I read with interest the articles on the brain drain of doctors.
This issue is not a new one. I graduated from Universiti Malaya as a doctor 10 years ago in 2012. About 30 of my batchmates eventually left the system and are working in Singapore.
Four years later in 2016, the government introduced the contract doctor system — a messy, temporary “solution” to the long waiting times for housemanship and lack of permanent posts. Rather than solving the problem, it greatly worsened the problem of brain drain and loss of Malaysian talent.
The unfairness in salaries and benefits; lack of postgraduate pathway (until recently); job uncertainty; double standards by administrators; and so much more drove the sinking ship underwater.
I personally saw bright, capable junior doctors leave the system in search of a better future outside the Malaysian government system. The issue does not lie solely with the Ministry of Health (MOH), but also with the Finance Ministry (MOF) and the Public Service Department (JPA).
Here are some of the major issues:
Subtle Discrimination
From hospital directors to state health directors — contract doctors have been discriminated against by them. An email by a university hospital in Kuala Lumpur once wrote that certain duties are only to be performed by permanent doctors only, despite having the same training and seniority as contract doctors.
Another state health director repeatedly asked during a meeting, “You need medical officers? How about JUST contract doctors?”. This was the same state that insisted on the word “contract” being written on the name tags of doctors.
Such a ridiculous practice was only stopped after repeated emails to the Ministry of Health, after which a circular was released to ban the word “contract” from name tags. Benefits such as flight warrants and hazard leave were only granted recently after multiple meetings and letters.
Do not underestimate the power of such words in making contract doctors feel unwanted and thus, driving them out of government service. This also influences the way admin staff speak to them; often, a contract doctor is treated differently simply because they are not permanent staff.
Salary Schemes, Grades, and Contract Duration
Up till today, there is still no news on the promotional grades and salary schemes for contract doctors. What happens after UD43? Why does it not correspond to the salary scheme/grade for permanent officers?
The current system is a 3+2+2 years of contract duration; or an additional four years should the doctor qualify for a postgraduate training programme. There is no clear pathway for those we do not qualify yet — will they be terminated?
Remuneration
There is a long overdue review on on-call allowances and salaries. A government doctor gets paid RM220 for a weekend on-call shift. That comes up to RM9 per hour for 24 hours of work. How do we expect to retain government doctors with that?
Subspecialists have the same salary as general specialists. This does not mean that the work done by general specialists is less important — but if we send a doctor for three years of training (many with families, some with inadequate allowances) and they come back to the same salary as their general specialist counterparts, why would they want to remain in government service?
Come this new year, we hope that our new Prime Minister/ Finance Minister and Health Minister will look into these issues.
Many issues lie with MOF and JPA that must work together with MOH to retain doctors in government service for the sake of the public health care system.
Dr Timothy Cheng is an orthopaedic surgeon from Duchess of Kent Sandakan Hospital (HDOK), Sabah.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
