Doctors Need Longer Contracts, Malaysia Lacks Specialists, Medical Groups Say

Contract doctors are not eligible for local postgraduate specialisation courses even if they are self-funded.

KUALA LUMPUR, July 17 — Two medical groups today criticised the Ministry of Health (MOH) for telling contract doctors to self-finance specialist training abroad as they’re ineligible for a government scholarship for local postgraduate study.

The Malaysian Medical Association (MMA) noted that even if a Malaysian doctor completes specialist training overseas, there are no job vacancies in the government service for doctors due to a hiring freeze since 2015.

“What we must understand is that specialist training in Malaysia is almost entirely dependent on the MOH hospital system together with the training platform of the universities,” said MMA president Dr N. Ganabaskaran in a statement today.

“The private sector does not have the patient load nor the variety of cases to perform specialist training and not to mention the issues with indemnity and patient choice,” he added, highlighting proposals like partnerships with private hospital groups or a transfer fee imposed on specialists moving to the private sector.

He also said SCHOMOS (MMA’s Section Concerning House Officers and Medical Officers) had recently met MOH officials and will be presenting proposals soon to the Public Services Department on extended contracts for contract junior doctors to allow for specialist training.

According to MMA’s projection, Malaysia requires approximately 13,000 specialists by this year, but currently the country only has 8,000 specialists across public and private health facilities. Currently, 51 public hospitals accommodate specialists, while most of specialty care is centred in major cities.

MMA expressed its disappointment over the response given by Health Minister Dr Adham Baba on MOH’s contract policy that would affect junior doctors’ chances of furthering specialist study.

The health minister told Tangga Batu MP Rusnah Aluai (PKR) in a written Parliament reply that the current 23,928 permanent medical officers who have not yet pursued specialist training are sufficient if extra specialists are needed in MOH.

“The reply does omit that with every generation of doctors, there will be some who would like to specialise and some that would not. This could be due to personal interests, social and personal capabilities as well as opportunities,” Dr Ganabaskaran said.

“What the MMA would like to see is that every generation of doctors be given this equal opportunity to become the best that they can be, and specialisation is one of those ways.”

Although Dr Adham had mentioned that contract medical officers can finance their own specialist study and go abroad as they’re currently not eligible for the Hadiah Latihan Persekutuan (HLP), the Academy of Medicine of Malaysia (AMM) highlighted that this was not realistic. The HLP, a full scholarship by MOH for doctors to pursue specialisation in local public universities while working, is only available to permanent medical officers.

“Besides that, contract officers are not eligible for local postgraduate specialisation courses, even if they are self-funded,” AMM said in a statement.

“We acknowledge that it would be financially unsustainable for the government to sponsor all MOs (medical officers) through specialist training. While there have always been doctors who paid for their own postgraduate studies or gone abroad to pursue international qualifications, this is not a realistic option for many graduates.”

At the same time, MMA also indicated the possible emigration of highly trained doctors if they pursue their specialisation abroad.

“Should we encourage more doctors to leave for training, we will see less and less return to serve. The brain-drain of professionals seen in Malaysia over the course of the years has been great and should we continue our current arrogance, we may lose even more,” Dr Ganabaskaran said.

“Malaysian doctors are trained with ample hands on experience, with the resourcefulness to practice in a resource-poor environment. However, what we are lacking at the moment for our junior doctors is the opportunity to continue their training to the higher levels that they aspire to,” he added.

According to Dr Adham, as of March 31 this year, there were a total of 5,322 specialist medical officers nationwide, with an increase of 797 specialists, or 15 percentage points, compared to 4,525 specialist medical officers as of December 31, 2016.

He also mentioned the possibility of considering an initiative to increase the number of specialist doctors through cooperation with the private sector in the long term.

AMM pointed out that the Covid-19 pandemic has reflected the need for qualified and well-trained specialists in Malaysia, as the group representing medical specialists urged the government to provide longer-term contracts and permanent posts for medical officers.

“The contract hiring policy introduced in 2016 was a laudable short-term solution to ensure that graduates were given the opportunity to complete their medical training. As this first batch of doctors are approaching the end of their contracts, there must now be a long-term plan to provide them with permanent posts and clear pathways for continuing their postgraduate studies,” AMM said in a statement.

CodeBlue reported previously that 1,500 contract housemen from the third cohort — whose training started in May 2017 — were offered two-year contracts as UD41 medical officers from May 2020 to May 2022 to complete their compulsory government service. MOH’s offer letter stated that this would be their final contract. Not a single doctor from this cohort reportedly received a permanent post in the public sector.

In such a scenario, AMM recommended introducing longer-term contracts for MOs, such as four to five years, which will provide better job security and experience to pursue specialist training.

“Meanwhile, the government must increase the number of permanent posts available in the country. There must also be clear eligibility guidelines and performance indicators set for MOs to be offered permanent positions at the end of their contracts,” AMM stated.

“Therefore, it is incumbent upon the government to provide alternative pathways in public institutions to MOs who wish to specialise. If contract-based hiring is going to grow more common, the government must create opportunities for contract MOs to pursue postgraduate specialisation courses too.”

It is to be noted that in mid-April at the peak of the Covid-19 outbreak in Malaysia, the government extended by six months the contracts of government doctors, pharmacists, and dentists whose service ended late last year or is due for termination this year.

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