Existing inequalities in remuneration, benefits, job security, and access to career progression opportunities have led to a wellbeing and welfare crisis that disproportionately affects contract doctors, leading to record numbers of Malaysian doctors leaving public service.
This has created a nationwide rota gap that the remaining doctors — both those on contracts and those holding permanent positions — are struggling to fill. If left unchecked, increases in service pressures secondary to this exodus will exact a severe toll on the doctors who remain in public service.
To counteract these dire consequences, we make the following recommendations.
1. Prioritise Well-Being and Welfare by Addressing Contract Doctor Issues
We call on the Ministry of Health (MOH) and the public services department (JPA) to urgently work towards facilitating the timely promotion of contract medical officers to UD47 grade, upon meeting the period of service that would make them eligible for this promotion.
This would harmonise remuneration between contract and permanent doctors, which is apt, given their equal contribution to the health system.
We recommend full standardisation of leave availability between contract and permanent doctors — covering partial pay/unpaid leave, critical illness (tuberculosis, leprosy, and cancer) leave, educational leave, and child care leave — to safeguard the wellbeing of contract doctors.
Guaranteeing equal access to critical illness leave would prevent contract doctors from being forced to choose between their vocation and their health, to the detriment of their well-being.
Moreover, being entitled to the same educational leave (cuti belajar) and examination leave (cuti tanpa rekod untuk tujuan peperiksaan) as permanent doctors would remove a key systemic barrier to specialty training that contract doctors currently face, and would improve contract doctor wellbeing by enabling them to realise their career goals through specialisation.
We recommend that any changes to the leave scheme for contract doctors are formally gazetted, announced via circular letters, and made accessible through official MOH channels.
We support the health director-general’s call on Parliament to amend the Pension Act, that would provide contract doctors with the opportunity for permanent employment alongside social security benefits through the Employees’ Provident Fund (EPF), so as to secure the long-term future of contract doctors.
Given the importance of social security to welfare and wellbeing, we recommend that the feasibility of any proposed amendments to the Pension Act are thoroughly studied, and made compatible with the realities of the Malaysian health care system.
We believe that the Health White Paper to be tabled in November 2022 presents a unique opportunity for the reformation of the social security of contract doctors to be achieved within the next decade.
2. Implement Strategies To Prevent Bullying And Horizontal Violence At Workplaces
We call on the MOH and the Malaysian Medical Council (MMC) to prepare comprehensive, clear guidelines on acceptable conduct at workplaces.
We recommend that these guidelines outline an appropriate escalation plan for the MOH, should hospital-level referrals fail to be dealt with in a satisfactory manner.
We propose the implementation of anonymised 360-degree reviews, where feedback on an individual doctor’s performance and professional conduct is sought from all members of the health care workforce, including allied health colleagues.
This would be invaluable for reporting incidents involcing unprofessional conduct. We also recommend that any submitted feedback be considered as evidence at any fitness-to-practice hearings in cases of horizontal violence.
For convenience and accessibility, we recommend that feedback forms be made available on the MOH e-portal, to be used by all health care workers, so as to maximise privacy and security while minimising costs.
For health care facilities where Internet accessibility is restricted, we suggest that physical copies of forms be provided and collected on a monthly basis for further action to be taken, particularly against individuals who have received multiple complaints.
To guarantee the transparency and impartiality of the adjudication process for cases of workplace bullying and horizontal violence, we implore the MOH to establish an independent workplace professionalism panel, comprising senior officials from the MOH and MMC, with participation from relevant doctors’ representative bodies, such as MMI doctors and MMA Schomos.
The panel should have the authority to open and conduct investigations into workplace misconduct, examine, and deliberate on evidence, and refer cases to the MOH for further disciplinary action.
Any decisions made by the panel should be transparently disclosed and promptly updated to follow the progress of any investigations, and made accessible through the MOH e-portal.
3. Revamp Fitness-To-Practice Evaluations For Doctors Living With Mental Health Conditions
We recommend the establishment of fitness-to-practice committees, led by a panel of suitably experienced clinicians, at each hospital. This would allow consensus-based decision-making at the hospital level, and mitigate bias or discrimination in fitness-to-practice evaluations.
These evaluations should be holistic, and consider both past and current conduct when gauging a doctor’s fitness to practice.
We recommend that the MMC reviews existing policies surrounding the assessment of “suspected impaired doctors”, as previously described in the “Managing Impaired Registered Medical Practitioners” document.
This review should focus on introducing a set of objective criteria that would enable reproducible judgements on whether individual doctors are capable of safe practice, despite their specific mental health condition.
To accompany this, we recommend the creation of a code of conduct for assessing psychiatrists to adopt while conducting fitness-to-practice assessments.
To minimise disruptions to the career progression of junior doctors suffering from mental ill-health, we recommend that MOH introduces new policies permitting more flexible time frames for junior doctors to complete their training, particularly housemen, who are ineligible for reassignment to non-clinical duties prior to completing housemanship.
This reduces the number of housemen being forced to withdraw from service due to mental ill-health, and destigmatises mental health issues in the workplace, particularly among those fearing repercussions such as loss of employment.
We also suggest the establishment of MOH-sanctioned mental health support services, alongside flexible policies permitting junior doctors to hold non-clinical roles while experiencing poor mental health.
4. Introduce Policies That Safeguard The Mental Health And Wellbeing Of Health Care Workers
We call on MOH and MMC to develop a national framework on the mental health and wellbeing of Malaysian doctors and medical students that focuses on key themes including, but not limited to, improving training and working environments, improving support systems, and mitigating toxic workplace cultures.
We strongly recommend the involvement of a national working group — represented by specialists, medical officers, house officers, and medical students — in addition to a review of best practice evidence, in developing this framework. The framework should be reviewed every five years by the aforementioned national working group to ensure its continued relevance.
We recommend that MOH implements mandatory anti-stigma workshops during the housemanship orientation period with the aim of reducing mental health stigma within this community.
These programmes have proven to be successful in significantly improving stigma-related knowledge and reductions in stigma-related attitudes among healthcare providers.
For maximum impact, we recommend the inclusion of doctors with first-hand experience of living with mental health conditions in developing these sessions.
We further recommend mandatory psychological first aid training for all junior doctors, aimed at teaching doctors to identify and support colleagues demonstrating signs of serious mental distress.
Finally, we call on all doctors’ professional bodies (such as MMI doctors and MMA Schomos) to collaborate on the rollout of a national programme pairing senior and junior doctors in a voluntary mentorship scheme, to help develop a direct feedback mechanism to remedy any stressors contributing to their poor mental health.
We suggest an informal anonymous system of sign-ups to create a well-protected and accessible mentorship programme that will in turn safeguard the privacy and security for the engaging doctors.
Supported by:
- MAHSA Medical Society
- University of Malaya Medical Society (UM MEDSOC)
- Monash University Medicos Society Clinical School Johor Bahru (MUMedS CSJB)
- Universiti Tunku Abdul Rahman Medical and Health Sciences Society (UTAR MHSS)
- Mind Matters Network
Malaysian Medics International (MMI) is an international medical student-led organisation that aims to connect, educate, and cultivate, advocating for inclusivity and diversity, reform in medical education, and the welfare of junior doctors and medical students.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
