To the people of Malaysia, and especially the people of Sarawak,
We write this letter not in anger alone, but with deep concern for the sustainability of health care services in northern Sarawak, especially for the specialists who have stepped forward to serve.
And most importantly, concern for the patients who will ultimately bear the consequences of administrative decisions made far from the bedside.
Hospital Miri: The Northern Frontier Of Care
Hospital Miri stands as the primary referral centre for northern Sarawak, serving a vast population spread across remote and logistically challenging geography. Kuching, the state’s main tertiary referral hub, lies approximately 700 kilometres away.
For critically ill patients, this distance is not an inconvenience — it is a risk factor.
Recognising this, subspecialty services have gradually been introduced in Miri, with further expansion planned, including cardiology, which is a service long overdue for the region.
Decentralisation was meant to bring care closer to the people, yet recent developments threaten to reverse this progress.
When Specialists Volunteer, But Recognition Is Denied
Subspecialist consultants have been willingly contributing to service development in Miri by:
- Managing complex referrals.
- Providing subspecialty on-call coverage.
- Establishing new treatment pathways.
- Training junior doctors and medical officers.
However, hospital administration has refused to recognise subspecialty on-call claims, citing that there were “too many specialists on-call in one day.” Such reasoning fails to reflect clinical reality.
Different subspecialties do not duplicate services, since they complement one another to ensure safe patient care.
Standby Without Pay (Passive On-Call): An Unacceptable Precedent
Following appeals to higher administration, a compromise was offered: consultants must remain on daily standby, but may only claim on-call allowance if a referral is received on that specific day.
In effect, this requires specialists to:
- Remain continuously available.
- Carry medico-legal responsibility.
- Be prepared for emergencies, yet receive no guaranteed compensation.
This arrangement undermines the fundamental principle that professional labour — especially specialist labour — deserves formal recognition.
It sets a dangerous precedent that standby responsibility does not warrant protected remuneration.
This issue emerges against a backdrop of severe manpower shortages in Sarawak. Hospitals across the state continue to face inadequate specialist numbers, limited medical officer staffing, heavy on-call burdens, and service sustainability challenges.
Workforce maldistribution between Sarawak and Peninsular Malaysia remains stark.
Why Doctors Hesitate To Serve In Sarawak
Peninsular Malaysia-based doctors have long been reluctant to transfer to Sarawak due to factors such as limited financial incentives, geographic isolation, higher workload intensity, and reduced subspecialty ecosystem support.
Without meaningful structural benefits, relocation becomes professionally and personally difficult to justify.
More tellingly, even doctors originating from Sarawak frequently opt to remain in hospitals in Peninsular Malaysia. The reasons are pragmatic:
- Better manpower distribution.
- Larger specialist teams.
- More sustainable on-call systems.
- Stronger training environments.
In other words, safer and more humane working conditions. When specialists are scarce and recruitment is deterred, the burden shifts, not to administrators, but to patients. The people of Sarawak face:
- Delayed subspecialty input.
- Increased need for aeromedical transfers.
- Longer hospital stays.
- Higher complication risks.
Health care inequity will widen, not from lack of policy announcements, but from lack of workforce protection.
Wage Suppression Will Only Accelerate The Crisis
In this fragile ecosystem, denying subspecialty on-call recognition sends a deeply damaging message, that those who transfer to frontier regions should expect to shoulder responsibility without institutional backing.
It is therefore reasonable to ask this question: who would willingly transfer to Hospital Miri — or any peripheral centre — if subspecialty work is met with administrative resistance rather than support?
Policies like this do not strengthen decentralisation. They weaken it.
Service Expansion Requires More Than Infrastructure
Health care development is not built on buildings alone. It depends on other factors like skilled personnel, institutional recognition, and sustainable compensation frameworks.
Without these, subspecialty services cannot mature, regardless of how many are announced on paper.
If Sarawak’s health care system is to remain viable, the following urgent measures are required:
- Formal recognition of subspecialty on-call rosters.
- Guaranteed standby allowance.
- Transparent claim policies.
- Frontier service incentives.
- Administrative alignment with clinical realities.
These are not luxuries, but are prerequisites for workforce retention.
Sarawak is already facing a critical shortage of doctors. Transfers remain difficult, and retention remains fragile. To introduce subspecialty wage suppression within this environment risks accelerating an already dangerous trajectory.
We urge policymakers, administrators, and the Ministry of Health (MOH) to recognise the gravity of this issue. Because if subspecialists are driven away, service expansion will stall. And when that happens, it is not the system that suffers first, it is the people.
The author is a physician at Miri Hospital. CodeBlue is providing the author anonymity because 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.
