KUALA LUMPUR, March 21 — More than 1,100 medical officers did not report for duty for permanent positions last year, indicating that permanent appointments – historically the biggest pull factor – may no longer be effective to retain doctors in public service.
According to Ministry of Health (MOH) data, 78 of 3,215 medical officers (2.4 per cent) who were offered permanent appointments by the Public Services Commission (SPA) in 2022 did not report for duty at their placements.
In 2023, of 5,489 medical officers who were offered permanent positions, a whopping 1,118 did not report for duty at their placements, or 20.4 per cent.
This means that one in five doctors offered permanent positions last year did not show up for work on the first day at their placements.
The number of medical officers who did not report for duty at their permanent placements skyrocketed 14-fold, or 1,333 per cent, from 78 in 2022 to 1,118 in 2023.
This attrition on the first day of work also reflects a significant 18-point jump – within just one year – from about 2 per cent to 20 per cent of doctors offered permanent appointments.
Not reporting for duty in permanent placements can be used as a proxy for resignations, as offers of permanent appointments will be cancelled and the medical officer may remain in service at their current placement until the end of their contract, unless they officially quit earlier.
This data was revealed in Health Minister Dzulkefly Ahmad’s written Dewan Rakyat reply to Jerantut MP Khairil Nizam Khirudin last March 14, who requested figures on the number of contract doctors absorbed into permanent positions in the last two years.
“The Ministry of Health is committed to achieving the target of 1 doctor per 400 residents in 2025,” Dzulkefly added in his written parliamentary reply.
He cited the MOH’s 2023 Health Indicators that show a 1:412 ratio of doctors to the population in Malaysia in 2022, improving from 1:420 in 2021.
The high 20 per cent attrition rate among doctors offered permanent appointments in the public sector last year – occurring straight out of the gate on their first day of work in permanent placements – excludes other resignations that may occur later on among medical officers who did report for duty for permanent posts.
Previously, the MOH disclosed data in Parliament showing that the number of resignations among contract doctors increased by a whopping 1,131 per cent from 110 resignations in 2017 to 1,354 resignations in 2022. The number of resignations in 2022 among contract medical officers exceeded those in the two previous pandemic years combined at 1,279.
While it took five years to see a 12-fold increase in resignations among contract doctors, it took just one year to see a 14-fold rise in permanent medical officers not showing up for work for permanent appointments.
Contract doctors quitting in droves in 2022 may be attributed to burnout post-pandemic, but the attrition spike among their counterparts offered permanent positions is peculiar because only 2 per cent did not report for duty that year – before a jump to 20 per cent the following year.
So What Happened in 2023?
One massive change occurred last year, under Dr Zaliha Mustafa’s tenure as health minister in the Madani government led by Prime Minister Anwar Ibrahim that came into power in November 2022. Dzulkefly replaced Dr Zaliha, a freshman MP, as health minister about a year later in a Cabinet reshuffle last December. Dr Zaliha’s predecessor was Khairy Jamaluddin.
The MOH ran an unpopular mass relocation exercise of more than 4,000 medical officers nationwide for permanent positions in July last year. Sabah and Sarawak were the main beneficiaries of the exercise, making a net gain of over 1,000 doctors assigned to both states, while Kuala Lumpur and Putrajaya, Selangor, Melaka, and Negeri Sembilan lost more than 100 medical officers each.
However, the doctors offered permanent positions on July 31, 2023, were ineligible for transfer claims due to the disruption of their service from contract to permanent, forcing some to pawn gold and withdraw from their ASB accounts to fund their relocation from the Klang Valley to Sabah.
One UD43 medical officer – initially based at a public health clinic in Kuala Lumpur – previously wrote to CodeBlue about her dilemma in whether to accept her July 31 permanent appointment offer, as she was forced to choose Klinik Kesihatan Kapit in Sarawak for placement due to limited spots in the Klang Valley.
The MOH said in a statement last January that the number of resignations among permanent medical officers dropped from 915 in 2019 to 342 in 2022. Figures for last year were not provided.
Dzulkefly told the Dewan Rakyat last month that the MOH plans to offer 6,000 permanent appointments to medical officers this year. Given the MOH’s latest disclosure on the more than 1,100 doctors who didn’t turn up for duty for permanent placements in 2023, if the 20 per cent no-show rate continues or worsens this year, then whatever permanent appointments made will simply be to replace vacancies or resignations, not new positions per se to enlarge the workforce.
On the Ground, Doctors Quitting, Not Turning Up for Work, Not Even Informing They’ve Quit
But perhaps the huge numbers of no-shows at work by medical officers for permanent appointments last year was simply the culmination of years of frustration with low pay, poor working conditions, and unclear career pathways in the public health service – regardless of Covid-19 or the July 2023 relocation exercise.
When shown the 2022-2023 data on medical officers who didn’t report for duty for permanent positions, a medical doctor in the public service told CodeBlue that on the ground, they are seeing doctors quit, not turning up for work, or not even informing that they have resigned.
“Unfortunately, in today’s generation, what you dish out to them in character is the character you receive back from them,” said the doctor who himself is on the verge of quitting the MOH.
“We advocate to teach and treat humans with dignity, but we fail when it comes to the most important people – our future colleagues. Many do not even offer them the sense of dignity by treating them as we would our patients.”
The medical doctor observed that senior medical officers and specialists are now suffering because “the base of the pyramid has now shrunk”, causing the majority of work or procedures to fall to the next tier of staff.
CodeBlue reported last January that the number of house officer appointments declined by 47 per cent in just four years from 6,136 in 2019 to 3,271 in 2023, forcing the MOH to limit housemen placements in the first intake of this year to state hospitals, Kuala Lumpur Hospital (HKL), and university teaching hospitals, omitting smaller district hospitals.
“What everyone fails to realise is that the mode of progress is from a house officer to medical officer and to a specialist. We now cannot offer that progression to our young doctors. In time to come, we will not have enough specialists to hold the fort,” said the anonymous doctor.
He also said that the private sector being perceived as “greener pastures” may be a thing of the past, with increasing numbers of Malaysian doctors, including specialists, now leaving the country entirely in emigration.
“The problem is a different magnitude because by doctors leaving for the private sector, we still have an option of obtaining their services in the country, but if they leave the country – we have lost them for good.”
He reminded Pakatan Harapan (PH) of its previous pledges of health reform.
“However, we still face more of the same – punitive actions, demoralising statements and actions (parallel pathway), derogatory treatment (sexual harassment, poor career progress etc), and even worse, doctors now have to think about making ends meet rather than focus on patient care.”
