The medical profession has been facing challenges after challenges in recent decades that ironically on May Day, it may be the time to cry out the same words “May Day! May Day!”, before the flight, “crew, cargo and company” MP 1525 crashes or disappears into nowhere, like the fateful MH 370, the numbers signifying yesterday, the first of May, 2025.
It is obvious that the medical profession is closely, if not directly linked to the Ministry of Health (MOH), Malaysia, the body that governs and manages or looks after the health of the nation.
It begins with the study of medicine, a long five to six years before the young enthusiastic graduate emerges as a doctor at a hefty cost of anything from half a million ringgit to double that and more if overseas, as entry into a national university is very competitive.
On exit with an MBBS, once-upon-a-time a prestigious degree, and much wanted and hunted on graduation, the young doctor now faces an uphill task, even to get a stable job.
In recent years, many doctors were made to wait over a year for a job, hence forcing them either to work various temporary jobs e.g. driving Grab, or to leave the country. This in part explains how a “glut” within years became a “shortage”!
What sort of job? A contract for four or five years, after which they may be in a limbo, with no rock to stand on.
Once in the system, the “nightmare” begins for some, with trying work hours, bullying, difficult bosses, leading to high drop out rates and suicide. It is unthinkable that the young doctor who had sweated it out for five years, at the expense of a fortune from parents and guardians, would now want to quit, if not terminate his or her life.
For those who cannot take it and decide to quit, the door is shut on them, as an appeal to return often results in an uphill task that can take a few years.
The next nightmare is postings and training. The trials and challenges to get the right training in the right centre of choice is still unsatisfactory, whereas in countries like the United Kingdom, there is coordination and understandable schedules and pathways.
While this was, to some extent, helped if not partly solved by the Ministry with regards to the parallel pathway, it is still far from healthy. Many then quit and leave to neighbouring or other nations to start a fresh hopeful career, with better income and a clearer career path.
All the above were relatively a smooth and enjoyable path and ride in career development for many years until recent times.
Once a specialist, issues of gazettement, promotion and income become an issue for the “poor” doctor, compared to his or her counterparts in other professions, who now have incomes well above the government doctor, who struggles to pay bills.
Many now see a bleak future in the government or public sector, as promotion prospects dim or are slim for various reasons in recent years, resulting in an exodus to the private sector, a recently booming industry.
They think that they are entering greener pastures with beds of roses, but are instead struck with new rules, regulations, and a much less doctor-friendly environment or situations. Whether as a general or family practitioner or as a specialist, there are serious and tough challenges now.
The number one unfair and suffocating law is the Private Healthcare Facilities and Services Act 1998 (Act 586), which is totally archaic, ancient and agonising to the point the fees have been capped for over 30 years for the General Practitioner, and 12 years for the Specialist.
It is only through procedures and medications and treatment processes that the private doctor can survive, as the capping of fees have made their professional services much lower in all aspects with their other professional colleagues, and even lower than the hairdresser, masseuse, plumber or electrician.
As major funding comes from private health care insurance bodies, many big players and third-party administrators now unilaterally introduce and implement new rules and regulations on admissions, excluding many potentially life-threatening conditions to day care, insisting on only one visit for certain hospital admissions, rejections and delay in admissions.
They make the whole process of treatment of sick patients a new nightmare for the consultant and patients. The specialist often has to answer query after query on why the patient needs admission, even when the illness requires urgent treatment.
Because of rising costs of health insurance premiums, with attention now by the government and Parliament, the MOH appears intent on introducing further control measures e.g. DRG (diagnosis-related groups) to fix and limit the cost of care based on diagnosis, further capping specialists, whose fees have been capped for 12 years.
Yet another blow has come, with the introduction of drug price display enforcement under a different government agency, putting doctors under a trade.
This exposes the medical profession to potentially ruthless inspectors, like market stalls. It is quite clear that this rule or law will make dispensing of medication a “mental torture” for the doctor, for just a few ringgit. This is very unfair when GPs’ consultation fees remain capped at a low RM35.
At the same time, over the past decades, patient expectations and medical litigation have skyrocketed, resulting in astronomical premiums that run into six figures or more for some disciplines, raising the cost of practice exponentially. Doctors remain helpless in this area, unless new laws bring in mediation, arbitration, and capping of medicolegal claims.
The respect and appreciation for the care and treatment of the doctor, whether in government or private, whether family practitioner or specialists, has declined in recent years. This makes medicine a not so pleasant or satisfying career, looking after increasingly demanding and ungrateful patients.
As doctors work very hard, and hence earn a steady and higher, albeit shrinking income, all eyes are focused on the doctor as to the lifestyle, cars and houses they live in. The biggest eyes are the tax department, where recent harsh tax rulings turn the medical profession into a working horse for the Tax Department’s annual budget!
When GST (goods and services tax) came in, the private doctor or specialist was considered an independent contractor, and hence had to be taxed 6 per cent. But the Customs Department relented and shifted the bill to the patient or insurance company. Next time around, who knows what the decision will be?
Finally, except for the independent family practitioner or private specialist clinic doctor, other doctors now face challenges with management and employers, with terms and conditions of service getting tougher and more one-sided. Before long, the private specialist will be salaried. By then, Labour Day will truly become a significant day for us.
Yes, it is no longer green pastures and a bed of roses for doctors, young and old, government or private, family practitioner or specialist.
Why? Perhaps, the world has become harsh, tough, shrewd, severe and only the fittest can survive, while the good doctor continues to be kind, gentle, caring, loving, helpful, diligent, selfless, dedicated, working round the clock, dedicated with their lives, blood, sweat and tears for their patients.
What then is the future for the doctor in the next few decades? Well, since AI (artificial intelligence) is a big and powerful incoming or already arrived thing, the only hope is to produce more and more futuristic doctors, what I will call RDs, or “Robotic Doctors”!
RDs will imminently replace DRs, and this article will be totally irrelevant!
Dr Sng Kim Hock is writing in an independent capacity.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
