KUALA LUMPUR, July 15 — Two senior medical officers believe overworked health care professionals in public service likely do not want to toil after hours in Rakan KKM for higher pay.
A doctor at a government hospital in Selangor pointed out that some medical officers (MOs) do five to six on-calls a month. Each call is about 35 hours. Assuming that doctors perform two on-calls a week (one weekday and one weekend), that amounts to a whopping 97 to 100 hours of work a week.
“Now if you add Rakan KKM to this, which is similar to the full-paying patient (FPP) model, the procedure has to be done outside of our elective list, which will definitely be after 5pm. Who would want to work extra hours in addition to the crappy hours we are putting in?” the senior MO, who requested anonymity, told CodeBlue.
MOH officials have claimed that Rakan KKM – which aims to provide expedited elective procedures in select government hospitals for paying patients – will only operate in the evening or on weekends.
Health Minister Dzulkefly Ahmad’s special functions officer Ahmad Fadhli Umar Aminolhuda claimed on X that the public queue might even be shorter because Rakan KKM will utilise health care workers’ “unused time”, like their off days and the “middle of the night”, while compensating them for it.
“With the hours I am putting in weekly, no amount of money from Rakan KKM is gonna push me into putting in more hours that are after office hours or weekends,” said the senior MO in response.
“These guys in KKM or Rakan KKM are thinking that if they offer more money to add on to the already mental hours we are spending at work, it will keep specialists from leaving. The current generation of health care workers value time, I feel. That is why people resign without hesitation.”
Instead, the doctor called for a higher base pay or for on-call allowance to be raised from RM9.16 to RM30 to RM40 per hour – for existing workloads in public service, not additional (paid) work in Rakan KKM.
“No amount of money is gonna buy time, which is already limited in a health care worker’s life,” said the doctor. “People would want to rest on their off days. How many rest days do we even have to begin with?
“There is no such thing as ‘unused time’ in KKM. Every minute is stretched for the sake of serving the poor. We don’t have enough time to even serve the rakyat, more so finding time for Rakan KKM.”
The MOH plans to launch Rakan KKM, operated by Rakan KKM Sdn Bhd, in the third quarter of this year at Cyberjaya Hospital, Putrajaya Hospital, Sultan Idris Shah Serdang Hospital, and the National Cancer Institute (IKN).
Dzulkefly recently acknowledged a shortage of medical officers that prevents the implementation of the Waktu Bekerja Berlainan (WBB) shift system in the MOH, hence why doctors’ on-call allowance can’t be raised.
Anaesthesiology Trainee: Can’t Replicate University Hospital Model In MOH
An anaesthesiology trainee pursuing his Master’s said he works about 60 to 69 hours a week, if this includes one weekday on-call. Working hours will be higher if MOs do five to six on-calls a month. Usually, doctors get two free weekends in a month.
“I have struggled enough. Perhaps I will give Rakan KKM a pass if something comes up,” the senior MO, who requested anonymity, told CodeBlue.
When asked how much money Rakan KKM would have to offer him to work on his rest days, he said health care staff other than doctors must be similarly remunerated. Currently, the government only pays doctors for Saturday locum in public health care facilities at RM80 per hour for medical officers and RM200 per hour for specialists. Staff nurses and other health care workers do not receive payment.
The anaesthesiology trainee told Rakan KKM to offer health care workers the same rates as the private sector. “That would be fair. The more complex, the more procedures to be done, the higher the payment.”
He also said university hospitals, which have been operating private specialist centres for years, had a superior system to the MOH’s earlier FPP model due to better doctor to patient ratios in teaching hospitals.
“Universities can do the FPP or private job while treating the public a fair amount. Of course, this cannot be replicated in public hospitals due to a vast patient to physician load,” said the senior MO.
Even then, university hospitals still face unequal work distribution between senior and junior specialists. “Consultants tend to do private cases, while juniors have to clear the public ones (which are mostly high-risk cases).”
Hartal Hopes Rakan KKM Can Curb Medical Brain Drain
Hartal Doktor Kontrak (HDK) acknowledged that while junior medical officers, especially those in high-pressure departments like emergency medicine, are already working excessive hours with frequent on-calls, some specialists and consultants may have “comparatively lighter schedules.”
“These individuals could potentially contribute to Rakan KKM by seeing patients outside official hours,” HDK spokesman Dr Muhammad Yassin told CodeBlue.
“Departments such as orthopaedics, general surgery, and obstetrics & gynaecology may use this platform to deliver specialist services and ease A&E congestion.
“Many specialists already do locum work after hours or on weekends in the private sector—Rakan KKM may provide a public-sector alternative for them to do the same work within the government system.”
Since 2018, the government allowed specialist doctors to work four days a week and to use the additional day off for locum work in the private sector, in a bid to reduce attrition rates.
The difference between locum in the conventional private sector and Rakan KKM is that for the former, the specialist has a fully staffed team waiting for her in the private hospital. But in Rakan KKM, the specialist’s teammates are expected to come from the public sector.
HDK said a fair and competitive remuneration package from Rakan KKM could incentivise specialists to remain in public service and contribute to the training of junior doctors.
“Importantly, compensation should not be limited to doctors alone—it must extend to all health care personnel involved in supporting Rakan KKM services, including nurses, medical assistants, and administrative staff.”
The contract doctors’ group acknowledged concerns that senior doctors could end up monopolising Rakan KKM, like the FPP model.
“The tendency for senior consultants to take all high-paying or complex cases until they reach their quota, only then passing leftovers to junior consultants, should not be allowed here,” said Dr Muhammad Yassin.
“Furthermore, if senior consultants rely on trainees, junior doctors, or even house officers to perform tasks like blood-taking or tracing investigations, these juniors must be appropriately compensated. The integrity and fairness of the system must be safeguarded from the start.”
When CodeBlue asked if it would be preferable for the Public Service Department (JPA) to halve the 45-hour work week for doctors participating in Rakan KKM or for the MOH to reduce or eliminate on-calls—so that doctors don’t work 24/7 doing two jobs and increase medicolegal risks – HDK disagreed with the proposal.
“Rakan KKM should remain a voluntary initiative—strictly to be done outside regular working hours, on weekends, or during designated locum slots, especially for senior specialists as per existing MOH guidelines. It should not interfere with existing public service responsibilities or compromise core hospital functions.”
HDK also said it was still too early to tell if Rakan KKM would improve or compromise public health care, due to the lack of clarity on its operational scope.
“While we reserve judgement, we sincerely hope that this initiative will help curb the ongoing brain drain, especially considering how rapidly private hospitals are expanding across the country.”
MCA deputy president Dr Mah Hang Soon pointed out that government hospitals and medical facilities in Malaysia have been overburdened for decades.
“How will MOH ensure that the hospital which takes up Rakan KKM has adequate staff?” Dr Mah told CodeBlue.
“Extra work and usage of government hospital resources will further burden the already overstretched medical doctors, nurses, and support staff, e.g. administrative staff, van drivers, who would thus be required to work longer hours.”
Dzulkefly told a recent press conference that unlike the MOH’s FPP model, Rakan KKM would not just compensate specialist doctors, but also nurses and auxiliary staff like medical assistants. He posted on X last Sunday that Rakan KKM aims to support the retention of health care workers by “providing opportunities to increase their incomes considerably.”
But JPA announced last Friday that five service schemes in the MOH, including nurses and assistant medical officers, would be exempt from a 45-hour work week and retain a 42-hour work week instead.
Last February, associations representing nurses, medical assistants, and allied health personnel opposed the addition of three working hours, saying health care workers already work “well beyond” 45 hours a week due to “chronic understaffing.” Longer working hours, they warned, could increase medical errors and put patient safety at risk.
