KUALA LUMPUR, July 17 — A senior consultant surgeon in the Ministry of Health (MOH) believes that Rakan KKM may not be able to attract specialists for overtime work, nor retain them in public service.
The surgeon explained that specialists leave government service mainly because they’re underpaid and overworked, while a distant third factor is slow promotion.
He pointed out that Rakan KKM is unlikely to match specialist doctor fees in the private sector, as regulated under Schedule 13 of the Private Healthcare Facilities and Services Act 1998 (Act 586). Act 586 caps doctors’ professional fees, including consultation fees, fees for ward visits, and procedure or operation fees.
Hence, specialists will likely still earn less under Rakan KKM than in the private sector.
“Point 2 – overwork – is important and crucial for many young specialists who have kids and value quality and family time. They’re not going to bite the bait, where you work overtime in both private and Rakan KKM and have no quality time,” the surgeon told CodeBlue on condition of anonymity.
“Might as well go private full-time where work is less and pay is more, meaning both points 1 and 2 are sorted. If they do Rakan KKM, it will just be a temporary measure to buy time while they seek cushy well-paying jobs outside.”
Younger generation doctors, he observed, are not like “old-timers”, as this generation is more aware about their rights and talks about work-life balance.
The senior consultant surgeon further noted that doctors are taxed heavily at 26 per cent of their income.
“If you’re going to be taxed for extra earnings, either in Rakan KKM or full-time private, you might as well take the full-time private option. At least you gain in terms of more valuable time and less work.
“Otherwise, you work like a dog in public service, work some more in Rakan KKM, and then pay heavy tax and lose your free time and weekend time. Bad deal.”
Health Minister Dzulkefly Ahmad told a press conference yesterday that Rakan KKM targets specialists who do locum work in private hospitals, without specifying if they would have to choose between locum in the conventional private sector and Rakan KKM on their one working day a week for locum.
Neither did he specify if other overworked doctors, nurses, or allied health care professionals in the public service would be expected to labour overtime in Rakan KKM, beyond simply saying that the specialist service isn’t targeting “those who don’t have the time.”
The surgeon who spoke to CodeBlue called for clarity on the exact number of nurses, medical officers, and staff required to run services on any given day in MOH, including weekends.
Rakan KKM, which aims to offer elective procedures, will supposedly operate only after hours or weekends, though Dzulkefly’s remarks yesterday indicate that the elective service may also run during regular hours.
The MOH plans to launch Rakan KKM by the third quarter of this year at Cyberjaya Hospital, Putrajaya Hospital, Sultan Idris Shah Serdang Hospital, and the National Cancer Institute (IKN).
“We have been understaffed for many years,” the surgeon said. “We need a national health services commission.”
The senior specialist cited Pakatan Harapan’s campaign promise in the 15th general election to set up a National Health Services Commission to manage the human resources of health care staff in public service.
“As long as PTD officers in JPA (Public Service Department) and MOH continue managing health care workers, like what has been happening for the last 60 years, I’m not too optimistic.”
He stressed the importance of equal access to care in the national health service, amid public backlash against Rakan KKM that acts like an “express lane” for paying patients in government hospitals.
“The rakyat pay taxes like SST (sales and service tax) and whatnot. They deserve free, good, and quality health services, like the UK’s NHS,” said the surgeon.
“Any politician who messes around with the NHS is guaranteed to lose elections. Let’s see what happens in Malaysia Boleh.”
Another doctor questioned the rationale in Rakan KKM providing elective services only after hours, pointing out that patients will need to be admitted before and after their surgery.
“Will they somehow come up with a new ward? Depending on the type of operation, certain patients will require observation and rehabilitation post-operatively. Since op was done outside office hours, will they allow discharge in the middle of night?
“How about those who need rehabilitation post-op? Which MO (medical officer) and specialist will follow up on them the next day during working hours?” he wrote on Facebook.
“If they manage to address these issues correctly, then I guess no one will oppose the Rakan KKM programme.”
The doctor said patients in government hospitals are still being admitted to overcrowded and understaffed wards. The “supposedly in-charge” specialist typically requests the staff nurse (SN) to take care of the patient and deliver medications; the house officer is asked to insert branula and trace blood investigations; and the on-call MO is requested to review the case and settle consent.
“If they [Rakan KKM] have totally different in-charge specialist, MO, SN, and ward, and they all do it voluntarily, not under so-called KPI, then there should be no problem.”
In response to Dzulkefly’s comments about Rakan KKM targeting specialists, another doctor similarly noted that a health care team comprises various staff, including OT staff, anaesthesiology staff, ward staff (post-surgery management), staff nurses, and health care assistants.
“If the paying cases suddenly have problems, are other staff in that same ward expected to go and resuscitate the patient? Already they’re not paid, now they’re burdened with even more work,” he posted on Facebook.
“The entire chain needs to be worked out; it’s not just a matter of ‘oh we just want to reward specialists so that they don’t run away to private. Other staff don’t matter; they just need to treat them [Rakan KKM patients] like regular patients.’ This ignores the importance of other staff in patient management. Remember, there aren’t just specialists in a hospital; other staff work there too.”
CodeBlue previously reported, citing MOH data, that the public sector is short of nearly 11,000 specialist doctors this year, having only 44 per cent of specialists needed. Most specialties have less than half of the number of specialists needed.
The New Straits Times (NST) reported yesterday a shortage of about 8,000 nurses in the public service. Malayan Nurses Union president Saaidah Athman told the newspaper that the nurse-to-patient ratio reaches 1:10 or 1:16 in many busy government hospitals, far exceeding the ideal ratio of 1:6.
Doctors and nurses also related to NST their vast workloads and burnout caused by severe staff shortages. “The system is bleeding and we’re using our hands to plug the holes,” said a specialist doctor.
Rakan KKM, which is applying for licensing under the MOH’s Private Medical Practice Control Section (CKAPS), will be prohibited under Act 586 from opening up beds if it cannot meet nursing ratios – should the ministry enforce the same standards on its new private health care service as conventional private providers.
