In many government hospitals, medical officers (MOs) often face gruelling work schedules, particularly during on-call duties. An on-call shift typically starts at 8am and continues until 5pm the following day, amounting to a 33-hour work period.
At times, they could not even go back home on time due to unforeseen circumstances (patient collapse, last-minute jobs added, paperwork, etc).
This exhausting schedule poses significant challenges and concerns for the wellbeing of medical professionals and the quality of patient care.
Physical And Mental Exhaustion
The demanding nature of a 33-hour shift without adequate rest periods has led to severe physical and mental exhaustion among medical officers.
Prolonged working hours can result in sleep deprivation, which diminishes cognitive function, reaction time, and decision-making abilities.
The constant pressure to perform under such strenuous conditions exacerbates stress levels, leading to burnout, anxiety, and depression. The physical toll includes fatigue, headaches, and increased vulnerability to illnesses due to weakened immunity.
Low On-Call Allowance Rate
Despite the intense workload, the compensation for on-call duties remains strikingly low. In many regions, medical officers receive an on-call allowance of only RM200 per shift.
This amount is disproportionately low, considering the length of the shift and the high level of responsibility involved.
The inadequate remuneration fails to reflect the critical nature of their work and the personal sacrifices they make, including time away from family and personal health risks.
Negative Impact Of Extensive Working Hours
The adverse effects of extensive working hours extend beyond the individual to impact patient care and the health care system as a whole. Fatigued medical officers are more prone to making errors, which can compromise patient safety and outcomes.
The diminished quality of care due to exhaustion can lead to misdiagnoses, medication errors, and delayed treatments.
Additionally, chronic overwork contributes to higher turnover rates among medical staff, exacerbating staffing shortages and placing further strain on the health care system.
Why This Practice Is Still Allowed: A Condemnation
The continuation of extensive working hours for medical officers in government hospitals is a troubling issue that demands immediate and decisive action.
The practice of requiring medical officers to remain on call from 8am one day until 5pm the next, totaling 33 hours, is not only inhumane but also dangerously outdated.
The persistence of this practice reflects a severe disregard for the wellbeing of medical professionals and the safety of patients.
Staffing Shortages: A Negligent Excuse
Citing staffing shortages as a reason for maintaining such grueling schedules is a reflection of poor planning and mismanagement. Governments and health care administrations have a duty to ensure that hospitals are adequately staffed to meet patient needs without compromising the health of their workers.
Relying on overworked staff to fill gaps is not a sustainable or ethical solution. It is imperative that authorities prioritise the recruitment and retention of medical staff to alleviate these burdens.
Budget Constraints: A Misplaced Priority
The argument of budget constraints holds little weight when juxtaposed with the critical importance of health care. Governments allocate funds based on priorities, and the health sector should be at the top of this list.
The failure to allocate sufficient resources to hire additional staff or increase on-call allowances is a stark indication of misplaced priorities.
This financial negligence not only undermines the welfare of medical officers, but also jeopardises patient care.
Institutional Inertia: An Unacceptable Status Quo
Institutional inertia and resistance to change within the health care system are unacceptable excuses for perpetuating harmful work practices.
The reluctance to update policies and implement reforms to improve working conditions demonstrates a lack of commitment to progress and innovation.
Health care institutions must actively seek and embrace change, recognising that the health and efficiency of their workforce directly impact patient outcomes.
Cultural Factors: A Harmful Tradition
The cultural expectation that medical professionals must endure long hours as a rite of passage is an archaic and damaging notion. This mentality undermines efforts to promote work-life balance and mental health within the profession.
It is crucial to shift this cultural paradigm, valuing the health and wellbeing of medical officers as much as their dedication and hard work. The perpetuation of this harmful tradition is inexcusable and must be eradicated.
The Need For Post-On Call Off
One critical reform that must be implemented immediately is the provision of post-oncall off periods. After enduring a 33-hour shift, MOs need adequate time to rest and recover before returning to work.
Denying them this essential recovery period not only compromises their health but also the safety of patients. Fatigued doctors are at a higher risk of making errors, which can have serious, if not fatal, consequences for patient care.
Departments Without Proper Post-On Call Off
An informal survey was carried out via WhatsApp from May 21 to 24, 2024. Civil servants are not allowed to condemn the government openly; the medical officers involved would have been easily identified if this survey was done via Google Form.
This survey received nearly 50 respondents, all of them are medical officers from departments in Ministry of Health (MOH) hospitals. We identified certain departments in key hospitals as failing to provide proper post-oncall off periods, particularly evident in:
- Tuanku Ja’afar Seremban Hospital (all departments except anesthesiology)
- Tengku Ampuan Rahimah Klang Hospital (surgery, ophthalmology)
- Selayang Hospital (internal medicine and its subspecialties — endocrine, rheumatology, respiratory and neurology)
- Kuala Lumpur Hospital (paediatric surgery, surgical, ophthalmology, neurology – IKTAR, paediatric – HTA)
- Miri Hospital (paediatric and general surgery)
- Jitra Hospital (all departments)
- Raja Perempuan Zainab II Hospital (internal medicine)
The list goes on.
In these departments, medical officers are often required to continue working regular hours immediately following their on-call shifts. This practice is not only unethical but also counterproductive, as it leads to decreased performance and increased risk of errors.
One particularly interesting response from a medical officer in Selayang Hospital regarding a very toxic person by the name of Dr N, a consultant:
“It has been a dark era in this particular department of Selayang Hospital in the last couple of years or so, precisely to say, when the MOs, the army of [Department X], was taken charge of by this consultant – the one who shall not be named – let’s say N.
“If you think the workload is not enough to make MOs shudder, with the looming lack of HOs (house officers), this N has made sure their lives would never be better, by strictly limiting the applied leaves, and even throwing some racial slurs.
“Well, one or two may have escaped it, most probably being in her good books with flatteries and compliments received. Postcall MOs are told to buck up and their lack of rest does not mean anything to her.
“Oncalls are imposed without any mercy on having exams etc. It was never like that before her reign. Never toxic. It sounds like the MOs are stuck between the government, who is taking away their HOs, and N who just does not bother about anyone’s welfare or mental health.
“It seems that no one could bring her down because the higher-ranking people are backing her up. Wonderful news to hear.”
Well, we are sure there are similar toxic people in other hospitals as well. No wonder massive amounts of doctors are quitting.
Can’t the government see the vicious cycle? No HOs taken (with a lie to the public that we have an excess of doctors, but in fact, you don’t have money to hire them) leads to more workload on MOs, which leads to more MOs quitting, which leads to a greater workload.
Conclusion: A Call To Action
Allowing the practice of extensive working hours for medical officers to continue is a blatant failure on multiple levels.
It endangers the health and well-being of medical professionals, compromises patient safety, and highlights systemic issues within the health care system. Immediate action is required to address staffing shortages, reallocate budgets, overcome institutional inertia, and challenge harmful cultural norms.
Governments and healthcare leaders must prioritise the urgent reform of work schedules, ensuring that medical officers are treated with the respect and care they deserve.
Adequate staffing, fair compensation, and a supportive work environment are not luxuries but necessities. It is time to condemn the acceptance of such detrimental practices and work towards a health care system that values and protects its most vital asset: its people.
This letter was written by a group of five medical officers at MOH hospitals in Kedah, Kuala Lumpur, Kelantan, Negeri Sembilan, and Selangor.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
