The premature cancellation of the Waktu Bekerja Berlainan (WBB) system was a lost opportunity to explore a third alternative, besides the on-call and shift systems, to transform the work schedule of health care professionals.
I concur with Health Minister Dzulkefly Ahmad when he lamented, in an interview with The Edge, “to not even try is already a failure in itself.”
A former MMA-SCHOMOS chairperson remarked, “We could have given it (WBB) a chance by piloting in a few hospitals.”
It was a project designed by doctors and for doctors to directly address the issue of burnout, to improve the quality of life, and sustain the work-life balance of health care workers.
It was targeted to be piloted in seven departments which met the inclusion criteria, namely:
- Paediatric Department, Tunku Azizah Hospital
- Medical Department, Slim River Hospital
- Obstetrics and Gynaecology Department, Putrajaya Hospital
- Orthopaedic Department, Raja Permaisuri Bainun Hospital
- Emergency and Trauma Department (Emergency Physicians only), Melaka Hospital and Sultanah Bahiyah Hospital
- Oral and Maxillofacial Surgery Department, Tengku Ampuan Rahimah Hospital.
It was most unfortunate and irresponsible that the WBB document was leaked prior to its approval by the health minister or the Public Services Department (PSD).
This has led to spurious, fake, and even slanderous interpretations of the content, intentm and context of the WBB system.
Leaders of the medical profession, netizens, and more recently, politicians, have issued statements which were tainted with misinformation, and suggested misleading recommendations based on a leaked document.
A novel project that has been in gestation for at least one year since January 2024, developed by clinicians in multiple medical and surgical disciplines, working on the ground (not in ivory towers or offices nor by Pegawai Tadbir Diplomatik officers as alleged), had hoped to shorten on-call hours, from the present 33 to 18 hours and the weekly working hours from the current 99 to 72 hours
The endpoint was to safeguard the physical, cognitive, emotional, and mental health of health care workers in order to deliver high-quality and safe health care services to the Malaysian public.
Notwithstanding, former Health director-general Dr Abu Bakar Suleiman’s stellar leadership of the newly formed WBB Task Force, would most certainly address the key concerns of health care workers, which primarily revolves around the potential loss of income due to changes in the disbursement of on-call allowances.
Here are some other issues which the Task Force may need to seriously consider:
1. Call for an increase in on-call allowances for all three systems as soon as possible. The Ministry of Finance must invest in the Health Resources for Health (HRH), or risk further attrition of health care workers to the private sector and/or overseas.
Our southern neighbour is already recruiting new house officers from our premier medical schools and offering attractive remuneration to our medical officers, specialists, nurses, and other health care workers.
It was Dr Abu Bakar who slammed the Ministry of Health (MOH) as “being stuck in the last century”. A MOH fit for the 21st century, is not achievable without sufficient nurses, midwives, house officers, medical officers, specialists, ambulance crews and all other vital staff.
In the United Kingdom, the Prime Minister and health secretary have pledged a whopping £25 billion to revive an ailing National Health Service, due to 14 years of Conservative Party neglect.
The increase requested by our doctors is a pittance compared to the 22.3 per cent rise in salaries over two years in a new pay deal for junior doctors in the UK secured from the new Labour government.
2. Similarly, it needs to address the exorbitant and exaggerated on-call claims and clamp down on unnecessary numbers of doctors doing on-call duties.
Honest clinicians on the ground are well aware of the lousy work ethics of these doctors misappropriating taxpayers’ money.
3. The Task Force must ensure that it is mandatory for post-call doctors to leave by 10am after the pass-over. This must be made as an exception to the PSD work rules and regulations.
4. The ideal doctor-to-population ratio as recommended by the World Health Organization (WHO) is 1:400. The ratio for Malaysia in 2023 stood at 1:406, as shown in the table below.
This suggests that we are not desperately short in terms of numbers. However, the acute on chronic issue of HRH maldistribution must be addressed immediately.
This can only be achieved with tangible and practical norms vis-à-vis workload in either a state, major or minor hospital. The ratio of medical officers and specialists to beds in general wards, high dependency wards, intensive care wards, day care wards, and clinics must be rationalised and take into account the number of doctors on leave.
Only then can one identify either the overpopulation, underpopulation, or appropriate representation of medical officers and specialists in the states, districts, hospitals, and departments.
5. If there is a real acute shortage of junior doctors, the Task Force must recommend to the Ministry of Education to increase the intake of undergraduates in medical schools.
6. To enhance loyalty and restore some semblance of stability to the HRH, the MOH must extend the contract periods to eight to ten years within a single contract, without having to renew it every two to three years after house officers have completed their terms.
Those who meet the KPIs should be offered permanent contracts, which come with EPF contributions, instead of pension schemes. in order to ease the government’s pension payments.
Dr Musa Mohd Nordin is a paediatrician.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
