no matter how the Government tries to lure them back. The other highly paid jobs are those working on space and aeronautical research, and those in military defense secrets. Those high-end professions are also only available in advanced western countries.
So Which Profession?
Once again, if you were to ask me whether I wish to be a doctor, research scientist, or be a pilot if I were given a second chance, I would instantly tell you I wish to be a pilot, not because a pilot commands a higher salary, or is it a better profession, but it is because I have always wanted to fly since childhood days. At last, it was a dream that I could never fulfill.
But I have not heard of a doctor becoming a pilot later, or vice versa. I think life is too short to be flickered minded to switch jobs and professions to and fro just like that. It takes many years to train a doctor or a pilot, and the training is very expensive too.
Return the Degree to Their Parents:
But I know of many doctors who gave their medical degree certificates back to their parents on graduation, and went on to do something else they loved since childhood. They told my wife and me what they did after returning the certificate to their parents is what they really enjoyed, because their parents forced them to be doctors. This is a sad end to any profession if you don't like it. Even among my doctor colleagues, almost all of them told me, if given a second, they will never want to be a doctor. It was their narrow minded, blinkered vision parents who wanted them to be one.
Salary is not the only thing to be a professional. Ethics, caring, integrity, honesty, skills, responsibility, compassion, among other virtues make a profession truly worth its salt. So I don't quite agree to the definition of profession' as given in the dictionary.