KUALA LUMPUR, Feb 20 – The Selangor state health department (JKNS) has stopped paying medical officers for extended hours (EH) on Sundays and public holidays in all three Klinik Kesihatan that provide the service on those days.
Since January, JKNS substituted the RM80 hourly allowance for doctors with replacement leave, or “claim hours”, for EH duty to see outpatient cases on Sundays and public holidays in Klinik Kesihatan Ampang, Klinik Kesihatan Taman Ehsan, and Klinik Kesihatan Bandar Botanik.
The three public health clinics serve the cluster hospitals of Ampang Hospital, Selayang Hospital, and Tengku Ampuan Rahimah Klang Hospital respectively.
KK Ampang, KK Taman Ehsan, and KK Bandar Botanik – as well as KK Mahmoodiah in Johor Baru, Johor; KK Kuala Lumpur; and KK Greentown in Ipoh, Perak – were six public health clinics identified by the Ministry of Health (MOH) to continue the EH service as part of their new operating hours from January 1, 2024, according to Health director-general Dr Muhammad Radzi Abu Hassan’s circular last December 30, as sighted by CodeBlue.
The circular formalising EH as the new operating hours for the six Klinik Kesihatans in Selangor, Kuala Lumpur, Perak, and Johor followed the end of the STAR pilot project on December 31, 2023, that aimed to reduce congestion at the emergency departments of public hospitals near those health clinics.
“Based on the evaluation of this project, MOH has decided that a change of operating hours for the six KKs is needed in the interest of the service,” said the Health DG.
For the five KKs in Selangor, Kuala Lumpur, and Perak, the new operating hours are 8am to 9.30pm from Monday to Friday, as well as 9am to 1pm on Saturday, Sunday, and public holidays. As Johor’s weekend is Friday to Saturday, KK Mahmoodiah’s new operating hours are from 8am to 9.30pm from Sunday to Thursday, as well as 9am to 1pm on Friday, Saturday, and public holidays.
It’s unclear if the suspension of payment for medical officers for EH work on Sundays and public holidays is only limited to the Selangor KKs, or if it also affects doctors performing the service at KK Kuala Lumpur, KK Mahmoodiah, and KK Greentown.
Medical officers assigned to EH duty at KK Ampang, KK Taman Ehsan, and KK Bandar Botanik are angry not just with the suspension of the RM80 hourly allowance for four hours’ work, totalling RM320, from 9am to 1pm on Sundays and public holidays.
Doctors also claimed that JKNS only informed them about the substitution of payment with replacement leave at the end of last month or early this month that took effect retrospectively in January – after they had already done the work.
A February 2 circular by JKNS deputy director (public health) Dr Wan Noraini Wan Mohamed Noor, as sighted by CodeBlue, said the department suggested replacement leave for EH work performed on Sundays and public holidays post-STAR pilot project at KK Ampang, KK Taman Ehsan, and KK Bandar Botanik, as an “interim approach pending a response from MOH’s headquarters”.
Six days later, Dr Wan Noraini said in a February 8 circular, as sighted by CodeBlue, that after receiving feedback from the district health offices (PKDs) of Klang, Hulu Langat, and Gombak that oversee KK Bandar Botanik, KK Ampang, and KK Taman Ehsan respectively, JKNS has decided to go ahead with the claim hours’ policy for EH work on Sundays and public holidays as an “interim approach”.
Replacement leave must be taken within six months from the date of approval by the head of department.
However, EH work from Monday to Friday from 5pm to 9.30pm – as well as both EH and running the neonatal jaundice (NNJ) clinic on Saturday from 9am to 1pm – at KK Bandar Botanik, KK Ampang, and KK Taman Ehsan are allocated claims or incentives like after-hours incentive or overtime payment, according to JKNS’ January 5 circular.
Other public health clinics in Selangor – such as KK Bandar Baru Bangi, KK Section 7 Shah Alam, KK Kelana Jaya, KK Dengkil, and KK Telok Datok – that exclusively run the NNJ clinic from 9am to 1pm on either Sundays and public holidays, or Saturdays, Sundays, and public holidays, provide medical officers an ETAP allowance of RM80 for four hours, together with mileage claims.
JKNS’ suspension of the RM80 hourly payment, in lieu of replacement leave, for EH work on Sundays and public holidays at KK Bandar Botanik, KK Ampang, and KK Taman Ehsan doesn’t just affect medical officers based in those three clinics, as PKDs also rope in doctors from other KKs within its jurisdiction for EH duty.
Medical Officers Forced To Pay Colleagues For EH Work
Dr Andie (pseudonym), who works at a KK in Selangor, complained that when they submitted their claims for EH work performed on weekdays, Saturday, and Sunday last month, the MOH excluded hours worked on Sundays and only paid them for weekdays and Saturday, despite a previous SISPAA complaint on the matter.
Medical officers were instead told to claim the Sunday hours for replacement leave at their respective KK. Dr Andie also said the Klang PKD has already released the March schedule by “randomly” picking medical officers for EH duty at KK Bandar Botanik.
For most of the STAR project last year, (paid) EH work at KK Bandar Botanik was voluntary, but it was made compulsory from last December, according to Dr Andie, with medical officers required to find replacements if they couldn’t work the assigned EH slots.
“Now, it is very difficult for us to find a replacement if we are unable to do the slots on Sunday or public holidays as it is not paid. Some medical officers who have really important work or family plans on the given dates had to pay other medical officers their own money for the slot to make sure it is replaced,” Dr Andie told CodeBlue on condition of anonymity, as civil servants are prohibited from speaking to the media.
Dr Andie pointed out that doctors see the same number of patients on Sundays and public holidays as other days in the EH service, saying “all the shifts will be packed with patients”.
“It is not fair at all to those medical officers who got their turn to do EH on public holidays and Sundays continuously, whereby they can’t claim money, but the MOs who got EH on weekdays or Saturdays can claim money.”
Dr Andie also said substituting payments with replacement leave (which will be burned if not used within six months) could only work if there were enough staff to work on the day that medical officers request for time off, same as cuti rehat.
“But why should we get paid in hours when on other days, we get paid money?” Dr Andie questioned.
“Back to the main issue of my initial complaint – why were we informed that we can claim hours only after we completed the job, when in fact we were promised to be paid the locum rate of RM80 per hour?
“It’s not fair for us. It’s like being cheated. You can’t change the terms after the job has been done.”
Leave Applications Frequently Rejected Due To Staff Shortage
Another medical officer at a public health clinic in Selangor said it is very difficult to get leave applications approved, due to insufficient manpower, pointing out that their leave applications have been rejected three times in the past three months.
“The patient load is crazy over weekends or public holidays. Today, I saw 31 patients in four hours, which is my normal workload on a normal working day,” Dr Madison (pseudonym) told CodeBlue recently on condition of anonymity, referring to an EH slot at KK Ampang (under the Hulu Langat PKD).
“Honestly, it was very overwhelming and I could only do subpar treatment as time was very limited for high patient load. On top of these 30 patients, my colleague had an emergency case to attend, in which we only finished work late. Didn’t even finish at 1pm.”
Dr Madison said two medical officers from their Klinik Kesihatan are quitting soon, while one is leaving for a permanent post.
“Workload is already exhausting and on top of that, to deal with these kinds of issues from the government is even more frustrating.”
Dr Madison also disagreed with RM80 payment, plus mileage, for four hours’ work in NNJ clinics on Sundays and public holidays, as locum work pays RM160 to RM200 for that amount of work.
With JKNS or the PKD telling doctors that they’re still awaiting approval from the MOH on compensation for EH work on Sundays and public holidays, Dr Madison asked why this wasn’t finalised before proceeding with the EH service this year.
“How could they proceed with a programme without a proposed budget? Or has it become a norm to just make us work because they know we’ll work when we are asked to?” Dr Madison questioned.
“To be honest, everyone wants a simple life. We work, government pays. Finish story. But no, the government decides to complicate things and make it hard for everyone.”
CodeBlue has asked MOH Putrajaya for a response. Given that it’s the start of the year, it’s unclear why – if budget constraints are indeed the problem – there would already be no money to run the EH service in three Selangor KKs on Sundays and public holidays.
The MOH also has yet to release a public report on the performance of the STAR pilot project, launched by then-Health Minister Dr Zaliha Mustafa, that ended in December 2023, after it was first launched at KK Bandar Botanik last March before expansion to other public health clinics nationwide.
The only report available is an early one from June that highlighted a 30.6 per cent reduction in outpatient visits to the Green Zone of Tengku Ampuan Rahimah Klang Hospital, as a result of the STAR project diverting patients to KK Bandar Botanik.
But the success of the project in cutting patient loads at the Green Zone of emergency departments in government hospitals may be in question, given that despite continuing the EH service in six KKs this year, MOH Putrajaya, in a January 12 circular, instructed the rotation of medical officers from other hospital departments (including non-clinical ones) to the Green Zone of public emergency departments nationwide due to “occasionally very long” waiting times.
