Over the past week, there was significant uproar within the medical fraternity. A January 10 circular introducing a pilot shift system by Ministry of Health (MOH) medical development division director Dr Mohd Azman Yacob was widely shared on WhatsApp.
The new system, also known as the Waktu Bekerja Berlainan (WBB) system, limits doctors and dentists in the public health service to 18 consecutive work hours, which is a reduction from the current 24 to 33 hours of continuous work during on-call duties.
However, this system does not provide allowances for working at night after 5pm on weekdays, categorising such hours as part of the standard 45-hour workweek. Graveyard shifts, under this system, are therefore treated as regular working hours.
The WBB system, set to pilot on February 1 in seven government hospitals, essentially designates only weekend or public holiday work as eligible for on-call duty allowances. Even then, certain shifts qualify only for the passive call allowance rather than the active call rate.
Medical and dental officers, as well as specialists, will not receive the full Elaun Tugas Atas Panggilan (ETAP) allowance for 18-hour weekday shifts deemed part of the standard workweek.
For shifts on Fridays or pre-weekends (3pm to 9am), officers can claim a reduced ETAP allowance (passive call) only for the second half of their shift (midnight to 9am). The first nine hours (3pm to midnight) are not additionally compensated, as they count toward the base 45-hour workweek.
The higher on-call allowances of RM275 per shift for medical officers and RM315 per shift for specialists apply only to WBB active calls on weekends or public holidays, requiring 15 or more consecutive hours of work outside regular hours.
At this moment, this increase in allowances is limited to departments or units implementing the WBB system. If this policy were implemented, it is expected that the take-home pay of many medical and dental officers and specialists would decrease.
The core problem lies in the disconnect between this circular and prior government promises. In Prime Minister Anwar Ibrahim’s Budget 2025 speech, it was announced that medical and dental officers would see an increase in on-call allowance rates by RM55 to RM65, depending on the service and department, under a targeted work system.
While not a substantial increase, the announcement was well-received, given that it was supposed to be the first increment in 13 years.
This circular, however, directly contradicts that statement, leading to widespread frustration within the medical fraternity.
Most importantly, this frustration highlights a crucial flaw in the process: effective policymaking must involve significant stakeholder engagement from the get-go.
The WBB system assumes adequate manpower to carry out the system, but has instead set off alarm bells among doctors’ groups, including the Malaysian Medical Association. This adjustment exacerbates existing manpower shortages, jeopardises the workload balance, and overlooks the increasing complexity of patient care, leaving frontline health care workers overwhelmed.
The first rule of effective policymaking is the need to involve significant stakeholder engagement. Were clinical doctors, especially junior medical officers who bear the brunt of active calls, consulted before this policy was drafted? The lack of such engagement is evident.
Following the backlash, MOH hastily organised a town hall session last Friday (January 17). During this session, the decision to pilot the WBB system was confirmed, with Health Minister Dzulkefly Ahmad lauding it as a novel game-changer.
However, with the pilot implementation already seemingly set, the town hall session appeared more as a formality than a genuine attempt to gather feedback. Many attendees felt unheard, and this perfunctory approach, which amounts to a fait accompli, undermines the credibility of stakeholder engagement efforts.
Doctors perceive this contradictory policy as a disregard for their welfare and a disrespect for their efforts, despite their hard work to uphold patient care amidst challenging circumstances. The proposed changes reflect a lack of understanding and sincerity from the management level, leaving clinicians disillusioned.
While we await the Ministry’s decision on its next steps after its management attended a three-day retreat over the weekend, the expectation of the medical fraternity is that the Ministry should halt the implementation of the WBB system and revisit the policymaking process.
Extensive consultations with clinicians, especially those on the frontlines, must be prioritised. Their insights should carry the most weight in shaping policies that directly impact their work conditions.
MOH deputy secretary-general (finance) Norazman Ayob recently emphasised the importance of field engagement when he said, “We can no longer be said to merely sit in our ivory tower, in our headquarters, while we’re ignorant of what’s happening on the field. We talk about norms and outfits, but the reality is that what’s happening on the field isn’t the same as our plans.”
This advice is particularly relevant in this instance. Policymakers should experience firsthand the realities of on-call shifts at the busiest hospitals, including dealing with manpower shortages, overcrowded wards, and the current on-call allowance structure.
Such immersion could provide valuable context and empathy for decision-making.
Furthermore, when they go down the field to experience the typical on-call day, MOH officials should invite officers from the Public Service Department (which manages human resources in government health care facilities) and the Ministry of Finance (which controls the nation’s budget) along, so that they, too, understand what is really happening on the field, instead of the usual practice of planning while sitting in ivory towers.
To create better on-call policies, MOH must embrace a more inclusive and transparent policy making process. Genuine stakeholder engagement, grounded in the realities of health care work, is essential.
Only then can we hope to craft policies that improve working conditions for our medical professionals and, ultimately, the quality of care for all Malaysians.
If not, the one at the losing end is simply the rakyat.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
