The College of Anaesthesiologists, Academy of Medicine of Malaysia (CoA), the Malaysian Society of Anaesthesiologists (MSA), and the Malaysian Society of Intensive Care (MSIC) would like to collectively respond to the issues surrounding the junior contract medical officers that drew attention and support from various organisations and groups.
Their frustrations are now expressed widely in social media, with threats of a strike by a group representing some of the junior doctors.
Firstly, we are of the opinion that now is not the time to call for a strike, especially when our country is in turmoil facing this devastating pandemic. We are aware that this issue is not recent, and has been simmering for an exceedingly long time, adding to the frustration.
This strike might lead to complications, worsening the situation in the fight against Covid-19, specifically when there is the possibility of compromises in patient care.
We need an all-hands-on-deck approach and owe it to Malaysians, who have been steadfast in their support for all frontliners over the one-and-a-half years.
We take note of some of the pressure points being felt by our junior colleagues. Their predicament started with the introduction of the contract system in 2016 as an initial solution to the delayed placement of house officers.
Upon joining government service, the junior doctors were given a five-year contract package that consisted of a three-year contract with an option of a two-year extension.
In a reply to a query at the Dewan Negara on September 14, 2020, Health Minister Dr Adham Baba responded that the government was reviewing the assessment of contract medical officers (MOs), who are to be promoted from Grade UD41 to Grade UD43.
This promotion would be in line with the career development of permanent MOs. With regards to career advancement and opportunities for further studies and specialisation training, the Ministry of Health (MOH) was exploring the feasibility of granting a longer contract period.
Following a succession of press statements by various associations over the last week, Dr Adham Baba released a press statement on June 23, 2021, and reported that 789 out of 2,544 (about 30 per cent) MOs from the first cohort of 2016 and 2017 and some from the second cohort of 2017 have been given permanent appointments.
Shockingly, he also informed that in the period between December 2016 and May 2021, 23,077 UD41 MOs were appointed as contract doctors to undergo graduate training and compulsory service.
It is no wonder we are now witnessing our young colleagues’ anxiety and their enormous dissatisfaction.
In 2012, the World Health Organization (WHO) reported that the MOH was able to fill only 64 per cent of positions for doctors in 2009.
The MOH expected then that the shortage of doctors will continue through to 2020. The deficit was addressed with increasing the number of graduates being produced through the increasing availability of entry into private medical colleges in Malaysia and the return of medical graduates from overseas.
Unfortunately, on April 22, 2015, the Jabatan Perkhidmatan Awam (JPA) issued a directive to optimally utilise human resources, focusing on controlling the number of positions available and filling of vacant permanent posts in the public sector.
As a consequence, the Suruhanjaya Perkhidmatan Awam (SPA) found itself faced with limited options to hire new staff, despite the assurance that critical sectors such as health care would not be affected.
The hiring of new health care personnel also did not increase in tandem with the requirements of our growing population. To alleviate the reduction in the availability of permanent posts and the inability to match the surge of qualified medical graduates, the contract system was introduced.
The current pandemic has exposed the shortage of human resources, especially in the fields of anaesthesiology and critical care.
Doctors and nurses in these fields are experiencing burnout and fatigue, as their duties in managing critically ill patients and those requiring surgeries are stretched for long durations, due to the inadequate staff numbers.
The Laporan Ketua Audit Negara Tahun 2018 Siri 1 highlighted significant manpower shortages that hampered the delivery of emergency services at the four hospitals which were audited.
However, recruitment of staff is still subjected to approved appointment warrants, government capabilities and current policies in force.
As the JPA’s directive is still in effect to reduce civil servant numbers by 1 per cent, new appointments could only be carried out on a rotating basis.
An appeal was made by the MOH to the JPA on March 1, 2019, for an exemption from the stipulation of the Human Resources Optimisation Policy for the purpose of maintaining the continuity of service delivery in health care.
In the same report, recommendations were made for the JPA to consider exempting the MOH from the Human Resource Optimisation Policy and allocate additional posts to overcome the shortage of health care workers, including specialists.
We urge the relevant authorities, especially the Ministry of Finance and the JPA to take note of all these recommendations and expedite policy changes that can assist the MOH in alleviating the situation, foremost of which is to create more permanent posts.
We are concerned about these developments but are aware of our roles. Our goal is to offer our expertise and assistance in any form that is deemed necessary.
However, for manpower planning and training, we will need full cooperation from policymakers to work jointly with us to ensure the future availability of a competent workforce in providing anaesthesia and intensive care services.
However, while planning the future, the current acute problems faced by junior doctors must be addressed appropriately.
Since 1984, our fraternity has established a postgraduate training programme offered by universities producing some world-renowned anaesthesiologists, critical care specialists and intensivists.
These achievements would not have been possible without the vision and foresight of our many leaders in health care and public administration, not to mention the political will of our leaders.
Our role as professional societies is to help train the next generation of anaesthesiologists, critical care physicians and intensivists.
In 2010, the total number of anaesthesiologists in Malaysia was 681 or one anaesthesiologist for every 42,000 people. For the country to achieve a target for a population of 32 million with one anaesthesiologist for every 9,000 people, we would need to have about 3,500 qualified anaesthesiologists, but as of 2019, we only have about 1,100 specialists.
We appreciate the limited numbers of training spots offered by the universities. Thus, to improve the ratio of anaesthesiologists to the population, we need to have alternative postgraduate training opportunities, either locally or abroad.
As a result, a long-term solution has been planned with a parallel pathway postgraduate programme, developed together with the College of Anaesthesiologists of Ireland, allowing more training opportunities for our young doctors to specialise in our field.
We have projected at least 100-150 qualified specialists will be produced annually from both postgraduate training pathways.
However, with the current situation afflicting our junior doctors, we are concerned that we might potentially lose some of our brightest talents, if they decide to resign from public service to join the private sector without specialisation, or even apply for employment abroad, which may offer more security with regarsd to career advancement.
As postgraduate training programmes offered by universities are awarding Hadiah Latihan Persekutuan, whose eligibility is only for permanent MOs, we foresee more contract MOs will be taking up the parallel postgraduate programme, as it is self-funded.
As a result, they will be qualified contract specialists. We anticipate we will be losing some of these contract specialists to the private sector or other countries, if they continue to be offered only contract positions.
All these uncertainties will only cause more confusion and resentment. Furthermore, career advancement would be affected when one is on contract basis employment.
Delays in appointment to permanent posts too will delay promotions. In fact, a good leader might be overlooked for promotion just because he or she is in the contract category, and not a specialist under the permanent category.
The nature of this dualistic approach towards specialist training will only split the workforce further, causing more anguish and demotivation as if it was designed to fail by default.
Finally, we are worried about the next generation of anaesthesiologists, when in a decade or two, most of the current senior anaesthesiologists will be retiring.
We cannot afford to have the current dilemma remain without a clear solution. Our vision to continue current training plans might be hindered.
Malaysia needs its brightest young talents to go the distance with us. We need them as much as they need our voice now to champion their cause as we reach out in solidarity.
Clear, systematic and transparent policies and strategies need to be enforced to mitigate this conundrum. We will continue to support the government and MOH, particularly in all areas of training to ensure that standards of anaesthesiologists, critical care physicians and intensivists will be at the highest levels for our rakyat.
We hope and pray that with good judgement and wisdom, we will find a solution for the plight faced by our junior contract doctors.
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