I’ll start off by saying that I know this is an extremely unpopular opinion in the medical fraternity, but it needs to be said.
The problems in our national health service have gone past the code blue stage requiring resuscitation and are now existential.
The Ministry of Health’s (MOH) doctor workforce declined in 2024 in an historic contraction, losing more than 1,400 doctors after over a decade of annual expansions.
This was likely a combination of rejections of permanent appointment offers, which happened among more than 1,100 medical officers in 2023, and resignations of over 3,500 medical officers from the public sector between 2023 and 2025.
Deputy Health Minister Hanifah Hajar Taib told Parliament that she expected half of medical officers posted to Sabah this year to reject offers of permanent positions, after 19 of 39 doctors didn’t report for duty in the state on June 29 for permanent posts.
The 50 per cent rejections in Sabah last month occurred even though these contract doctors were the first eligible batch to claim for transfers.
Hence, despite Health Minister Dzulkefly Ahmad touting 4,500 permanent positions for medical officers in 2026, only 50 or 60 per cent might report for duty, with the remaining doctors eventually leaving the service after their contracts end.
In fact, the 1,100 no-shows in 2023 and 3,500 resignations from 2023 to 2025 have effectively cancelled out this year’s 4,500 permanent appointments, leaving a net loss, even if every single doctor were to accept their offer.
Dzulkefly’s statement in the Dewan Negara last March about a 40 per cent no-show rate among medical officers nationwide for permanent positions should have already set off an alarm.
A 50 per cent no-show forecast is another warning, just like how the Johor state election was dubbed a second “wake-up call” to Pakatan Harapan after Sabah. Now, the fact that the MOH has fewer doctors than it used to have isn’t just an alarm triggered by smoke, but a house on fire.
However, like politicians, MOH seems to have hit the snooze button.
Rearranging Deck Chairs On The Titanic
“The lure or appeal of permanent government employment has soured over the past couple of years. This is significant because the struggle to convert contracts to permanent was previously prominent and urgent,” Galen Centre of Health and Social Policy chief executive Azrul Mohd Khalib tells me.
“There were years of complacency, ‘tidak apa’ attitudes, and lack of urgency in successive political leaderships on this issue. But now, neglect in addressing Covid-19 burnout and dissatisfaction over deteriorating working conditions, poor human resource management, and unreasonable expectations of long hours and sacrifice – combined – has led to this.”
A 50 per cent doctor no-show rate shows that it “might be too late” to fix things, says Azrul, likening it to rearranging deck chairs on the Titanic for certain public health care facilities.
Hartal Doktor Kontrak (HDK) describes the 50 per cent no-shows for permanent posts as a clear warning sign of a deeper systemic crisis in Malaysia’s health care workforce.
“Given that so many doctors are unwilling to accept these permanent placements, it reflects serious issues in career progression, placement fairness, and the workload in the public health care system,” HDK spokesman Dr Muhammad Yassin tells me.
“If the government wants to deal with this trend, they must address a few main issues, namely transparent career pathways, better placement policies. and improved working conditions.”
Schomos chairman Dr Timothy Cheng says doctors who leave don’t see a future in MOH, not so much about remuneration but career pathways.
The MOH assuming “absolute autonomy” for the management of its health care positions means that the ministry can no longer treat the Public Service Department (JPA) as a convenient scapegoat for all of its problems.
I don’t think JPA was the main cause of HR issues in MOH over the past decade that eventually led the doctor workforce to shrink in 2024. Specialists are furious at JPA for not budging on LNPT requirements for subspecialty training, but since funding isn’t from MOH’s budget, JPA has the right to set whatever conditions it wants (but must remain fair and consistent).
Providing positions is one issue; the bigger factor in staff retention is a healthy workplace environment, with good remuneration and clear career pathways, that falls primarily under MOH’s responsibility.
Even if a company has plenty of vacancies, people aren’t likely to seek employment if they believe that it’s a terrible organisation to work for. But a good organisation will attract — and retain — talented workers.
Doctors Don’t Need To Be Directors Of Hospitals, Bureaucratic Services
A big part of the blame for poor HR policy should be apportioned to medical doctors in management positions across MOH, be it headquarters, state health departments, district health offices, or hospitals.
If JPA and the Ministry of Finance (MOF) really failed to provide sufficient positions, funding, or staff remuneration as alleged, then it’s the responsibility of MOH as the employer to reduce workloads to a level commensurate with available human resources and facilities — even if that means cutting services, halting planned expansions, or turning patients away if safe and quality medical services cannot be provided.
Private hospitals are prohibited from opening beds without a certain nurse-to-patient ratio. If MOH follows the rules it imposes on other people, then it won’t allow overcrowding and the government will be forced to raise health workers’ pay and recruit staff that must not only be enough to run a service, but also implement protected rest periods.
Yet doctors in management across MOH often choose staff exploitation to fulfil unreasonable self-created KPIs, which weren’t set by JPA or MOF, instead of saying: “We won’t provide the service unless we get what we need to provide that service”.
Recently, a specialist at Sultanah Aminah Johor Bahru Hospital (HSAJB) complained about the hospital director and state health director rejecting applications for essential clinical assets made since 2022.
According to the specialist, MOH increased the number of hospital management staff last year, giving all hospitals additional deputy director positions, without extra clinical staffing positions.
A HSAJB houseman’s poignant complaint about deplorable toilets for staff shows that doctors in management are more concerned about patients’ urine output, “but no one cares about us”.
CodeBlue has also received complaints about doctors in upper management compelling staff to attend activities, like a talent contest in Selangor today, as an additional (uncompensated) responsibility, on top of clinical duties.
A general lack of solidarity from senior doctors with their juniors, which is why a disruptive doctors’ strike won’t be organised in Malaysia, hints at how certain doctors perpetuate a cycle of oppression within their fraternity. Their contempt towards Gen Z doctors for desiring work-life balance is palpable.
One of MOH’s most disastrous policy proposals was the Waktu Bekerja Berlainan (WBB) shift system that was, according to Dzulkefly, “built by doctors for doctors”. The Cabinet axed the pilot project in January 2025 following fierce backlash from the medical fraternity.
In the private sector, hospitals are run by CEOs who are not medical doctors; the position of medical director is separate from the CEO. By all accounts, these non-MD CEOs do their jobs well because hospital groups record healthy profits year on year.
KPIs in the national health service aren’t profit generation, but high patient and staff satisfaction. A non-MD hospital director might ensure amenities for staff like functioning toilets.
“Health care professions, especially in resource-scarce settings, should focus on health care. They don’t need to be directors of hospitals or bureaucratic services. Today’s health care space has many types of professionals for health care. The medical doctor doesn’t need to be a jack of all trades,” says Azrul.
Just like how doctors loathe the interference of non-doctors, such as insurers, with their clinical decisions, management positions in the MOH should be reserved for people who are qualified for the job, not medical doctors (unless they are specifically trained for it).
According to MOH’s Health Facts 2025, there were nearly 46,000 medical officers and specialists in the ministry in 2024. It’s unclear how many of them are in management or non-clinical positions.
PTD Officers Must ‘Have Their Heart In It’
“Management of the health service should be by qualified people accordingly,” a senior civil servant tells me.
“Management functions that require specialist or technical know-how should be handled by technical specialists, i.e. the medical profession. General management also requires technical know-how; treasury functions, procurement, IT, and HR would be best left to management professionals.”
Another senior administrative and diplomatic (PTD) officer tells me that he knows of some medical doctors in the health service who want to do management because they’re no longer interested in being clinicians.
“But they must have a strong grasp of management, rules and regulations, and do’s and dont’s. With procurement, some things are straightforward, but some are not,” he says. “They must have the experience to manage finance, HR, and procurement.”
He adds that he has heard praise of a PTD officer who was the deputy director of management in a public hospital. “He’ll try his very best to make things easy for doctors, in terms of procurement, finance, and approvals. People really enjoyed working with him.”
However, he also cautions fellow PTD officers who want to work in the health service to be “passionate, sincere, and have their heart in it”, instead of treating it like another management job, saying that most PTDs use an inappropriate one-size-fits-all approach based on their experience in other agencies.
“If you’re at the ministry level and completely isolated from the public, you might treat the job as something piecemeal,” says the PTD officer. “You need to put a face to your assignment – there’s an actual person there. This person needs my help. If I do it this way, how will it affect them?”
Place Doctors In Clinical Positions, Not Management
Last February, I suggested phasing out the colonial-era PTD scheme, but maybe I spoke too soon.
Given that MOH is facing increasingly dire straits that show no sign of reversal, perhaps PTD officers and other management professionals should be retained to help turn around the health service – if they are capable and put their heart in their work.
My only call would be for such professionals to remain in the MOH for at least five years to understand the complex needs of the national health service.
Many doctors dislike PTDs, who are often perceived to be dismissive and elitist, but it seems like doctors don’t understand (or don’t care about) each other’s needs either.
Doctors should focus on clinical work and building specialty services, not general management. Those who don’t want to practise medicine as a day job shouldn’t be transferred to clinical positions simply to address a doctors’ shortage; I don’t believe in forcing people to do something that they don’t want to do for a living.
But they should be dropped from the civil service and replaced with more qualified people for management jobs; or that particular management position should be traded off for a clinical position if the latter is deemed to be of higher need.
With perennial fiscal constraints, there is no room for unqualified doctors in management. The health service must hire the right person for the right job.
Retired senior consultants or those nearing retirement should be widely allowed to continue on contract to help sustain MOH’s specialist workforce just a little bit longer — if they’re still keen to work.
When I read stories of doctors quitting MOH to pursue their medical career overseas, joining the private sector, or leaving medicine altogether, I’m glad for them because the pursuit of happiness is a valid aspiration.
But Malaysia cannot continue down this path because people in my generation and younger might not have sufficient access to health care when we grow older – be it public or private – as there are no doctors left.
Many doctors may take offence at my suggestion for non-doctors to run the health service, but the rate of attrition is rising too high and too fast. If doing the same thing for years hasn’t worked, maybe it’s time to try something new.
Boo Su-Lyn is the co-founder and editor-in-chief of CodeBlue.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
