A Contract Doctor’s Dilemma: #CodeBlackMY Vs #HartalDoktorKontrak

If MMA wants to be taken seriously by the authority and their peers as the official union of Malaysian doctors, support the strike.

Here’s a quick recap and my version of the whole “Doktor Kontrak” issue for those who are unaware of the situation.

At the end of 2016, the government decided to offer contract positions to doctors to cope with the influx of medical graduates.

By offering contract positions, the government would save a lot from pension schemes (which the permanent doctors have the privilege to enjoy) and could absorb these medical graduates into the workforce faster.

Seems fair. Do you want a pension scheme, or to get a job faster? Of course, the latter.

However, the pension scheme wasn’t the only thing that the permanent doctors were enjoying. To enter into a specialisation programme or to be eligible for the Hadiah Latihan Persekutuan (HLP), you need to be permanent, not on contract.

Now, that seems a bit unfair. They informed us that they would find a solution for us soon.

That was five years ago. Some of us are approaching the end of our contracts at the end of this year, and still no solution has been found.

Well, there was a solution of sorts. They (contract doctors) can still further their specialisation studies through self-financing or outside sponsorship, and further their studies abroad.

The audacity! Hence, this has led to the #hartaldoktorkontrak movement. 

Earlier this year, when the Malaysia Medical Association (MMA) shared the “Salary ALARY Schemes: Contract vs Permanent Docotrs – What’s All the Fuss About?” document to raise awareness on the contract doctors issue, it garnered mixed reception from the public.

Some sympathised with our situation, but there were some who believe these young contract doctors should be more grateful, compared to other profession.

Being a young contract doctor in a Malaysian government hospital is incomparable to other professions due to the hazards that we face daily.

In this profession, chemical hazards are the least of our concerns, but there have been cases where doctors had to attend to situations like the multiple toxic gas poisonings in 2019.

We face physical hazards, such as wearing full PPE, radiation from X-rays, and even fire hazards, since some hospitals are fire-prone — so much so that we do not even count it as a hazard.

We also face ergonomic hazards when we are forced to push beds around without knowing the proper method, or the awkward postures we find ourselves in, when we rush to complete morning rounds.

Then, we have the worst hazards: psychosocial stress. More than one-fifths of Malaysian doctors suffer from burnout and had quit. If you google “doctor suicide in Malaysia”, there are reports almost every year.

This is in line with the findings of Patel et al, whereby physicians experience the highest suicide rate of any profession. Contributing factors could be workload expectations, fear of infection, toxic work environment, and sleep deprivation(.

Last but not least, there are biological hazards. When Malaysians in general worked from home because of the Covid-19 pandemic since March 2020, “these young contract doctors” were deployed to different states, and far from loved ones, to being first in line to fight this deadly virus. Despite all these hazards, have we complained or stop serving the people? 

That’s why the planned one-day strike has put a lot of us in a dilemma, and has even created tension among the contract doctors themselves, who have divided in two: #hartalkontrakdoktor (contract doctors supporting the strike) and #CodeBlackMY (an MMA initiative comprising doctors who are against the strike, but show solidarity with contract doctors).

First and foremost, I would like to thank the MMA for their endless efforts in trying to resolve this issue for the past five years by holding meetings and raising awareness. But it has been five years.

How many of our colleagues have left government service because they have given up on this issue? How close is the MMA in resolving this issue?

Is the best solution an extended one-year contract? How are we supposed to pursue our specialisation studies with this kind of contract? We are not getting any younger. Are you not frustrated?

As the only registered “union” of Malaysian doctors, you are supposed to support us. We cannot wait until most of us have quit.

What will you do then? Release a media statement stating “MMA condones this action”? Are you expecting after that statement, they will take us back?

Our pleas and appeals have been falling on deaf ears for five years. The time of diplomacy is over. We must act now.

We all understand the dilemma of mounting a strike during a pandemic. We all took the Hippocratic oath of “First do no harm”. The last thing we want to do is to jeopardise our patients’ care.

However, I am sure our senior, permanent colleagues could cover us for only one day. The first element of Basic Life Support (BLS) is danger: “Make sure you, the victim and any bystanders are safe.”

“You” comes first. We cannot save anyone if we are in danger ourselves. Currently, our livelihoods and futures are in danger.

A strike is not uncommon. In other countries, a union would organise the strike. Was patient care jeopardised during the 2015 National Health Service junior doctors strike in the UK?

No, because it was an organised strike that only took one day. There were other doctors covering shifts for the doctors on strike.

A movement of wearing all black and attempting to attract sympathy and attention will not do much. We do not need sympathy.

We did not need sympathy when we were sprinting to the blood bank during a Massive Transmission Protocol. We did not ask for sympathy when we were giving our all during the multiple times when a continuous, uninterrupted chest press compression was occurring.

We were not begging for sympathy when we donned PPE. We do not need sympathy. We need action.

How are people supposed to trust their lives with us when we are begging for sympathy and have no dignity? While #CodeBlackMY has gained attention and support, it is an ineffective attempt at making real change.

If the MMA wants to be taken seriously by the authority and their peers as the official union of Malaysian doctors, support the strike. Take lessons from the nurses’ union.

We are all aware of the power that they hold, because they are united. We can’t be fighting with each other; we are all fighting for the same goal.

To our dear Malaysians, we thank you for your endless support, and your aid for the frontliners. Nothing goes unappreciated.

However, we need you now more than ever. Help us create real change by supporting the #harteldoktorkontrak movement, so the government will take us seriously.

If you have visited a hospital in the past five years, did a nasal swab anytime over the past year, or even received consultation during your vaccination, you were most likely attended to by a contract doctor.

How was your experience? Did they smile when they were treating you?

Behind our smiles, at the back of our minds, we are constantly worried. We are only asking for the security of our future, just as you ask us to secure your health the best way we can.

To the government, we thank you for everything. A huge gratitude for the opportunities and training that we have received, and giving us the chance to be frontliners during the pandemic.

However, we do not appreciate the threats of termination when we are only concerned about our future, especially since we have been used as poster boys throughout the pandemic.

Wouldn’t you feel the same if you were in our shoes? We do not wish to leave the service; however, we know when we are being underappreciated or undervalued,

We won’t beg when we are not wanted. We understand the predicaments and complexities of this issue. We only ask for an alternate pathway for us, contract doctors, to achieve our maximum potential.

We are aware there is an alternate pathway for internal medicine, but what about the rest? Surgical? Forensics? Public health? Please provide clear official guidelines, that is all we ask for.  

There were times when a kid has come up and tell me that they want to be a doctor one day. One part of me wanted to say “Nope, not worth it, kiddo. The lack of social life, increase in mental stress and sleep deprivation is not worth it.”

Another part of me wanted to encourage the child, because being a doctor has got to be one of the best jobs in the world.

The only answer I could come up with is a smile because I remember being that kid once. The reality of it is, every doctor was once that kid who had a dream of helping people through medicine.

That is the basis of being a doctor. Many years later, here we are: fighting for the opportunity for career progress, for not only us, but also for the future generations of doctors.

We are proud to serve, and we aspire to our motto, “Kami Sedia Membantu.” But we must ask ourselves now, “Siapa sedia membantu kami?”

This article is published anonymously due to the government’s gag order on civil servants.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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