I started my career as a houseman at University of Malaya in May 1976. At the time, it was the only Malaysian university producing medical graduates, and about 110 of us were quickly enrolled into training in a few dedicated trainee hospitals nationwide. Universiti Kebangsaan Malaysia and Universiti Sains Malaysia’s first batches of graduates followed in 1979 and 1986 respectively.
Soon after, I was appointed to the Medical Advisory Committee of Universiti Malaya Medical Centre, as a representative for house doctors. My background as the president of the Interact Club, assistant officer with the Red Cross (now Red Crescent), followed by committee member and editor of the Medical Society for undergraduates helped me face the ‘bosses’.
The first concern for all of us was our monthly pay of RM630, at a time when on-call allowances did not exist. This amount was enough to feed a family of three or four in the 1970s, but not enough to own a car, which was then considered a luxury.
Midway through our service, we began our negotiations for a better income. Two groups visited Tun Mahathir (who was then Education Minister) and Dr Tan Chee Khoon (who was then opposition leader and one of the few opposition MPs). Both leaders were sympathetic, while mentioning that they managed to feed their families with RM400 and RM250 respectively.
Yours truly took the lead and drafted a two-page letter and sent it with a hundred signatories to the Prime Minister, seeking a pay rise, for the hard work we were doing then. We housemen were like family and worked closely with the medical officer, lecturer in charge, and the consultant, comprising a team of five or six at the most for a ward of 28 patients.
We did not picket or go on slow-down or strike, but our letter reached the Cabinet. By May 1977, the next batch of medical graduates graduated from University of Malaya. They also took a strong and united step not to register to work, unless the pay was reviewed.
Almost overnight, the Cabinet gave us a pay rise from RM630 to RM1,165, a whopping 85 per cent jump, backdating to my batch. Undeniably, one major factor did help, which was the daughters of the then Prime Minister and King were among the new graduates.
The next point of negotiation was the on-call allowance, an issue that every Schomos national chairman raised in their meetings and discussion with every subsequent health director-general. It hit a wall every time, with the statement that Division One officers are not entitled to on-call allowances.
During my tenure as Schomos chairman, we had access to the health director-general or his deputies whenever they visited the state. The face-off was often tense, intense, and direct but we conveyed our grievances without fear.
Apart from salary, another grievance was that nearly all the conferences, seminars, and long-term scholarships were literally taken up by the heads of department at Hospital Kuala Lumpur. I believe after that heated exchange at the Ministry of Health (MOH) between the director-general and his team and the senior Schomos team, many junior specialists and senior medical officers have since gone for conferences locally and abroad.
By 1994, during my term as national Schomos chairman, two simultaneous moves enabled the on-call allowance to be approved. Firstly, through some internal connections, the Treasury decided to study the working conditions for doctors in public service.
A team went down to study working conditions in Johor Bahru and Kluang Hospitals. Amazingly and thankfully, the report was strongly in favour of government doctors to be given on-call allowances, apart from the meagre critical allowance.
Next, we had the brilliant idea of inviting the outgoing health minister, Tan Sri Lee Kim Sai, to open our annual Schomos meeting. He listened intently as we presented point after point as to why doctors should be given on-call allowances.
When he was on his way out, we urged him to do something for us so we will remember him kindly. His parting words were “All right, I will talk to PM.” The Prime Minister then was Tun Mahathir, himself a doctor.
The breakthrough came when the government announced in 1994 that the on-call allowance has been approved. Many were not aware that private practice in government hospitals was already within the system. The consultants had their private patients whether in clinics or in admissions to first class wards, at a time when private hospitals did not yet exist.
The government consultants were then receiving RM25 for a private visit, and a radiologist was paid RM20 per film. The late Dato Syed Alhady, at one time the state surgeon of Selangor, told me that his pay then was over RM5,000, more than the state secretary.
The announcement of the on-call allowance was followed by the decision to allow government doctors to do locum after office hours. Soon after, beginning with Universiti Malaya Specialist Centre, private wards became a flourishing institution on its own. We never picketed, nor go on a slow-down or strike, and are thankful that through patient and persistent negotiations, the breakthrough eventually happened.
The third point of contention was private practice, which was then under the auspices of the Associations of Specialists in Private Medical Practice (ASPMP), founded in 2001. Though it was a small body, unnoticed by the MOH, its presence became vocal over the GST issue, Inland Revenue Board (LHDN) directives, and now, the impending DRG implementation.
On the GST issue, we were almost given the burden of the 6 per cent service tax, as we were independent contractors, while the rest of the health care industry was exempted with a 0 per cent taxation.
Thankfully, both the Customs deputy director-general, and the Association of Private Hospitals Malaysia (APHM) agreed to the shifting of the costs to the patients, which was also accepted by insurance companies, corporations, and patients (perhaps unknowingly for the latter).
Then in 2016, LHDN gave a circular that doctors could not use the Private Limited category for their practices, applicable for those who are independent contractors with hospitals, backdating it to a year or two.
This sudden announcement meant that many consultants had to fork out up to six figures to pay LHDN. The Malaysian Medical Association (MMA) took the lead and invited us to join in the negotiations.
Then came a serendipitous development, when a new government took over, and a Council of Eminent Persons was formed, and we managed to get a meeting to present our case. It probably lasted about 20 to 30 minutes, and the Council were convinced that the doctors were wrongly penalised with a backdating of the rule.
On the very same day, LHDN reversed the letter, cancelling the backdating, and many of our colleagues got their money back. Eventually, a senior ministry official told us that it had cost the government RM1 billion for our refund.
With regard to the DRG issue, the MOH and Treasury have recognised and acknowledged the ASPMP as an entity representing specialists in private practice, apart from the MMA and the APHM.
We now have a voice, and they said they are listening, but will we have our way? The answer is that at least we have a voice and we are being heard, together with the MMA and the APHM.
The fate of the prosperous general practitioner is over, and government doctors now have a steady improvement in their income, together with their limited private practices. But what about private specialists? I believe their days are numbered too, like the GP.
Meanwhile, the message is clear. It is always far better to talk and negotiate, and never to fight and threaten (picket, slow-down, strike) with our masters, because the doctor can never be king ever again.
With that, I quietly retire from practice and all the “talk across the table” after 50 years of service on May 1, 2026.
A personal swan song from Dr Sng Kim Hock.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
