Too Many Doctors, Too Few Jobs

Solutions include limiting the number of medical students, medical schools, and housemen positions.

KUALA LUMPUR, Nov 26 — The problem of medical officers forced into contract work with the government and their potential future unemployment is actually avoidable, doctors said.

The problem, they noted, is rooted in the oversupply of medical graduates — some allegedly subpar — and the limited number of housemen’s training and job positions for junior doctors in Ministry of Health (MOH) hospitals, even as government health professionals complain about overwork.

Junior doctors can’t simply join the private sector either, which Health Minister Dzulkefly Ahmad has told contract doctors to do after their contract ends, as private hospitals typically require specialists, while opening an independent clinic requires years of training and experience.

“This is a really serious issue with thousands of medical graduates ending up without a job. It is the result of failure of an integrated national human resource development policy,” Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) president Dr Steven Chow told CodeBlue.

Health policy researcher Lim Chee Han said the government, in principle, shouldn’t discriminate against contract doctors.

“Never mind that they are still in the housemanship contract, as soon as they’ve got confirmed as medical doctor, they should enjoy the similar benefits and privileges as other peers who are already civil servant under SPA (Public Service Commission),” he said.

Dzulkefly announced last week that the Cabinet has agreed to promote contract medical, pharmacy and dental officers from the UD41 civil service grade to their permanent counterparts’ UD43.

Naturally, there is a growing concern on the future of these young doctors.

“Previously all doctors were given permanent jobs, as in the compulsory service is as permanent doctors and they continue with their career. What has happened now is that there are too many doctors, so some are being offered permanent job and some are under contract,” said Dr S.S. Vikkineshwaran, the chairman of Malaysian Medics International (MMI), a group of doctors and medical students.

“This disparity is creating the issue for us because we do not know how some doctors are selected for the permanent job and some are getting the contract job.”

Lim supports this, saying that the issue is avoidable altogether.

“There should not be jobless doctors in the first place; it would be a waste of public resources, not just expenditure on medical education but housemanship training,” he added.

“Government should cut their coat according to their cloth: if the system could not absorb so many junior doctors into the public service sector, they should limit the number of medical students and housemanship training positions.”

Lim Chee Han, health policy researcher

With such contracts being called “modern slavery”, can these doctors turn to the private sector?

“Under existing regulations, a registered medical practitioner will have to serve two years of compulsory service in the public sector,” clarified Dr Chow.

“The Minister has the power to release them from this requirement and thus allow them to join the private sector. However, without sufficient training and experience how are these doctors going to practice independently by setting up their own clinics.”

Dr Vikkineshwaran also echoed this.

“There is no reason for private hospitals to hire doctors with no prior experience. People go to private hospitals seeking specialist services. So, doctors in private sectors should ideally be specialists or be in a long-term service before going into the private sector. This is to ensure that the service is of top quality,” he said to CodeBlue.

“Unlike in government hospitals, there are many senior doctors to monitor. In private, these junior doctors work on his own. It is not right to have a two-year experience doctor to be working alone.”

The doctors gave other suggestions to solve the issue.

Dr Vikkineshwaran said there is a need to limit the number of medical schools to ensure quality doctors.

“MOH is not equipped to train 6,000 medical graduates per year. Training of doctors is priority as quality is important. We need to cut down on the medical schools that we have, especially those overseas that we cannot monitor as closely as we do those in the country. We need to cut down on medical schools that are producing subpar doctors,” he said.

He also added that the government must increase the number of jobs available in government hospitals in order to help out these doctors, as well as to solve the issue of overworked hospital staff.

“MOH hospitals also need to increase jobs. That is up to the Public Service Department (JPA),” he said.

“New hospitals are created, but staff from other hospitals are just transferred therefore not creating new vacancies. This results in the staff getting overworked and burnt out and we don’t have enough staff working very long hours. So, it is important that JPA creates new jobs to address this problem.”

Dr Chow said that a mentor-mentee programme can also be extended to medical officers as well, to assist the young doctors.

“The best solution is to allow them to continue training and mentoring under senior doctors in the private sector. Since 2017, the FPMPAM have started a mentor-mentee program for the unemployed fresh medical graduates who were awaiting their housemanship.”

Earlier in November, Dzulkefly repeated his previous statements in Parliament that MOH could no longer guarantee permanent employment to MOs, who may be reappointed on contract to serve the government for a mandatory two years instead. These junior doctors were told that after their compulsory service with MOH, they could seek jobs in public university hospitals or in the private sector.

Almost half of the first two batches of contract housemen from the December 2016 and February 2017 cohorts, or 461 people, were reappointed as contract medical officers from December 2019 to December 2021.

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