We keep asking why doctors are leaving the public health care system. Perhaps we should start by asking ourselves: what are we doing to make them stay?
Doctors are already overworked. We work weekends, nights, public holidays and on call. We have worked through the Covid-19 pandemic, through staff shortages and overwhelming workloads, often with promises of better recognition and additional leave that many felt never fully materialised.
Yet we continue to measure commitment by how long a doctor remains physically in the hospital. It is time to rethink that.
A working day should not be about sitting in the hospital until the clock says 5pm. I propose that normal working hours be 7.30am to 4pm, with genuine flexibility.
If a doctor has completed their clinical responsibilities, documentation and handover, and adequate coverage is available, why should they be penalised for going home earlier?
Of course, this does not apply when a doctor is rostered for on-call duties or is genuinely required for essential patient care.
The principle is simple: if the work is done and the patients are covered, let the doctor go home.
A flexible working system should actually be flexible. It should not become another nine-hour compulsory attendance requirement.
On-Call Work Is Still Work
A doctor who works a full day and then spends the night on call does not magically become less tired because those hours are labelled “on call”. Fatigue does not recognise administrative categories.
In countries such as the United Kingdom and Australia, there are systems that take overall working time, out-of-hours duties, and fatigue into consideration, although the specific arrangements differ.
Malaysia should move towards a similar principle: a doctor’s total workload and recovery time should matter, not just their daytime attendance.
After a demanding overnight call, appropriate recovery should be part of the system. Every doctor deserves post-call pm off to recover from fatigue.
Doctors Need A Life Outside Medicine
Doctors have families. We need time to exercise, eat properly, sleep, spend time with our spouses and children, and simply recover. These are not unreasonable demands.
A doctor who has time to look after their health and family is more likely to have the energy to remain in the profession for the long term.
Work-life balance is not a luxury. It is part of retention. And for doctors working in the Klang Valley, there is another reality: traffic.
After a long day, many doctors face lengthy commutes through congested roads. Our public transport system does not adequately serve everyone, particularly those working irregular hours.
After an exhausting day or an overnight call, we still have to drive home. We should be designing working hours with fatigue and road safety in mind, rather than waiting for a tragedy to force the conversation. Doctors cannot work from home.
Doctors should also not simply be treated like other public servants when working policies are designed.
Many public sector employees have access to flexible or work-from-home arrangements where their jobs permit it.
A doctor cannot examine a patient, perform a procedure, scan a patient or manage an emergency from home. Our work requires us to be physically present.
That reality should be recognised when determining our working hours, benefits, and retention incentives.
Specialists Deserve Meaningful Recognition
If the Ministry of Health (MOH) genuinely wants to retain specialists, we need to make staying in the public service worthwhile.
Specialists carry years of additional training and responsibility including clinical care, supervision, teaching, administration and on-call duties.
Practical benefits matter. This could include dedicated or priority parking, meal allowances or provision of meals, proper rest facilities after overnight duties, and other meaningful retention incentives.
These are not extravagant perks, but recognition of the responsibilities we ask specialists to carry.
Medical Officers and specialists may also need different working arrangements, depending on their clinical responsibilities and on-call commitments. One policy does not necessarily fit every level of medical practice.
We Need A National Policy, Not Individual Discretion
Perhaps most importantly, flexible working should not depend on whether an individual hospital director or head of department (HOD) happens to support it. There should be a clear MOH-wide policy.
The policy should establish:
- 7.30am to 4pm as the standard working window.
- Genuine flexibility to leave earlier when clinical work, documentation, and handover are completed and coverage is adequate.
- No penalty simply because a doctor has completed their work early.
- Recognition of on-call and out-of-hours duties as part of total workload.
- Appropriate recovery after overnight calls.
- Different considerations for medical officers and specialists where appropriate.
- Specialist retention benefits such as parking and meal support.
- Monitoring of doctor retention, resignations, sick leave, overtime, and patient safety outcomes.
This is not about doctors wanting to work less, but about working sustainably.
We cannot keep training doctors only to lose them to the private sector or overseas because the public system has become impossible to sustain.
Every doctor who leaves increases the workload on those who remain. Those doctors become more exhausted, and eventually some of them leave too. This is how the cycle continues.
If MOH genuinely wants doctors to stay, we need to give them a reason to stay:
- Give them reasonable working hours.
- Give them time with their families.
- Give them time to exercise and look after their health.
- Recognise the burden of on-call work.
- Give specialists meaningful practical benefits.
- And most importantly, trust doctors to go home when their work is done.
Doctors have already demonstrated their commitment to Malaysia especially during the pandemic and through years of service in the public health care system. Now it is time for the system to demonstrate its commitment to doctors.
We have invested years in training our doctors. Now, let us invest in keeping them.
The author is a doctor in the Ministry of Health. 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.
