We agree with this writer that the Ministry of Health (MOH) poorly handled the Waktu Bekerja Berlainan (WBB) or staggered working hours system.
As the quote goes, “marketing is not a battle of products; it’s a battle of perceptions.” As far as the WBB system is concerned, the MOH has lost the battle of perceptions.
Health Minister Dzulkefly Ahmad vehemently denied approving the WBB proposal, which was still in its early stages as part of ongoing efforts to improve the working conditions of health care professionals. It had neither been approved by the MOH nor submitted to the Public Services Department (JPA).
In a way, the ensuing events were part of crisis management, consequent upon the leak of the WBB document by a senior member of the MOH. This should be immediately investigated and the offender dealt with seriously.
Thus, we suspect that the January 17 townhall was rushed to explain and rationalise the WBB system, and to obtain feedback from doctors.
We think Dr Azizul Salehudin (Dr AS) has scripted one of the better and fairer summaries of the WBB town hall. The section below is our response to critical points of Dr AS’ Facebook post – parts of the WBB deemed to be not beneficial to health care professionals – to hopefully offer clarity.
Dr AS: Ada shift yang kerja 18 jam straight, tapi kalau weekdays tak boleh claim apa-apa.
You are not eligible to receive on-call claims for 18-hour shifts on weekdays because you get two days off as replacement. In the real world, you can’t have your cake and eat it too. If you get two days off, you can’t expect to be paid. We think it’s a reasonable trade-off.
Dr AS: Kalau kerja pre-weekend/public holiday, boleh claim separuh saja.
At least you can still claim half the on-call rate on weekends and public holidays, while also getting to enjoy two days off work. We think it is the MOH here who is being generous and that the Malaysian Medical Association (MMA)-Schomos et al are being unreasonable and thankless.
Dr AS: Unit yang takde privilege untuk buat WBB, rate elaun oncall masih sama, tak naik. Dah lah tak cukup orang, kerja lagi lama, oncall rate lebih rendah. Ini susah nak brain. Meaning, 80% akan dapat rate sama macam sekarang.
Yes! The MOH must increase on-call claims for those who are not able to do WBB. This is what should be the practice until we have enough to do the WBB system.
Dr AS: Walaupun WBB ini shift system, working hours kurang, tapi workload akan bertambah sebab less people working in 1 shift.
We don’t think this is an issue because only units with enough doctors will be able to do the WBB system. If you have a good working culture in your department, you will cover each other in good and in bad times.
But if you have lousy Heads of Departments (HODs) and specialists (who don’t cover the shortfall) and MOs who are either just lazy or have a bad attitude, then your department is a failure from the outset.
With the supposedly alleged surge into private practice as a show of protest, they will very soon learn first-hand the realities of work burden and remunerations. Either one’s lousy work ethics attracts negligible patients (you can have all your free time now, but with not much to show in your daily or monthly salary slip) or too many patients.
We doubt you’d be complaining then, with the monies pouring into your kitty. Such is human behaviour and its idiosyncrasies!
Dr AS: Elaun kritikal dikatakan sebagai insentif kepada doktor yang kerja luar office hour (shift/oncall), tapi yang kerja office hour dapat juga. Nampak tak konsisten.
We agree on this point. Non-clinical doctors should not be given critical allowances because they do not do any form of shift, on-call or out-of-office hours clinical duties.
Dr AS: Ada plan untuk serap semula non-clinical MO untuk cover kerja-kerja klinikal.
This is surely a good move – getting non-clinical MOs back to doing clinical work and making up for the paucity of doctors in clinical practice.
Dr AS: Kalau dapat post-call off tak boleh claim elaun oncall atau ganti kerja weekend/cuti umum.
This is sheer common sense and fairness as you get two days off, which equals two days’ salary. At the end of the day, it’s all about money.
MMA-Schomos et al complain incessantly about long working hours and the need for time off and work-life balance. WBB does exactly that – it restricts on-call hours to not more than 18 hours and allows rest or quality time for the ensuing 48 hours.
It’s a fair trade-off to enjoy two days off and not enjoy on-call claims on weekdays, but still enjoy half call claims on pre-weekend calls and the revised on-call claims on weekends or public holidays.
Those joining private practice will soon learn that if you take days off, you will get zero salary, okay? You may employ a locum to continue your business but your clients come to your clinic to see you, not your locum. So you may have little business which would probably be offset to pay your locum.
Dr AS: Terlalu tertakluk kepada pekeliling JPA. Tak wajar pukul rata sektor kesihatan dengan skim lain. Norma & intensiti kerja tak sama. JPA kena bagi kelonggaran, sebab waktu bekerja 45-72 jam itu untuk mereka yang kerja office hour ikut circadian rhythm. Contoh kelonggaran, macam guru. Mereka tidak tertakluk kepada tempoh bekerja 45 jam seminggu.
We are afraid that this can’t be avoided, not until the MOH is separated from JPA. Let’s be real. All the issues facing MOH vis-à-vis human resource/salaries/holidays etc is because you are all tied to JPA and the Ministry of Finance (MOF).
Maybe it is pertinent to ask your previous health ministers or directors-general, who among them had the gall to challenge the power of JPA-MOF? Until and unless this umbilical cord is stripped, you are not special; you are just like any other civil servant.
Dzulkefly submitted Jusa C requests for all the chronic UD56 (most likely to leave service) multiple times to the MOF, which were flatly rejected.
It’s not fair to train your guns solely on the health minister and the MOH. MMA-Schomos et al should instead target their attention at the Minister of Finance.
The increment of on-call claims is also under the purview of the MOF. MMA-Schomos et al should go question the MOF, as to why your on-call increments were repeatedly refused.
My co-author is a senior consultant who has dedicated his adult life to the betterment of the MOH. His medical officer (MO) stint in rural areas did not deter his spirit. Instead, he learnt his best medicine there.
In his earlier stewardship of MMA-Schomos, he fought diligently for the rights, welfare, and wellbeing of junior doctors, in arms against the director-general, deputies director-general, and state health directors. Yet not a murmur on social media until this article as an anonymous writer.
With the WBB model, for example, an MO does 4 weekdays and 2 weekend calls and get 8 days off. He gets another 6 days off weekends, since he is not on call. In essence, he only works for 30-8-6 = 16 days per month. Isn’t that a solid so-called work-life balance if everyone gets to do WBB?
So MMA-Schomos et al need to be more reasonable and principle-centric and not hype and harp on the ringgit sign. MMA-Schomos et al must not be “penny wise pound foolish!”
Nevertheless, MMA-Schomos must continue to advocate better things for doctors in the MOH. However, this must never be at the expense of compromising patient care.
We have the responsibility to “give back” to the thousands of our previous patients who generously taught us the art of medicine during our times in medical school, who made us better house officers (HOs), MOs, specialists, and then subspecialists.
We owe the “Dr” in front of our names to these generous souls. Please don’t lose focus in service while fighting for improvement for health care professionals. If you must make a choice to resign and join the competitive and long hours of working in the private sector, that is fine. That is your right and hopefully a good and informed choice.
Private doctors work virtually 30 days a month, including Saturdays and Sundays. My patients actually wonder and have repeatedly asked me, “Eh! Dr kerja hari Ahad ke?”
Whilst you enjoy your precious Saturday rest, it’s our busiest day of the week. Mind you, try to function as HO-MO-Registrar-Specialist-Subspecialist-Consultant all in one in your daily duties as a consultant in private medical practice.
At the end of the day it’s all about the ringgit. It’s really tough with JPA-MOF calling the final shot. And it’s going to take a long time and tough duel to be independent as a Suruhanjaya Perkhidmatan Kesihatan.
Our final counsel is that if you cannot handle the money issue, then go make your money elsewhere and be a master of your own destiny.
It is after all the prophetic call for self-employment, self-financing, and self-sustainability. But please don’t carry on in the MOH service with a bad attitude and lousy work culture. It shows!
Dr Musa Mohd Nordin is a paediatrician at KPJ Damansara Specialist Hospital, while his co-author is a senior consultant in the MOH. CodeBlue is giving the latter anonymity because 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.
