KUALA LUMPUR, Dec 7 — Doctors’ groups have given mixed reviews for the first-year performance of Prime Minister Anwar Ibrahim’s government in tackling medical officer issues and doctor shortages in the public health service.
Dr Muhammad Yassin, spokesman for contract doctors’ group Hartal Doktor Kontrak (HDK), gave the Madani government Grade B on its management of contract doctor issues under Health Minister Dr Zaliha Mustafa.
He expressed gratitude for the addition of more than 4,000 permanent positions for medical officers (MO) this year, but told the government to be more proactive in resolving issues instead of waiting for problems to go viral online before taking action.
“Hopefully, the slots can be further increased and improvements made as in backdating the promotion of grade and salary,” Dr Yassin told CodeBlue in a written response.
“As of now, when a contract MO becomes a permanent officer, the clock starts when the person signed the offer, and all his previous years as MO are not taken into account in grade promotions, allowances adjustment, and even pension years.
“Someone who becomes permanent can only be promoted to UD48 from UD44 after three years being permanent, despite being a contract MO for many years. (Previous batches had their years backdated and were able to be promoted much faster, but not for recent batches who got permanent posts).
“I would give a ‘B’ to the government, although they should be more proactive and not wait until things become viral or need for any threat of strike before taking action.”
Dr Yassin held that while contract doctors were happy to receive permanent positions this year, he took issue with the rocky relocation exercise last July 31 involving more than 4,000 doctors nationwide that ensued subsequent to their permanent appointments.
“We are grateful for the permanent post, but if there is no pay rise, no backdating and adjustment in scale, it’s not [a] very attractive offer, considering one can get double or even triple the salary outside of the Ministry of Health (MOH) with a much better work-life balance.
“[The] transfer is necessary since we are in civil service, and as the saying goes: ‘Service comes first’. But there should be ‘budi bicara’ (discretion). For example, if someone has medical conditions and needs to be nearer to health care facilities to treat his or her condition, what’s the point of sending the person deep into the pedalaman (interiors)?
“In April when there were 4,000 permanent slots given, many had to be transferred far away and no rayuan diterima (pleas received). Only after Hartal Doktor Kontrak made it viral about how inhumane this transfer process was, some adjustments were made by MOH. Do they only improve when things get viral?”
Dr Yassin held that the 20 per cent approved appeals were “not enough” and that HDK is still receiving messages from health care workers, who are asking for HDK’s help as they are required to transfer despite “having various medical conditions or despite being pregnant etc.”
CodeBlue reported last Tuesday a circular by the MOH’s Human Resource Division (BSM) that instructed more than 1,000 UD43 contract MOs in the latest cohort to tender their resignations, effective on December 18, when they report for duty in their new location as permanent appointments.
The Malaysian Medical Association (MMA) has questioned the rationale behind these forced resignations, saying that it would not only prevent these doctors from claiming reimbursement for work transfers, but also affect their salary grades and promotion as their years of service under contract would be discounted.
Milton: Grade F For Implementation Of July 31 Mass Doctor Relocations
Former Malaysian Medical Council (MMC) member Dr Milton Lum gave the Anwar administration Grade F for the manner in which the MOH carried out the mass relocations of more than 4,000 doctors for permanent positions last July 31.
Dr Lum noted that transfers have been the norm in the public sector for decades, but pointed out that junior doctors were “treated poorly” this year, as only a fraction of them received permanent posts while their transfers were “messed up”.
“There were multiple factors for the chaotic situation including poor coordination and communication between Putrajaya and the health care facilities in the community; ignorance of health care facilities’ needs and requests; and an insensitivity to the attitudes and needs of the junior doctors.
“The minister needs to be reminded of her pledge to address the problems of junior doctors when she took office,” said Dr Lum in a written response to CodeBlue.
In July, CodeBlue ran a series of stories detailing the impact of the massive relocation exercise on major public hospitals in Melaka and the Klang Valley — notably at Kuala Lumpur Hospital’s emergency department and Selayang Hospital’s obstetrics and gynaecology (O&G) department — where staff shortages could lead to potential resignations, longer wait times, suboptimal care, and possibly endangering patients’ lives.
CodeBlue also reported that some young doctors in their early 30s resorted to pawning gold and withdrawing from their Amanah Saham Bumiputera (ASB) accounts to fund their relocation from the Klang Valley to Sabah.
Dr Zaliha recently claimed in Parliament that the issues faced by medical officers during the July 31 relocation exercise were an “exaggeration”, as the MOH saw only one in 10 doctors reject their permanent offers, which, according to the health minister, was “not that high.”
Official data until last September showed that 426 medical officers (9.9 per cent out of 4,263 contract doctors offered permanent positions) declined their permanent offer. Among the 426 MOs who declined to take up permanent appointments, 35 opted to resign.
MMA president Dr Azizan Abdul Aziz said the digitalisation of the placement system used to relocate doctors for permanent positions, though commendable, needs to be further tested before it is rolled out, as it caused “immense frustration” with many doctors who encountered problems with the system.
“For such an important exercise, the government should have spent more time testing the system before the placements were announced to prevent such issues from arising. The MMA has requested that the government make the necessary improvements before the next placement exercise.
“The top-down approach being practised is not in line with the Madani government’s aspirations of being inclusive.”
HDK: Grade C For Medical Officers’ Low Pay, On-Call Rates
HDK graded the Anwar administration a “C” on poor wages for government doctors.
When commenting on the low pay and on-call rates that medical officers receive, HDK’s Dr Yassin said while he understood that it was ultimately up to the Public Service Department (JPA) to approve pay increments, he stressed the need for leaders to champion their cause.
“Having a stern and persuasive minister of health — who constantly pushes for this matter — would give some assurance and hope to the MOs,” he told CodeBlue.
“Unfortunately, we don’t get that impression, rather we feel we have spineless leaders who are not willing to voice out this issue in Parliament or in public.
“Yes, lower grade civil servants should be a priority, but our health sector is crumbling with the increasing exodus of MOs and specialists and increasing number of patients. In the end, who will be paying the price of subpar health services? It will be the poor who can’t afford to go to private hospitals.
“As the days go by, the [February] town hall seems more like a show just to calm down the HCWs (health care workers) who were having a beef with KKM and its leadership.”
MMA: Government ‘Totally Clueless’ On Health Workers’ Responsibilities
MMA president Dr Azizan Abdul Aziz expressed MMA’s “major disappointment” with the unity government’s rejection of the association’s proposal at Dr Zaliha’s town hall with doctors last February to increase medical officers’ weekend on-call allowance from RM9 to RM25 per hour.
Government doctors said that the RM9 hourly rate – based on the RM220 allowance for 24 hours’ work of active on-call duty – is lower than some retail staff who get RM10 per hour and cleaners who are paid RM20 per hour.
“It was apparent from the reply we received on our proposed increase of RM25 per hour, that the department attending to our request may have lacked the necessary information to facilitate an informed decision,” Dr Azizan told CodeBlue.
“Following the government’s decision, MMA has asked that the government re-evaluate our proposal and reconsider its decision. From the reply given to our proposal, it appears that the government is totally clueless with regard to the type of work done by health care workers and their responsibilities.
“Policymakers should take the trouble to see for themselves the nature of their (medical officers) work and understand the high expectations to deliver duty of care in a hostile work environment, compromising their own work-life balance to the detriment of their health and well-being.”
MMA Slams ‘Subjective’ Selection Criteria For Doctors’ Permanent Posts, No Comprehensive Plan To Tackle Health Worker Bullying
Dr Azizan also expressed disappointment at the Anwar government’s refusal to increase transparency of the selection criteria for permanent positions for doctors, as stated in the MOH’s response to MMA.
“In their response, they stated that ‘JPA has a Selection Criteria which is subjective, whereas MMA’s Selection Criteria is an objective one which allows our doctors to better prepare themselves prior to the selection process’.
“This goes against the principles of good governance and transparency preached by the Madani government.”
MMA also said the Anwar administration has not done enough to tackle workplace bullying against health care workers, despite having met Dr Zaliha and proposing numerous solutions.
“After we released the findings of our survey on Malaysian doctors which confirmed that bullying still exists in public health care, the health minister responded with a statement that the ministry will not tolerate bullying,” Dr Azizan said.
“However, to date, there has been no comprehensive plan by the ministry to effectively tackle the issue. The ministry has promoted its helpline to report bullying. However, no efforts have been made to address the toxic work culture which is largely to blame.
“MMA has lodged official complaints on cases of bullying but the MOH has not shown any urgency in taking action. This lack of urgency is demoralising for the complainant who is also the victim.”
A survey on Malaysian doctors conducted by the MMA Section Concerning House Officers Medical Officers and Specialists (Schomos) and its Junior Doctor Network (JDN) from last September 15 to October 1 found that 30 to 40 per cent of doctors across Malaysia reported having experienced some form of bullying.
In a small survey by CodeBlue involving 87 public health care workers, 89 per cent of respondents linked their mental health issues to work-related factors, with bullying being one of the several concerns expressed by respondents.
The MOH told MMA last October that 195 complaints were filed on MyHelp over the past year, from the channel’s launch on October 1, 2022, until October 16, 2023. Only eight of the 195 complaints are currently under investigation for “potential” bullying, as the remaining cases were not related to bullying.
