KUALA LUMPUR, July 16 — In a radical proposal, Bukit Gasing state assemblyman Rajiv Rishyakaran has urged the Ministry of Health (MOH) to use its newfound autonomy to decentralise doctor recruitment and remuneration to the hospital level.
The DAP lawmaker proposed that the MOH replace the existing centralised placement mechanism with an open recruitment system that allows medical officers to directly apply for open vacancies at specific hospitals where they want to build their careers.
“Giving doctors the agency to choose their institutional path honours their professional choices, respects their personal agency, and naturally aligns doctors with environments where they feel they can thrive and contribute best,” Rajiv said in a statement today.
Currently, placements of medical officers for permanent positions are managed in centralised intakes from MOH Putrajaya about twice a year under the ePlacement system that requires applicants to select three facility options, including a mandatory “choice” of Sabah or Sarawak. Putrajaya then decides on the postings.
Many doctors, however, have rejected permanent appointment offers when they were posted to Sabah or Sarawak. Nineteen of 39 medical officers posted to Sabah last month failed to report for duty for permanent positions, with Deputy Health Minister Hanifah Hajar Taib projecting an overall 50 per cent no-show rate for Sabah postings this year.
Last year, 43 per cent of medical officers posted to Sarawak for permanent appointments, or 332 doctors, didn’t report for duty.
Rajiv also suggested decentralising the regional incentive payment (BIW) allowance framework, saying individual hospitals or clinics should have the power to determine BIW rates.
“The mechanism must be market-driven: the more remote, understaffed, or challenging a specific facility is, the higher its localised BIW allowance should be,” he said.
“These allowances must be dynamically adjusted to a high enough financial threshold to generate genuine, self-sustaining interest. If the premium is competitive and robust, young MOs and specialists will willingly and voluntarily apply to rural posts, viewing them as lucrative opportunities to build their savings rather than a forced exile away from their loved ones.”
Under the Public Service Remuneration System (SSPA), the BIW allowance for transfers to Sabah, Sarawak, and Labuan was changed to a fixed RM360 monthly rate for officers appointed from December 1, 2024, compared to the old framework of a percentage of basic salary.
Health Minister Dzulkefly Ahmad recently announced that the Public Service Department (JPA) gave the MOH “absolute autonomy”, starting last July 9, to manage the allocation of health care positions.
It’s unclear if MOH’s newfound autonomy includes setting remuneration or allowance rates independent of JPA. Anything related to finance, which is a departure from what has been approved, typically requires approval from either the finance or economy ministries.
Rajiv further proposed corporatising government hospitals to give hospital directors the power and responsibility to fill vacancies, in line with his proposals for an open job marketplace and BIW allowance revamp.
Once these are in place, hospital directors can then be held directly responsible for workplace environments in their facilities.
“When a hospital’s leadership is operationally and legally accountable for recruiting and retaining its own workforce, it will serve as a natural check against workplace bullying and favouritism,” said Rajiv.
“For too long, toxic work environments have been swept under the rug because centralised deployment systems automatically replaced departing staff, shielding bad administrators from the consequences of poor leadership.
“By holding local hospital directors directly accountable for doctor retention rates, toxic workplace practices, favouritism, and systemic bullying become existential threats to the hospital’s operational survival.
“Directors will be heavily incentivised to actively protect their doctors, cultivate healthy working conditions, and treat their staff with dignity.”
CodeBlue reported yesterday that the MOH’s doctor workforce contracted for the first time in more than a decade in 2024, losing 1,444 doctors (2.7 per cent) from 53,512 in 2023 to 52,068 in 2024.
“When you treat doctors like numbers on a centralised bureaucratic spreadsheet, whether that spreadsheet sits in JPA or Putrajaya, you lose them,” said Rajiv.
