Compelling Need To Immediately Address The Plight Of Contract Doctors — CUMIG

Many young doctors are experiencing adverse mental health problems, and this contract vs permanent employment issue, coupled with high work demands will contribute to the development of depression, anxiety and stress.

Concerned UM Indian Graduates (CUMIG) view with much concern the unsolved issue of the contract medical officers (MOs). The more-than-23,000 contract doctors are among those who are tirelessly working at the forefront of the fight against Covid-19, but are rewarded with a bleak future.

These contract doctors are constantly on tenterhooks, due to the lack of job security and opportunities for career progression under the current contract employment terms.

CUMIG would like to highlight a few points that need to be addressed as soon as possible to alleviate the predicament of these contract doctors with whom we stand in solidarity with.

1. Contract medical officers should be given permanent appointment as medical officers, equal to their counterparts. While we understand that this may not be implemented immediately and will probably happen in a staggered manner, an alternative solution should be implemented immediately. 

2. The government must expedite the restructuring process of the civil service with rigorous rationalisation of positions and job scope. Rapid digitisation has rendered some jobs obsolete.

Warrant of Appointment (Waran Perjawatan) awarded for these positions can be apportioned for other ministries such as the Ministry of Health (MOH), in order to create more permanent positions for contract medical officers. This can also reduce any financial implications for the government if more permanent positions are created.

3. We suggest the selection criteria or guidelines for the appointments of permanent posts be made transparent. The government has offered permanent posts to 789 contract medical officers from only three cohorts, who started their medical graduate training (housemanships) in December 2016, February 2017 and May 2017.

Permanent positions were offered only to these three cohorts, and those from different cohorts, who began housemanships as early as July 2017 onwards are left in the lurch.

All the doctors who have completed their housemanships from 2020 onwards were given an extension of contract until 2022, and are currently serving the MOH as floating medical officers, or posted to hospitals as contract medical officers.

Merely extending their contracts until 2022 would not suffice.

4. An alternative solution would be to provide contract medical officers who were not offered permanent positions an extension of 10 years on their contracts with immediate effect, in order for them to continue their specialisation studies and required clinical training, and be gazetted as specialists.

Under the contract system, medical officers are being forced to continue specialist training overseas under the parallel pathway system, but are not guaranteed to be able to finish, due to the uncertainty of the contract employment.

All the contract doctors should be eligible to apply for the federal government’s Hadiah Latihan Persekutuan (HLP) scholarship to pursue their specialisation studies.

5. The contract doctors should also receive all the benefits as their permanent counterparts with immediate effect, as the workload is just the same for both.

Although UD43 MOs are supposed to get the same salary as their permanent counterparts, this does not guarantee that they will be getting permanent posts after completion of their compulsory two-year service.

It also means that they will still not be able to enjoy certain benefits as what the permanent MOs are having, including hazard leave and other benefits. 

6. We also seek to clarify the proposed new remuneration of contract medical officers under the UD43 grade. These contract medical officers who were upgraded to the UD43 grade were not informed about their new salary scale.

There are uncertainties on whether there is a hike in salary, or if the government is retaining their previous UD41 net salary.

Many of those serving previously as UD41 and have now been offered a UD43 post have reached (through yearly increments) RM 3,622 while the entry-point salary scale offered with the UD43 grade is RM 3,611. 

7. The Malaysian annual population growth rate is 0.4 per cent, according to the Malaysian Department of Statistics. The ratio of doctors and specialists serving the nation must be proportional to this growth rate.

Obstruction of these contract medical officers’ specialisation routes will lead to a shortage of specialists in the future. 

8. This situation is further aggravated by the pandemic, as well as the prevalence of non-communicable diseases (NCDs) that have risen substantially in the last decade.

It is estimated that by 2025 our diabetes prevalence will be about 31.3 per cent among adults as highlighted in the National Health and Morbidity Survey (NHMS). 90 per cent of the NCD-related premature deaths occur in low-income and middle-income nations and could have been largely prevented.

The SWOT analysis of National Strategic Plan for NCD (NSP-NCD) 2010-2024 was found to exhibit weaknesses in terms of lack of indication and evaluation criteria with no specific target outlined for each strategy.

The current NSP-NCD listed strengthening and orienting health systems to address the prevention and control of NCDs through primary health care and universal health coverage.

This contract system will eventually lead to a negative impact in implementation, when these contract doctors who are the pillars of primary health care and health coverage have their contracts terminated after 2022.

9. High-income countries continuously reform their health care system. With the ongoing pandemic, as well as to foster our progress towards the goal achieving high-income nation status, it is highly recommended that we model after these countries.

Among the reforms that they have implemented are the strengthening and increase of staffing levels, which were implemented in France, Denmark, Italy and Latvia.

10. In order to curb the issue of a medical graduate glut, which also contributes to the problem, the medical programmes run both locally and internationally that keep churning out thousands of medical graduates each year must be regulated.

To date, Malaysia has 32 medical colleges, which comprise both private (21) and public (11) institutions. That is more than Australia, the UK, and the US on a per capita basis.

In addition, we currently recognise over 360 medical programmes that are run in 36 foreign countries. This yields about 5,000 medical graduates each year. 

11. More stringent regulations have to be implemented to ensure this large influx of medical graduates is kept in check. The government should identify medical schools or foreign medical programmes that are admitting students who do not meet minimum requirements, and de-recognise these programmes.

12. It must also be noted that there have been several articles published in the media with regards to the mental health of young doctors during the Covid-19 pandemic.

Many young doctors are experiencing adverse mental health problems, and this contract vs permanent employment issue, coupled with high work demands will contribute to the development of depression, anxiety and stress.

If this issue is not dealt with immediately, many more mental health issues among these doctors will occur.

This issue, which has been dragged on for years, has now sparked an outcry among the affected doctors.

We truly believe that the matter is being addressed and a positive outcome will be achieved as soon as possible.

We trust that the minister will consider urgently to mitigate any potential devastating consequences. 

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

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