Health care workers are the backbone of any nation’s health care system, whose dedication and sacrifices are vital to saving lives.
However, the on-call system practised in Malaysia raises serious concerns about fairness, sustainability, and the long-term impact on health care workers. For decades, medical officers have worked under grueling conditions, yet little has changed to address the growing challenges they face.
It is time for meaningful reform.
The current on-call system requires medical officers to work from 8 am to 5pm the following day, a staggering 33-hour shift. These shifts demand unwavering focus and energy, as they involve managing patients’ lives under high-pressure situations.
While the number of on-call teams has remained static for years, the number of patients seeking treatment has skyrocketed. Additionally, litigation risks have risen, adding immense stress to health care workers already stretched thin.
Proponents of the system often argue that long hours build resilience. This outdated perspective fails to account for the increased workload and heightened stress in today’s health care environment. Resilience should not come at the cost of physical and mental well-being.
One of the most glaring issues is the disparity in pay for on-call work. Medical officers reportedly earn RM200 for 33 hours of service, equating to approximately RM6 per hour – less than what a fast-food worker earns.
Authorities defend this by stating that the RM200 covers work rendered from 5pm to 8am, with regular hours (8am to 5pm) covered under monthly salaries. Even with this justification, the effective hourly rate rises only to RM13 – still unacceptably low for such critical work.
Compensation during weekends and public holidays is equally troubling. The additional RM20 offered as a token for holiday work is insufficient, reducing the effective hourly rate to RM9.20, which is lower than weekday rates.
This discrepancy devalues the sacrifices health care workers make by working during these times, often at the expense of their families and mental well-being.
Moreover, even with the purported increment of RM55 to RM65 promised by the prime minister (which has yet to be implemented), it is concerning that the increase in mandatory working hours to 45 hours per week was rolled out without prior studies.
This lack of preparation further underscores systemic dysfunction within the Ministry of Health, which appears disconnected from the realities faced by health care workers on the ground.
Beyond monetary compensation, health care workers deserve fair recognition of their time. Weekend and public holiday on-call hours should be integrated into the mandatory 45-hour work week.
For every active on-call shift during these periods, workers should receive a day off during the current or subsequent weeks. This would provide much needed rest and help prevent burnout.
While some argue that the current shortage of doctors makes time compensation challenging, this should not be an excuse to perpetuate an unjust system. Addressing systemic inefficiencies and increasing workforce numbers should be prioritised to alleviate these challenges.
One of the biggest obstacles to reform is the disconnect between policymakers and frontline health care workers. Decisions about the on-call system and working conditions are often made by administrators with little or no clinical experience. This disconnect leads to policies that fail to reflect the realities on the ground.
Policymakers, including those with “Dr” titles, should periodically return to clinical settings to experience firsthand the challenges faced by health care workers. A transparent feedback mechanism that allows field workers to voice concerns without fear of retaliation is essential.
Threatening contract doctors with termination for raising grievances only fosters resentment and demoralises the workforce.
To address these pressing issues, the government must take decisive action. On-call pay should be reevaluated to ensure fair compensation that reflects the critical nature of the work, with weekend and public holiday rates significantly higher than weekday rates.
Time compensation should be introduced by recognising weekend and holiday on-call hours as part of the mandatory 45-hour work week and guaranteeing rest days to promote worker well-being.
Protecting contract doctors is vital; this includes establishing a transparent grievance mechanism and safeguarding health care workers from unfair treatment or termination. Closing the leadership gap by mandating clinical rotations for non-clinical administrators and implementing regular consultations with frontline workers can help bridge the disconnect between policymakers and health care workers.
Finally, any reforms should be preceded by thorough pilot studies with findings shared transparently to ensure accountability and inclusivity.
Malaysia’s health care workers deserve better. The current on-call system is not only unsustainable, but also unjust.
By addressing these issues head-on, we can create a health care system that values its workforce, ensuring better outcomes for both providers and patients. Reforming the on-call system is not just the right thing to do – it is essential for the future of our health care sector.
The author is a specialist doctor at a government hospital in Perak. CodeBlue is providing 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.
