The recent Ministry of Health (MOH) announcement of the Waktu Bekerja Berlainan (WBB) shift system pilot project is a stark reminder of how disconnected policymakers are from the on-the-ground realities of health care.
Cloaked in promises of efficiency and welfare improvements, the plan reveals a fundamental misunderstanding of both the workforce and the patients it serves.
At its core, the shift system assumes that splitting an already overburdened workforce into smaller units will somehow improve outcomes. But in the absence of adequate manpower, such a plan is destined to collapse under the weight of its own inefficiency.
Imagine a department with 12 medical officers (MOs). In theory, the new system divides them into two shifts, leaving just six doctors per shift to manage 40 patients — a significant rise in the doctor-patient ratio.
Now, factor in clinic duties. Clinics typically run from 8am to 5pm and serve upwards of 100 patients daily. Under the shift system, only one or two MOs would be available to manage this workload, with each seeing as many as 50 patients.
This inevitably increases waiting times and compromises the quality of care. Meanwhile, the ward team is further depleted as doctors are pulled for clinic duty. And what about emergencies, operating theaters, referrals, or unexpected staff absences? The number simply doesn’t work.
If these logistical flaws weren’t glaring enough, the policy’s financial implications are even more troubling. MOs working night shifts on weekdays will no longer receive on-call allowances — a long-standing compensation for the physical and emotional toll of such work.
Even security guards earn a premium for night shifts, recognising the strain of working against the body’s natural rhythms. By redefining “on-call” to apply only to weekends and public holidays, the government has effectively cut wages for doctors, delivering a blow to their morale and livelihoods.
One might wonder how such a policy came to be. The rationale likely combined two objectives: improving staff welfare and balancing the budget.
Studies from developed nations show that shift systems can reduce physician fatigue while maintaining patient care. But these studies assume robust staffing levels, adequate infrastructure, and carefully planned implementation — conditions far removed from Malaysia’s overstretched health care system.
By importing the shift system wholesale, policymakers failed to consider local realities. Worse, the redefinition of out-of-hours work seems less like a misstep and more like a calculated cost-cutting measure. The result? A poorly conceived plan that doctors rightly view as an insult rather than an improvement.
Pilot projects, by definition, are meant to test feasibility. But any clinician could have predicted the flaws in this approach. Dividing an insufficient workforce and slashing pay is not innovation — it’s neglect.
Malaysia’s health care system is already grappling with systemic challenges: medical inflation, an aging population, an exodus of health care professionals, and a rise in non-communicable diseases.
Retaining talent should be the government’s top priority. Competitive pay and improved working conditions are essential, as is the exploration of sustainable health care financing models. At the same time, district hospitals and clinics desperately need infrastructure upgrades to meet growing demands.
Instead of addressing these pressing issues, the leadership has opted for a stopgap measure that only exacerbates the crisis. The shift system pilot is more than a policy failure; it’s a symbol of a government out of touch with the very people it serves.
If there’s one lesson to be learned, it’s this: the well-being of health care workers is inextricably tied to the quality of patient care. Ignoring one imperils the other. For the sake of Malaysia’s health, it’s time for policymakers to step out of their offices and into the wards to truly understand the consequences of their decisions.
For the sake of Malaysia’s health, it’s time for policymakers to step out of their offices and into the wards to truly understand the consequences of their decisions.
The author is a doctor at a public hospital in the Klang Valley. CodeBlue is giving the author anonymity as civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
