Amid Halved Housemen Numbers, District Hospitals Omitted From First 2024 Placement Intake

As the number of house officer appointments dropped by nearly 50% from 6,136 in 2019 to 3,271 in 2023, MOH is limiting placements of the first 2024 housemen intake to state GHs, HKL, and university teaching hospitals, excluding smaller district hospitals.

KUALA LUMPUR, Jan 30 – The Ministry of Health (MOH) has opted to exclude district hospitals from the first intake of housemen placements for this year, due to a sharp decline in house officer appointments.

With housemen appointments falling by almost 50 per cent from 6,136 in 2019 to 3,271 in 2023, the ministry has decided to allocate placements of trainee doctors exclusively to state general hospitals (GHs), Kuala Lumpur Hospital (HKL), and university teaching hospitals — all tertiary centres.

In a circular dated January 24, sighted by CodeBlue, Health director-general Dr Muhammad Radzi Abu Hassan said the appointment of house officers (HO) has shown a declining trend since the onset of the Covid-19 pandemic.

In 2019, a total of 6,136 house officers were appointed, followed by 5,113 HO appointments in 2020. 

However, after the Covid-19 pandemic, only 3,245 housemen were appointed in 2022, rising by a mere 0.8 per cent to 3,271 appointed house officers in 2023. 

The trend indicates a whopping 47 per cent decrease in housemen appointments within just four years from 2019 to 2023, resulting in insufficient distribution of house officers across 49 graduate training hospitals (HLS) in the country, said the Health DG.

His circular did not provide the number of HO appointments in 2021.

“Given that state hospitals and university teaching hospitals have a more optimal number of patients and case variety (casemix) for house officers to undergo graduate training, the ministry has decided that housemen placements need to be concentrated in selected university teaching hospitals as a temporary measure,” Dr Radzi said.

“Therefore, the offer of training slots to place house officers starting from the appointment of the first cohort of UD41 house officers in 2024 will only be opened at state hospitals, HKL, and university teaching hospitals in the e-Housemen system.

“The distribution of slots for each houseman will take into account the number of candidates to be appointed and the current percentage of housemen training slot occupancy from time to time. 

“If the training slot occupancy in these hospitals has been filled, training slots for HO placement in other HLS will be opened gradually based on assessment and review by MOH in the subsequent appointment sessions,” Dr Radzi added.

The circular stressed that the appointment of house officers is for undergoing graduate training, not for providing health care services or to serve as an “extra pair of hands” for medical officers or specialist doctors.

“Therefore, the relative shortage of house officers in HLS should not be unreasonably raised as an issue because health care services need to be carried out by medical officers or specialist doctors even in the absence of HOs. 

“Measures to optimise existing human resources, including medical officers and specialist doctors at the hospital level, can be implemented to address the potential decrease in housemen appointments,” the circular read.

CodeBlue reported on January 15 that a shortage of house officers has forced the Department of Medicine at UMMC to consider adopting a “Zero HO Protocol”.

The “Zero HO Protocol”, termed by UMMC’s Department of Medicine then-acting head, urges staff at the largest department of the Klang Valley hospital to operate “under the assumption that we no longer have the services of house officers”.

To address the manpower shortage, UMMC’s Department of Medicine suggested a separate process for recruiting and appointing house officers to decrease reliance on MOH for manpower of junior doctors. MOH, in turn, said it supports an independent housemen recruitment process for university hospitals free from MOH control.

Health Minister Dzulkefly Ahmad previously told CodeBlue that housemen placement priority is for HLS in the MOH as distributing HOs thinly across many facilities renders it meaningless.

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