This statement is released to call for permanent positions for all medical doctors in Budget 2021 for the future of the health care system in Malaysia.
The contract system for medical doctors was introduced in December 2016 as a plan to address the glut of medical graduates in Malaysia. These doctors were offered a 5-year contract (a 3-year contract with 2-year extension), whose tenure begins with housemanship and continues into the position of medical officers.
Despite the benefits posed to the government, there are disadvantages that will negatively impact the future of the health care system.
An Obstacle in the Specialisation Process
The current specialisation pathway requires doctors to complete at least 3 years of service with good SKT (Sasaran Kerja Tahunan – an annual evaluation tool for healthcare workers) marks as well as sufficient experience working in a specified field to be considered into the local master’s programme.
Once admitted into the local specialty training it would take at least four years to complete the speciality training. Therefore, with the current contract term, mentioned above, this tenure is insufficient for contract doctors to complete any specialisation training which is heavily dependent on the Ministry of Health’s public hospital system.
To make matters worse, contract doctors are ineligible for Hadiah Latihan Persekutuan, or HLP, a study grant awarded by the government to only medical officers who hold permanent positions.
Despite having parallel pathway programmes which exist as alternative means for doctors to attempt specialisation, there is insufficient time for contract medical officers to complete their specialist training prior to the conclusion of the contract.
Lack of Welfare Benefits of Contract Medical Officers
Contract medical officers are appointed as UD41, a grade equivalent to that of house officers, despite holding the same responsibilities as their permanent counterparts (of service grade UD44).
Contract medical officers receive lower remuneration (approximately RM8,000 in annual salary difference) and are not entitled to the same benefits, as highlighted in our previous press statement dated 26 August 2020.
For example, they are ineligible for government loans enjoyed by their permanent counterparts. They too are not entitled to crucial leaves, such as study and hazard leaves to name a few, which are essential in their continuous professional development and personal safety respectively. This is important to ensure that our doctors are in their best form to provide the best care for the patients.
Uncertainties In The Future Of Medical Officers
As of July 2020, only 3.3% of contract medical officers (665 out of 19,909) were offered permanent positions. Since the commencement of the contract system in 2016, there have not been clear selection criteria regarding the appointment of contract medical officers for permanent positions. There was also no information regarding the selection criteria for a possible extension of the current contract.
Admittedly, it is challenging to absorb all contract doctors into permanent positions. However, MMI believes that this will only benefit all parties in the future. Thereby, MMI requests for the implementation of permanent positions for contract doctors for these reasons:
Our nationwide doctor to patient ratio of 1:454 seems largely promising when compared to the WHO recommendation of 1:400. However, we are still constantly bombarded by words like “underfunded, understaffed, underpaid, overworked, overstretched, and with facilities overcrowded with patients” while describing our health care system.
The explanation is apparent when we zoom into individual states and areas. Eastern states of Malaysia, Sabah and Sarawak, operate with a doctor to patient ratio of 1:856 and 1:662 respectively.
One of the only ways to diminish this glaring disparity is to increase the number of doctors serving in these areas, which can be achieved by increasing the number of permanent positions in these areas.
Supplying The Demand
Malaysia is heading into an ageing nation. The ageing of the population will have far-reaching implications on our society which will result in direct pressures to the healthcare system.
Furthermore, as our society progresses, there will be greater understanding and awareness of health issues as well as greater expectations for the health services. This will undeniably increase the demands for specialists and subspecialists as we face these challenges.
Specialists For The Now And The Future
At present, there are only 3.9 specialists per 10,000 population. On 21 October 2020, Academy of Medicine of Malaysia (AMM) proposed for more permanent medical officer positions to address the ongoing issue of shortage of specialists in Malaysia.
This issue is evident across the country, but especially prominent in rural and Eastern Malaysia. If the current trend continues, Malaysia will see a further decline in specialists available, from the lack of opportunity, to cater to the needs of the growing population.
In conclusion, MMI implores the government of Malaysia to consider providing permanent positions for all medical officers in Budget 2021 by first increasing the number of permanent positions.
We understand the impact of the pandemic on our current economic situation, and that this is a complex issue that cannot be addressed within a day.
However, we believe a systemic shift is needed within the health care system to cater for the impending challenges that Malaysia will face. The Covid-19 pandemic has shown us that health care workers are the biggest assets of our health care system.
A large number of our contract doctors are contributing to the frontlines of the nation, providing health care services to the rakyat when and where needed most. We would like to reiterate that the investment in our health care workers can only benefit the nation and its people.
Malaysian Medics International (MMI) is an international medical student-led organisation that aims to connect, educate, and cultivate.
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