KUALA LUMPUR – Government doctors are looking back on a year of snail-paced reforms for doctors’ welfare with mixed feelings, unsure as to when all their demands can be met, as many problems are due to legacy issues.
Speaking anonymously to Scoop, as public servants are not allowed to speak to the media, they noted how the Health Ministry’s 2016 decision to take on contract medical staff due to the lack of permanent posts has now become a crisis.
The lack of funds for more permanent posts has meant that contract doctors have to put up with low pay, long hours due to manpower shortages as a result of resignations, as well as a lack of career progression.
One government doctor said medical staff are still paid a near-minimum wage, with little year-end bonuses and on-call claims, despite their calls for increased wages each year.
Until these core issues are solved, the intake of more contract workers will be a futile exercise.
“They (MoH) tried by getting more contract workers (to solve the issue of overworked and underpaid doctors and nurses), but the resignation rate is so high, (they) cannot keep up,” she said.
“My nurses, who worked under the MoH for 10 years, are willing to give up their pension schemes and work in Singapore to provide a better life for their children,” she said, explaining that the average starting pay for a nurse there is S$5,000 (RM17,547), while her starting pay as a doctor here was RM2,900.
Another government doctor spoke of the uncertain career prospects for contract doctors as they are never sure if they will be absorbed by the ministry and given permanent posts.
And those who are absorbed must serve three more years before receiving major salary increments, he added.
He said he was paid about RM200 for a 24-hour overtime shift, an hourly pay equivalent to fast-food chain employees.
“For RM8 per hour, it’s better to work in McDonald’s,” he added.
On December 13, the ministry pledged to examine the issue of doctors’ on-call allowances – which were last reviewed over a decade ago.
Thorough reforms are politically risky
The same doctor agreed with the first that although the ministry had absorbed some contract doctors, this had not eased the work or made it more efficient, as just as many were leaving the public healthcare system for the private sector or opportunities overseas.
He and colleagues feel that Malaysia should emulate Singapore’s tier-based healthcare system to generate more funds for the sector, but acknowledged that such reforms could be politically risky for the government.
“Our country is known for having free healthcare. If you change that, then no one will vote for you. You can understand why nothing much has changed, regardless of which government is in charge,” he said.
“I do not blame the old or new government, because there is not much you can do unless you restructure the whole government and make sure the funds are properly allocated.
“When you look at fund allocations, you can see it is not spent properly. Not only are we understaffed and underequipped, but we also have to handle a large population,” he added.
In April, Prime Minister Datuk Seri Anwar Ibrahim said there were 20,330 contract doctors in the public healthcare sector, and 12,800 of them would be given permanent positions within the next three years, under a RM1.7 billion allocation from Budget 2023.
The same month, the ministry said 4,263 contract doctors had been absorbed up till then.
On October 21, the ministry said an additional 2,083 medical contract workers will be absorbed as permanent staff by the end of this year.
Light at the end of of a very long tunnel
While what little previous health minister Dr Zaliha Mustafa could do for government doctors in her one-year tenure was hampered by larger structural issues, doctors are still hopeful that her successor, Datuk Seri Dr Dzulkefly Ahmad, can bring about deeper change.
Another government doctor said Dr Dzulkefly already had experience as health minister, when he held the post from 2018 to 2020, whereas Dr Zaliha had to spend a part of her brief stint learning the ropes.
However, the doctor also said that public healthcare workers should allow Dr Dzulkefly time to deal with reforms as well as ongoing issues.
“Medicine moves by the day, there will be updates and revisions of previous ideas.
“What was relevant then may not be relevant now, which is why I say he needs time,” he said. – December 22, 2023