KUALA LUMPUR, Feb 7 — The contract doctor system pushes Malaysian medical graduates to emigrate to other countries, said a contract medical officer serving at a government hospital in Perak.
The UD43 contract medical officer (MO), who wants their basic monthly salary of about RM4,000 doubled, works two other jobs to make ends meet and is planning to quit once they have enough money to start a business outside medicine.
According to the MO, contract doctors do not know what are the selection criteria for permanent positions, further alleging that applicants are subject to “passive-aggressive” questions during their interviews, such as being asked for their opinion on contract doctors’ movement, Hartal Doktor Kontrak.
In addition to the plight of contract doctors, the MO touched upon the brain drain of medical graduates, the many vacancies for housemen posts, the lack of training housemen receive in hospitals, low payments for contract doctors, the injustice of contract doctors having to start from scratch when they enter permanent service, and unsustainable health care financing.
The contract medical officer from a Ministry of Health (MOH) hospital was among the 1,652 respondents of CodeBlue’s poll among government health care workers last month that revealed 95 per cent believe Malaysia’s public health care system is currently in crisis, 98 per cent are angry at the situation, 73 per cent are thinking of quitting their job, and 52 per cent are willing to go on strike if one is organised.
On workplace issues, 83 per cent perceive that the government isn’t serious in addressing issues in the public health care system, 80 per cent say they’re underpaid, 78 per cent complain of overwork, 74 per cent suffer from burnout, and 61 per cent feel insecure about their career progression. A quarter allege workplace bullying, while 2 per cent claim workplace sexual harassment.
Below is the contract medical officer’s story in their own words. As civil servants are prohibited from speaking publicly, CodeBlue is providing them anonymity. The transcript of CodeBlue’s interview with the medical officer has been edited lightly for clarity.
After Everyone Knew About the Contract Deal, Fewer Medical Graduates Returned to Malaysia
The domino effect of doctors’ shortage in Malaysia is falling very fast and hard. I entered the service not knowing that I would be a contract doctor. I only knew that I was going to be a contract staff when I came back because, unfortunately, it was the same year that the contract doctor system was implemented. I was the second batch.
After everyone knew about the contract deal, less and less students returned to Malaysia. A lot of local graduates who graduated from UM (University Malaya) and UKM (Universiti Kebangsaan Malaysia) just moved over to Singapore.
Come on, no one wants to serve as a contract doctor after you’ve studied hard for five years to get the degree.
Timeline wise, your peers already have a head start. They probably started working at age 22. We have friends who were already accounting firm consultants when I graduated as a medical doctor.
When less and less doctors are registering to be new doctors to serve in Malaysia, then all the burden of the work falls on to the medical officer who completed their housemanship.
But because they are contract [doctors], no one is obliged to stay in the government until the end of the compulsory service (two years).
An alarming amount of contract doctors actually left the service. I think my batch, I’m the only one left. In my department, I think I’m the only one left.
I work two other jobs to make ends meet. I am leaving once I have gathered enough funds to start my own business (something non-medical related).
Contract medical officer, MOH hospital, Perak
The rest have left for greener pastures, and now, all the burdens of work fall on me and on my permanent colleagues — who in fact are also looking for avenues to exit KKM (Kementerian Kesihatan Malaysia), being unable to cope with the workload.
A good chunk of the workload has already fallen on specialists, and believe me, no specialist wants to work extra for free. The point of being a specialist is that there are medical officers and house officers to do much of the tedious and simpler tasks.
The specialist has no obligation to stay for very long in the government. Private is willing to snatch them up anytime. Eventually, the old consultants will have to do the bulk of the job. Can you imagine 50-year-old plus consultants performing menial tasks like lifting heavy patients or pushing patients for scans?
I will leave the rest to your imagination.
Hence the impending collapse of the system if it is not rectified quickly.
Lots of Vacant Posts for Housemen: Still No Takers Three Days After Job Posting
We definitely need more facilities. We need more hospitals with training. We need more trainers, and we definitely need a lot more people.
We need at least three times more manpower than we have currently.
We have many hospitals in Malaysia. There are district and tertiary hospitals; then there are your klinik kesihatan (health clinics) and klinik desa (rural clinics).
Klinik desa doesn’t have doctors; only nurses. Klinik kesihatan – some of them have doctors. They only have one specialist that they call the FMS, family medicine specialist. So usually, the normal medical officers will work there. They see normal cases, like your high blood sugar, hypertension, and minor stuff.
Then you have the district hospitals, which are without specialists. They only have medical officers. So these medical officers are usually doctors – house officers who have completed their training and put into district hospitals according to the service.
Now, we have the final one, which is the tertiary hospital. Tertiary hospitals are where all the specialists are. All the housemen are required to go to tertiary hospitals for training by specialists before they are sent out into district hospitals, klinik kesihatan, or anywhere they’re needed.
In the past, we didn’t have enough tertiary hospitals to train doctors, but now, a lot of jobs for housemen are not even filled; they’re vacant.
Contract medical officer, MOH hospital, Perak
This actually reflects how poor the confidence of potential junior doctors in our current system is, and how severely crippling this contract policy is to our workforce as a whole.
Doctors who left for private are not replaced, leaving the remaining to work extra for NO EXTRA PAY.
When I started out, if I was three seconds late to register for my placement, I would not get a spot.
Nowadays, three days can go by without anyone taking up the spot. Does this not sound an alarm? It went from three seconds to three days, with still lots of vacancies.
The Best Doctors Aren’t Selected for Permanent Postings
I am still a contract doctor, but I’ve already served more than five years. I’m currently in my sixth year of service.
Heck, as a contract senior doctor, I am training junior permanent doctors.
There is a huge flaw in the selection of permanent doctors. No criteria whatsoever.I know of many of my friends, who have specialist part one or two papers, who are on the good way to becoming a bright young specialist, but still on contract.
Sadly, some doctors who have never appeared to work and who usually take MCs (medical certificate) got permanent postings.
An example of my personal experience – doctors who do not know basic life support emergency procedures are the first few to be selected for permanent positions.
During my housemanship, they were the worst doctors, in the sense that they would be the last person I would choose to treat my family – they got permanent first. Yet, we have people who — if they had gone overseas, they would already have become a specialist — are still on contract. At this point, you have to wonder if it is a skill of the higher-ups to select talents poorly.
We have lost so many good doctors that my heart aches every time I think about it.
Contract medical officer, MOH hospital, Perak
It’s an unfortunate fact: the best doctors are not selected for permanent postings.
There needs to be a huge revamp of the floor in the doctor’s selection, and it needs to be transparent. Currently, it’s not transparent. Nobody is able to give the proper selection criteria for permanent doctors.
Heck, the selection criteria should be abolished as every contract doctor serving in the government has worked hard and earned their place in the government sector. If the higher-ups cannot get this simple fact, we have worked for nothing and should not stick around any longer.
It used to be – you serve how many years, you become a permanent doctor because “Hey, you have been loyally serving the government”.
Job Interview Question: ‘What Do You Think of Hartal Doktor Kontrak?’
But now, you have to go for another interview just to become a doctor. If you are denied, you have to repeat the process over and over and over again, which I find ridiculous. It’s a complete waste of resources.
The questions they asked me had nothing related to my work. It’s not a test of knowledge. I mean, it’s not fair to test the knowledge because everyone works in different departments.
Basically, they would just ask very simple questions like, “Are you willing to go to Sabah, Sarawak, if the government is obliged to give you permanent, et cetera, et cetera, et cetera, et cetera?”. Also: “What do you think of Hartal Doktor Kontrak?”.
Some of the questions, I don’t know how to put it…it feels kind of passive-aggressive – it’s threatening to answer because we do not know what they want.
The question – “What do you think of Hartal Doktor Kontrak?” – we don’t know why we’re supposed to answer it. That is a question that I don’t think should be asked during an interview.
Contract medical officer, MOH hospital, Perak
My true answer would be, “Hartal Doktor Kontrak has done junior doctors a mountain of service and brought light to issues that have been suppressed and silenced for long enough”.
They were our voices when we were threatened with tindakan tatatertib or worse, not being able to practise medicine.
Do you know that most pioneers of Hartal Doktor Kontrak are contract doctors that left for private practice? Even though they left on such a bitter note, they are willing to work for FREE to help those remaining in the government.
Future doctors will forever owe Hartal Doktor Kontrak something they cannot repay. We have an organisation who is supposed to fight for doctors called MMA (Malaysian Medical Association). Most junior doctors feel that they do not do enough and under-represent our needs.
Hence, Hartal Doktor Kontrak could not have come at a better time. I would also like to thank Hartal Doktor Kontrak again for their services to Malaysian doctors.
Other interview questions that were asked included: “Are you willing to go to Sabah, Sarawak?”. Most of us who didn’t get the permanent position agreed to go to Sabah, Sarawak. Strange, is it not?
But those that said that they will not go to Sabah, Sarawak – they got the position.
In short, I spent my time talking to interviewers about things unrelated to the medical field. We were talking about economics. We were talking about politics. We were talking about shares, the war in Russia and Ukraine. More like current news issues, and not about the current health system.
Contract medical officer, MOH hospital, Perak
I think a proper question for the government to ask us would be, “Where do you think is the need for improvement? How could we do better for the people? Where do you think we can improve?”.
I think that would be a better interview question, or how do we retain the doctors who are leaving MOH? Where did MOH go wrong? I think that would be a good interview question.
We do not know what their intention is. Only they know, and god knows.
Potential Lawsuits Deter Doctors From Training Housemen
We have a very huge problem with the system nowadays because everyone is afraid of lawsuits.
Some crooked lawyers need a source of income and would take every opportunity to get a paycheck. So, all the doctors are afraid because what do we have? Licence. Yes, our licence is on the line.
Housemen are protected by laws. They cannot be brought to court with medical negligence. They are protected by law, but not medical officers and specialists. So out of fear, a lot of the time, medical officers and specialists just do it (the procedure) themselves just to be safe. It becomes an effect where you really need good doctors who are motivated and who are kind and willing to train housemen.
Doctors who are willing to come and train you and say, “It’s okay. You can do it. Anything, I will answer” – we lack those leaders nowadays.
Plus, right now, there is also, probably, a shift in working attitude. Maybe that is hard to prove, but I feel that there is a shift in the working attitude from the previous generation.
My generation would be happy to stay back to work longer hours just to learn, but — I can’t generalise this — I feel that the younger doctors just don’t see the point in staying longer to learn something.
Contract medical officer, MOH hospital, Perak
To be fair, I think it is due to the overloaded system; that is why a lot of doctors just want to go home and rest.
What I would say is that for every bad doctor, there are many good doctors.
Most junior doctors in Malaysia are good because most junior doctors in Malaysia are overqualified for everything. No joke. Malaysian junior doctors, our training, six months is equivalent to two to three years in the UK because that is how much overworked we are.
We are super doctors to even our neighbouring country, Singapore. And we are losing super doctors to them.
Nobody Wants This Work This Kind of Crappy Deal
The pay is bad. One day of on-call work is only RM200. For 28 hours of work, it’s RM200. That is like a ridiculous sum for a doctor.
And we have no choice. We’re forced to do it. And the young doctors, I mean, if you’re young, you’re still semangat, you still can go ahead and do it, but then what happens when you’re 35, 40 and you have children?
Doctors are humans, too. They have children, and nobody wants to work this kind of crappy deal.
Contract doctors are being dealt with all sorts of bull when we try to make small claims. For example, when we need to travel for service to another hospital for a day or two – permanent doctors get small claims, we do not.
Contract medical officer, MOH hospital, Perak
Then another thing is, previously, contract doctors were not able to take study leave while permanent is able to, but thank goodness, my head of department is quite understanding, so he allows us to take a study leave as well.
Then, bank loans. Not all banks are willing to give loans to contract doctors because they claim contract doctors are not stable. Not all banks are able to give loans because contract doctors are not considered government service.
And of course, it’s an allowance with discrepancy. Basic pay is about RM2,000, but the workload is the same.
Half the deal, but full responsibility like a permanent doctor.
They have to cut out this permanent doctor bull**** once and for all, or actually come up with a proper system.
Too Much Paperwork for Doctors
Increase the number of hospitals, increase manpower, and stop all these funny admin things – all this extra paperwork that we need to do just to cover your a**.
For everything that goes wrong, I mean, for every small little thing that goes wrong, there will be extra policies that involve a lot of paperwork that has to be dealt with.
I don’t know whether this is in general throughout the whole nation or just the hospital or state policy, but whenever an issue arises, to prevent it, we will need to be accountable and there will be more reports. It actually adds on a lot more burden to doctors.
The reporting, the paperwork, is not something that takes a few minutes. It is something that takes five minutes, which is a lot of time for a doctor.
Contract medical officer, MOH hospital, Perak
For example, some person comes and complains. You have to write a report on why that person complained, regardless of whether you are right or wrong, basically to explain what happened, even if it’s an unreasonable complaint.
Heck even if a staff files a complaint of the flaw in the system, the one complaining needs to look for the root cause and come up with solutions. This discourages progressive intervention or change.
Raise Patient Fees, Start Charging for Non-Essential Medication
I think the public health care system is in crisis because of the overload of patients in public hospitals.
The number of public hospitals is increasing too slowly compared to the number of patients that we get. Especially after the pandemic, everyone has problems, like financial problems and economic problems. So more and more people are turning to public hospitals.
In fact, we give very good care because we follow the latest guidelines all the time; they’re always updated.
Now, we have an overload of patients to the point where a lot of times, doctors have to sacrifice their lunchtime just to finish seeing all the patients.
Contract medical officer, MOH hospital, Perak
Plus, the RM1 fee per patient is not going to fly. We have medications, lots of medications which cost way more than just RM1. It just places too much burden on the health system.
I think they actually need to increase the RM1 to RM5 or even RM10 to make it actually sustainable. Currently, it’s definitely not sustainable; it’s an impending collapse.
To be honest, at this point, I think even if you raise it RM5, it could take a huge burden off the medical system. It doesn’t have to be RM5, RM10 for everybody. RM10 for non-emergency cases, RM1 for semi-emergency cases. I think that’s very fair.
I mean, if you go to a private consultancy, it is RM30; come to government hospital, RM1.
The main issue is we are severely overburdened, and we are offering overtly cheap medication. It’s probably the cheapest in the world. We can’t continue doing that.
A lot of medications are free. We need to stop giving free medications. We need to give only essential medications.
Like diabetic medication, do you know our pharmacy is also providing the syringe? It costs a lot; It costs RM100 plus. And if the patient says, “Oh, saya hilang”, we will just graciously give them another one because if their sugar gets too high, they need to come to the emergency department.
So out of goodwill, we will give them the syringe. That is a lot of burden on the system. If 10 per cent lose their syringe, it’s RM1,000 per day. That is one small example.
I understand it’s a very politically unpopular move to charge more for medication and to charge for non-essential medication, so no one is going to raise the price even though we doctors are sick and dead.
Contract medical officer, MOH hospital, Perak
No one is going to raise it until there is an actual impending collapse. They’re going to wait. They’re just going to wait it out until it collapses. And then after that, try to fix the problem poorly.
Furthermore, we can’t reject life-threatening cases. A lot of life-threatening cases usually involve foreigners. So in that case, they can’t pay; they’re not paying taxes either. They can’t pay, but they don’t contribute anything to our economy, but out of goodwill and out of humanitarian reasons, we still save them.
There are a lot of foreigners in our country, so that also places a burden on our health care system.
On top of that, we still have lots of problems. For example, drug addicts. We have a lot of people who abuse drugs and all, but out of goodwill, we do not reject them and treat them like humans, which places even more strain on our already overstretched health care system.
Double My Salary; It Hasn’t Increased For the Past Six Years
No, because I am bound by the government. If not, I would have quit a long time ago. I only haven’t quit because I still owe the government money.
So, number one, raise my salary. My salary hasn’t increased for the past six years. It’s just a yearly bonus of, I think, RM100, RM200. Mind-blowing, right? It doesn’t mean anything. My current monthly basic salary is RM4,000 plus; including allowances and minus other deductions, my net pay is about RM5,000.
Doctors in Malaysia, we do everything: doctor’s work, nurse’s work, PPK’s (health care assistants) work. We don’t just see patients.
We take blood, we do paperwork, we push patients to X-rays and CT rooms if needed, which is probably not our job. I broke my back doing that once, and it is still hurting badly at times.
If we put it as purely doctors’ work without any extra outside work, I would say my salary should be doubled. I don’t think it is possible, but I think we are worth two times more than our current salary for the amount of work that we have to do.
But hey, as a doctor, we are very happy to treat people. Very happy. I mean, that’s why I’m a doctor. When I see patients get well, I’m very happy. I think it’s more of the poor policy that contributes to our dissatisfaction.
Contract medical officer, MOH hospital, Perak
The head of department can’t do much because the head of department answers to JKN (state health department), and JKN has to answer to MOH. MOH does not communicate with the Jabatan Perkhidmatan Awam (JPA).
It’s all dependent. We have many levels of management. MOH is not doing a good job retaining their doctors, especially taking care of their junior doctors and nurturing young talents. All the younger talents have left.
Number two, abolish the contract doctor system. Give contract doctors their rights. Now, when contract doctors enter permanent service, they start as Day One even though they served four, five years previously under contract. Hence, their next promotion needs to wait.
For example, say they serve three years already. After three years, they are supposed to be able to be promoted to another level, but even after you serve four years from your contract, when you become permanent, that is your Day One. You have to wait another three, four years for promotion.
This is even though you have served long, even though you have served the amounts that if you are permanent, you could be promoted. They need to stop robbing doctors of their experiences, of their years. They need to increase their salary.
Number three, they need to significantly increase the on-call allowance as on-call itself is a health hazard. God created us humans to need sleep. Not sleeping due to on-call is a health hazard.
Contract medical officer, MOH hospital, Perak
No fool — if given a choice — will trade RM200 for worse health. I would say RM500 would be minimally reasonable.
Number four, they need to add a lot more staff, not just doctors. They need to add a lot more supportive staff.
Number five, build more. Build more hospitals.
Number six, increase the hospital fee.
Number seven, reduce the admin workload.
Number eight, stop lying to the public that we have enough doctors.
Correction note: The 9th paragraph was corrected to state UKM, instead of HUKM.
