Doctor Relocations Prioritise Klinik Kesihatan Over Hospitals, PKDs

The July 31 placements of over 4,000 permanent medical officers prioritised primary care facilities: 11% of doctors originally at hospitals and 76% of MOs previously based in health offices (PKD/ PKB) were transferred to klinik kesihatan or small clinics.

KUALA LUMPUR, August 3 – Primary care clinics gained from the nationwide relocations of more than 4,000 permanent medical officers in Malaysia, pulling doctors away from hospitals and health offices.

Among 4,088 medical officers involved in transfers between hospitals, clinics, and health offices under the Ministry of Health (MOH), 11 per cent and 76 per cent previously based in hospitals and health offices respectively were relocated to primary care facilities.

These clinics included public health clinics (klinik kesihatan), 1Malaysia clinics, UTC clinics, community clinics, polyclinics, and mobile clinics (klinik bergerak and klinik bot bergerak).

Government doctors in clinics increased 44 per cent from 707, who previously served in primary care facilities before relocations, to 1,021 given such placements this year.

The increase in medical officers for clinics came at the expense of hospitals and district or division health offices (PKD/ PKB).

Doctors for hospitals declined by 4 per cent from 3,118 medical officers prior to relocations to 2,980 for their new placements, whereas health offices suffered a 67 per cent loss from 263 to 87 medical officers, before and after transfers.

Public hospitals involved in the relocations of contract doctors for permanent positions – which occurred last July 31, the same date permanent appointments came into effect – spanned across district and tertiary hospitals in the country.

Although the majority of medical officers remained in the same setting (though not necessarily the same facility) for their new placements – 87 per cent for hospitals and 68 per cent for clinics – most doctors previously based in health offices (92 per cent) were transferred to other facilities: clinics (76 per cent) and hospitals (17 per cent).

These are the overall figures of the change in facility type for 4,088 medical officers nationwide whose previous facility and new placement were either hospitals, clinics, or health offices (the data excludes a small number of doctors whose old or new placements were other types of facilities):

(Note: The entire state of Melaka and Wilayah Persekutuan Kuala Lumpur and Putrajaya, with the exception of Kuala Lumpur Hospital and Tunku Azizah Hospital, were completely omitted from placements).

Number of medical officers previously in hospitals: 3,118
Hospital to hospital: 2,741 (88%)
Hospital to clinic: 341 (11%)
Hospital to health office: 36 (1%)

Number of medical officers previously in clinics: 707
Clinic to clinic: 481 (68%)
Clinic to hospital: 195 (28%)
Clinic to health office: 31 (4%)

Number of medical officers previously in health offices: 263
Health office to clinic: 199 (76%)
Health office to hospital: 44 (17%)
Health office to health office: 20 (8%)

(To view this live graphic below, tap or hover over the dark strip on the left to see the changes for each facility type).

CodeBlue’s analysis was derived from a list by the MOH’s Human Resource Division (BSM) of 4,149 medical officers who obtained placements for their permanent appointments for 2023, as sighted by CodeBlue. Placements may not be final, subject to last-minute changes by the MOH or medical officers not reporting for duty.

However, this is likely the first glimpse of data on health care professional distribution by the MOH that has never made such information public.

As BSM’s placement list does not include details – such as whether the medical officer is clinical or non-clinical based, or the number of total positions available in each facility that could indicate need – it’s not possible to know whether the MOH’s massive relocation exercise of more than 4,000 doctors actually corrects maldistribution or exacerbates staff shortages in certain facilities.

Although the government touts moving away from curative to preventive care, hospital-based doctors – particularly those from tertiary referral centres – have warned the MOH that the mass relocations would leave their department even more severely understaffed than it already is, putting patient safety at risk.

These include Melaka Hospital, Tuanku Ja’afar Seremban Hospital in Negeri Sembilan, Selayang Hospital’s obstetrics & gynaecology department, and Kuala Lumpur Hospital’s emergency department.

Doctors are not a homogenous lot, requiring years of training to be competent in specific fields. For example, a medical officer may have been working for years in neurosurgery at a hospital, but is relocated to a klinik kesihatan, a doctor wanting to be a family medicine specialist is posted to a hospital, or a doctor can’t continue to train in her desired specialty because she was transferred from a tertiary to district hospital.

Dr Sivapathasundaram Nadarajah, a retired head of department at Melaka Hospital, posted a comment recently on Health Minister Dr Zaliha Mustafa’s Facebook page that the relocation of over 4,000 medical officers was the “worst mess I have seen in years”, highlighting the impact on services in major hospitals across multiple states.

The mass departure of medical officers from district and division health offices, however, may be welcomed by environmental health officers and assistant environmental health officers, also known as health inspectors.

One previously wrote to CodeBlue last March, complaining about an excessive number of medical officers in district health offices, saying that many of these doctors are not public health specialists and that PKDs have become a “dumping area” for medical officers with competency issues at hospitals or health clinics.

Penang Hospital Retains Largest Number of Medical Officers

BSM data indicated that out of 3,136 hospital medical officers who obtained placements this year for permanent positions, 2,741 (87.4 per cent) were assigned to a hospital setting for their new placements. Among them, 1,066 (34 per cent) remained in the same hospital.

Penang Hospital retained the largest number of medical officers, with 69 of its doctors securing placements at the same facility.

Other hospitals with strong retention, included Sultanah Nur Zahirah Hospital (HSNZ) in Kuala Terengganu with 57 retained doctors, Tengku Ampuan Rahimah Hospital in Klang with 49, Queen Elizabeth Hospital (HQE) in Kota Kinabalu, Sabah, with 49, Raja Permaisuri Bainun Hospital in Ipoh, Perak, with 45, and Raja Perempuan Zainab II Hospital in Kota Bharu, Kelantan, with 45 retained medical officers.

Another 341 hospital doctors (10.9 per cent) were assigned to clinics, while 36 (1.1 per cent) were posted to health offices.

The remaining hospital doctors were allocated to other settings, including the Sarawak Heart Centre, Serdang Heart Centre, Institute of Respiratory Medicine (IPR), and an Orang Asli mobile unit (Pasukan Bergerak Orang Asli).

For clinic medical officers, totaling 711 doctors, 481 (67.7 per cent) remained in a primary care setting. Among those who remained, only 60 continued to serve in the same clinic.

The highest number of retention was in Klinik Kesihatan Bintulu in Sarawak with four.

Others were in Klinik Kesihatan Tatau (3), Klinik Kesihatan Sarikei (3), Klinik Kesihatan Sri Aman (2), Klinik Kesihatan Bunan Gega (2), and Klinik Kesihatan Limbang (2) in Sarawak, and Klinik Kesihatan Tawau (2) in Sabah.

Another 195 clinic doctors (27.4 per cent) moved to hospitals, while 31 doctors (4.4 per cent) found placements in health offices. Others were redeployed to IPR and the Serdang Heart Centre.

Health office medical officers accounted for 263 doctors, with the majority, 199 (75.7 per cent), being placed in primary care facilities. Meanwhile, 44 (16.7 per cent) were redeployed to hospitals, and 20 (7.6 per cent) stayed in a health office setting. None remained at the same health office.

At a special press conference last Saturday in Kota Bharu, Kelantan, on medical officers’ placements for permanent appointments, Dr Zaliha said the MOH approved 332, or 18 per cent, of 1,843 doctors’ appeals.

The considered appeals included those from medical officers seeking to pursue specialisation studies in their respective fields, individuals facing significant family challenges, and those with security-related concerns.

The MOH’s nationwide relocation exercise involved trained medical officers who have been working in the public health service for four to seven years. Many have undergone at least two years of specialised training, while others had plans to take the Medical Specialist Pre-entrance Examination (MedEx) and apply for the Hadiah Latihan Persekutuan (HLP) scholarship this year.

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