When Doctors Strike: Historical Lessons From Malaysia’s Past

In ’77, housemen went on strike for nearly a week and delayed registration with MMC, forcing salary hikes for HOs and first-year MOs. In ’82, junior doctors protested against low salaries and lack of on-call pay with work-to-rule and day-of-rest tactics.

KUALA LUMPUR, March 8 – As the country continues to grapple with a health service crisis, reports of a potential strike by government health care workers have emerged, highlighting rising anger with staff shortages, low pay, and toxic workplace conditions. 

The threat of a strike underscored an urgent need for action to address these perennial issues, with the Ministry of Health (MOH) organising a town hall meeting in February to address concerns raised by government doctors.

There are fears that the strike – if it happens – could be even larger than the Hartal Doktor Kontrak (HDK) walkout that occurred last year, after a CodeBlue poll revealed that health care workers’ dissatisfaction with their working conditions, including low wages, cuts across various professions and levels of seniority, not just among contract doctors.

This is not the first time the government has been pressured to take action on the issue of low pay among medical workers. Historical events in 1977 and 1982 demonstrate that compensation for government health care employees, particularly among doctors, has been a recurring problem and can only be resolved with significant intervention.

Speaking to CodeBlue, Dr Steven KW Chow, the current President of the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM), recounted the events that triggered a strike among University Hospital doctors (batch of 71/76) and the subsequent boycott of registration with the Malaysian Medical Council (MMC) in 1977 by the succeeding cohort of house officers. 

“This all started in 1976. The graduating class of University of Malaya, 1971/1976, were already very upset that the [monthly] salary of the houseman, at that time, was merely RM680. Our take-home cheques was a mere RM400-odd after deduction for accommodation rental, laundry, and meals,” Dr Chow told CodeBlue in an interview.

“It was an embarrassment to go to the bank every month to bank in our pay cheque. All other non-medical university graduates (both arts and sciences) were already joining service with starting [monthly] salaries of RM1,150 or more.

“On top of that, virtually, the entire legwork of daily patient care was done by the houseman – the clerking of patients, discharge, to registration of birth and death, normal deliveries, assisting in post-mortems and major operations, including basic duties of blood-taking. If needed, housemen were even delegated to be runners for carrying laboratory reports and blood from the blood bank to the OT for urgent cases.

“In those days, housemen were on-call almost once every two days. Typical working hours were from 7am to 4.30pm, immediately followed by call duty to 7am the next day and continuation to 4.30pm (or later if there are last-minute admissions) before clocking off. The same routine applied a day later. 

“Housemen those days were a tough lot taking all in stride as part and parcel of our duty and training. From Day 1, after passing MBBS, we were told that the year of housemanship is not going to be a bed of roses. It was a steep learning curve for all. 

“The objective then was to train doctors who would be able to practise without supervision the day they become medical officers. Despite the tough times, the attrition rate of housemen (those failing to complete training) was nominal those days compared to now.

“When we complained to our consultants, it landed on deaf ears. We were invariably told how it was when the consultants themselves were housemen and junior medical officers,” Dr Chow said.

“We were encouraged by some of our senior colleagues that it can’t go on this way forever. So what did we do at that time? We formed an action committee among the University Hospital group, called a meeting of all our housemen, and decided that we should take class action to have our grievances heard.”

Tunku Abdul Rahman: ‘Oh, All You Doctors Are Asking For Is More Money’ 

A class photo of the University of Malaya 1971/1976 medical students’ batch. Picture courtesy of Dr Steven KW Chow.

Dr Chow said the trigger event for a nearly week-long strike by the 1971/76 batch of University Hospital doctors occurred in early 1977, just as they were about to finish their housemanship year.

“The officer in charge of the medical records department issued a written directive to us to complete all discharge summaries before a specified date or we will not be signed up for completion of housemanship. We took offence to the fact that a lowly  administrative officer could decide on the fate of our career in such a callous way,” Dr Chow said.

“Together with representatives from GH Penang, Johor, Ipoh, Klang, also from the east coast, Kuantan GH, we met and prepared a 20-page memorandum to the Minister of Health, the late Lee Siok Yew, highlighting our grievances.”

The meeting with the minister was a disappointment, Dr Chow said.

“He didn’t even bother to talk to us and refused to accept the memorandum. All he said was, ‘No compromise, no compromise’ over and over again. We left feeling even more aggravated.”

Afterward, the group was granted a meeting with Tunku Abdul Rahman, who at the time, was a former prime minister.

“We had a pleasant meeting over tea one evening in his residence near Tugu Negara,” Dr Chow said. “After looking through the 20-page memorandum, all he said was, ‘Oh, all you doctors are asking for is more money. You just need more money.’ That was his simple way of analysing it.”

Despite the meeting, trainee doctors in University Hospital went on strike for nearly a week, but housemen in other general hospitals did not follow suit, Dr Chow said.

“The pressures then came on. The heads of hospitals were called in and we were all instructed to end the strike or they would discontinue our training. So, that was the end of the story. 

“We went back to work, completed our housemanship and were immediately posted out as medical officers scattered to different parts of the country, never to see one another again till decades later,” Dr Chow said.

Boycott Through Delayed Registration With MMC Led To Salary Hikes

Celebrating passing final MBBS Nite with the late Prof IS Puvan. “Thereafter, it was work, work, work… for one solid year.” Picture courtesy of Dr Steven KW Chow.

In the follow-up action, Dr Chow said the succeeding University Hospital cohort, upon completing their housemanship, delayed their registration with the MMC by about two weeks, as a response to MOH’s failure to address the ongoing issues.

“This delay in registration, if continued, would have created a serious gap in the ability of MOH to provide medical officers for its basic service. 

“I believe that, subsequent to this, a firm assurance to rectify the housemen’s salary was given by the authorities which resolved the dispute,” Dr Chow said.

“Subsequently, the houseman salary was raised to RM1,050 per month and first-year MOs were also proportionately increased. However, up to today, the failure to holistically address the issues of doctors working condition, salaries and career pathway remain to date. 

“The matter now is further complicated by the gross over-production of doctors which have created even more disruption in career pathway prospects for the new generation”.

Earlier this month, an old article from The Star circulated on social media, featuring a front-page headline from June 10, 1977, which read “Register With MMC Advice. Doctors Told: End Boycott”. 

The article detailed then-MMA (Malaysian Medical Association) president Prof A Sandoshan’s advice to 118 University of Malaya medical graduates, who were serving as housemen at government hospitals, to end their boycott and register with the MMC.

Life As A Houseman and Medical Officer In 1970s Malaysia

Medical school class reunion dinner after my return from the UK in 1983. Picture courtesy of Dr Milton Lum.

Dr Milton Lum, who had previously served as president of the FPMPAM and MMA, spoke with CodeBlue about his days as a house officer and medical officer.

Dr Lum recalled that during his time as a houseman, he received a monthly salary of RM650 with no overtime pay. 

When he was promoted to a medical officer a year later, his monthly salary increased to RM1,050, but there were still no overtime benefits. “After deductions from EPF (Employees’ Provident Fund) and all that, I have very little left,” Dr Lum said.

“Of course, at that time, we (housemen) were provided quarters. We didn’t have to pay for rent. For RM500, you can buy a lot of things but you cannot be liberal with your spending. At the time, bus fares were less than RM1 – you’re talking in terms of cents.

“And RM1, you can get a meal already. So, it was different then but as I said, my salary as a houseman was RM650. As a medical officer, a year later, it was RM1,050. When I sat for my Part 1 exam in Singapore, it cost me 2.5 months of my medical officer salary,” said Dr Lum, who is an obstetric and gynaecology specialist.

Dr Lum was in Edinburgh, the United Kingdom, during the 1977 strike.

Junior Doctors In 1982 Protested Using Work-To-Rule, Day-Of-Rest Tactics

University of Malaya’s clinical students’ hostel committee 1972 in front of University Hospital in Kuala Lumpur. Picture courtesy of Dr Milton Lum.

The 1970s was not the only time when government doctors expressed their dissent over pay issues. In the subsequent decade, junior doctors protested by working no more than the minimum required by their contract and by taking a day off.

To protest, junior doctors employed a work-to-rule tactic which involved doing only what is stipulated in their employment contract and work policies, with no additional effort, to pressure their employers to agree to a fair contract.

On the day-of-rest, doctors went on an emergency or medical leave to take a break from their overworked schedules, said Dr Shanmuganathan Ganesan, who is honorary secretary of FPMPAM.

Dr Shanmuganathan said key issues at the time involved poor salary, understaffing of doctors in hospitals, frustration with the service, and a lack of on-call compensation. 

“We would do 16 hours of on-call for free,” Dr Shanmuganthan told CodeBlue.

In addition to the lack of compensation, the shortage of doctors in hospitals meant that night calls were frequent, with doctors receiving a call every two to three days. “The call room conditions were poor,” he recalled. “We were even served patient food while on call.”

Dr Shanmuganathan said the issue of poor salaries only added to the existing problems. He explained that despite having studied for five to six years, government doctors were earning the same amount as graduates with three or four years of study in the arts or science fields.

“We, government doctors, finally got a meeting with the Health secretary-general, but he put our agenda at No 12 and finished the meeting at item 10, saying time was up.

“There were calls for strike, but we said no. Instead, we opted for work-to-rule. After inaction despite promises, we then launched a day-of-rest,” Dr Shanmuganathan said.

During the work-to-rule period, medical professionals strictly followed their work hours, took breaks “on the dot” at the appointed times, and ended their workday at 4.15pm. 

On the day-of-rest, essential services and emergency medical care continued uninterrupted, while in elective areas, doctors took emergency or medical leave to rest and recover from their heavy workload.

Dr Shanmuganathan said during the work-to-rule period, which took place on a Monday, outpatient departments experienced delays due to a slowdown in work, and doctors refused to sacrifice their breaks to see patients. However, the accident and emergency (A&E) department continued to operate as normal, and hospital wards were not affected.

“We did on Monday what we normally did on Sundays or public holidays.”

On the designated day-of-rest, a skeleton staff was left to manage the hospital wards. However, those who were on-call worked throughout the day.

“If they really meant it, the action could have been averted,” Dr Shanmuganathan said. “They were too busy doing their own thing under one very strict (Prime Minister) Mahathir Mohamad. The late Khalid Sahan, who took over as Health director-general (DG) from one rather laid back DG, was concerned and met us to call off the actions, but we stood firm.”

Dr Shanmuganathan said the tactics were effective and resulted in the government inviting doctors, including the chairperson of MMA Schomos, for a meeting at the Prime Minister’s Office. 

“Politicians must be hit hard if you want change.” 

Dr Shanmuganathan Ganesan, honorary secretary of the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM)

“In any action, avoid risks to patients at all costs. But you can be an inconvenience to the government; that will be good enough.” Due to their actions, Dr Shanmuganathan said the Special Branch were closely monitoring their activities. “We were anasir anti-kerajaan.”

CodeBlue uncovered a series of front-page articles on The Star, which chronicled the events that occurred between April 16, 1982, and May 13, 1982. 

The April 16 article revealed that doctors were involved in an “unofficial go-slow” at major hospitals, citing their dissatisfaction with their salaries and a lack of on-call allowances after 4pm. Some doctors were reportedly only taking home RM600 monthly after deductions.

The Star’s front page on April 19 featured the headline “Work-To-Rule In UH Today” in large, bold letters. The accompanying article detailed how the University Hospital (UH), now known as the University Malaya Medical Centre (UMMC), had become the third major hospital to be impacted by the work-to-rule action after Kuala Lumpur GH and Penang GH.

Media coverage continued on April 21, as more doctors from Klang, Ipoh, and Sarawak joined the work-to-strike movement. It’s worth noting that April 22 was the date of the 1982 general election in Malaysia.

Post-election coverage dominated headlines over the next few days. On April 27, The Star ran a prominent headline in block letters that read “Docs Call It Off”. It was reported that government doctors who had participated in the work-to-rest protest at general hospitals had stopped their action in a goodwill gesture on the premise that MMA will meet the MOH.

Changing Values, Covid-19 Sacrifices May Drive Junior Doctors Towards Strike

Dr Lum said the threat of industrial action or a potential strike among young doctors today would be “understandable”, citing changes in societal values and sacrifices made by junior doctors during the Covid-19 pandemic.

“Young doctors come from society, and you cannot blame them for having the values they have,” Dr Lum said. “Today, society is more consumer-oriented and money-oriented.”

Dr Lum added that it may not be enough to appeal to doctors’ altruistic values if they are not being treated in a manner befitting any profession.

“During Covid, junior doctors kept the country running, you know. They made a lot of sacrifices. Some even sacrificed their lives,” Dr Lum said.

“And now, the number of cases is so low, people, politicians seem to have forgotten that the health system during Covid was on the verge of collapse at one time, particularly in July to September 2021.

“Without the junior doctors, many people who had Covid-19 during that time might not be here today, and as a senior doctor, I am disappointed with the approach and attitude of some politicians and leaders in the MOH. They are there to solve problems.”

Is A Strike The Way To Go?

“The bottom line is any action by the doctors should not affect patient care,” Dr Lum said. “The public should not be made to suffer any consequences from their actions.”

There are various ways to achieve this, Dr Lum said. “They can learn from their colleagues in other health care settings where they have been able to balance the needs of patients and their own concerns.”

He suggested that one approach could be prioritising emergency cases and delaying elective procedures. He stressed the importance of keeping any work stoppage brief and ensuring that patient safety is never compromised. 

“That should be the bottom line.”

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