The People’s Health Forum sympathises with the contract doctors in government service who have been given a bad deal.
There are now around 23,000 young doctors in the Ministry of Health (MoH) serving as house officers and medical officers on contract basis for the past five years. In fact, upon the completion of their five-year contract, only a small percentage of them (3.4%, ie 789 out of 23,077) have been offered permanent jobs with the MoH.
The problem is that five years of service in the MoH does not give enough time for them to specialise. So the doctors who are not absorbed into the ministry can only work as GPs. But the GP sector is already crowded with more than 7,000 registered doctors, and the going is tough for them.
The problem actually began over 15 years ago. The federal government then allowed too many private colleges to provide courses for doctors, nurses, physiotherapists, x-ray technicians and lab staff. Over 20 private colleges were granted approval to train doctors, and they applied for large entry quotas to these courses, driven mainly by commercial considerations.
The proliferation of medical schools was in part facilitated by retired senior officers from the health and education ministries who went on to helm many of these private institutions. These developments were accompanied by the approval of excessively large quotas for student intakes as well as PTPTN study loans for the thousands of hopeful medical students.
Belatedly, a five-year moratorium was placed on new medical courses in Malaysia in 2011, and extended for another five years in 2016. Despite this moratorium, in the past 10 years, there were still some new private colleges approved for medical courses.
This is a serious failure in planning for human resources for health and health systems governance. The personnel needs of the country were not properly assessed by the government agencies overseeing and regulating higher education. Nor was the capacity of the MoH to provide proper housemanship training for the medical graduates taken into consideration. Equally, the issue of permanent positions after completion of housemanship was also not appraised. Within such a scenario, while the commercial interests of the private colleges were prioritised, regulation of the growth of these private medical schools failed to keep pace.
Now, the current government seems to be washing its hands off the matter. In his 23 June 2021 statement, Health Minister Dr Adham Baba admitted that the addition of permanent positions in the MoH does not consider the total yearly addition of medical graduates, and he pushed this to the “rightsizing policy” of public services that is in effect for all ministries.
He also suggested that there are positions outside the MoH such as the Ministry of Higher Education, the Ministry of Defence and the private sector. Thus, implicitly this amounts to saying, “We will only take in a small fraction of you as permanent medical officers. We are not responsible for the rest of you. Go and find a job elsewhere.”
Is this a fair position to take given that the tuition fees for medicine in private colleges in Malaysia range from RM300,000 to RM800,000? Most students have taken huge loans or their families have sold properties to finance their studies. The existing GP clinics are struggling to keep afloat. How would these new entrants to the GP sector fare?
The 23,000 young contract doctors have a legitimate expectation that there would be a proper career path, since the government has allowed all these private medical colleges to operate and provided PTPTN loans for all the students who applied. It is not fair to ask these doctors to pay the price of misaligned planning by the government.
Thus, the People’s Health Forum suggests:
- An immediate extension of contracts to 10 years to allow the affected doctors sufficient time to get a specialist qualification. Doctors under contract should be given a fair opportunity to develop their specialist careers
- An immediate reduction of the intakes of private medical colleges – perhaps a reduction of 50% or even more based on our personnel projections. If necessary, the colleges should amalgamate. There also needs to be tighter control of the number of students going overseas for a medical education, with an explicit understanding that the graduating returnees will not be automatically guaranteed a housemanship position but will have to pass the exam for provisional registration (EPR) organised by the Malaysian Medical Council. This is necessary to ensure the quality of the doctors entering the system
- An increase in the health budget so that more permanent posts for medical officers can be created. The government medical services are overburdened at present. We need more public hospitals and medical staff. In relation to this, the government should consider setting up a separate healthcare services commission instead of being constrained by the Public Services Commission (SPA).
- More comprehensive planning regarding our personnel needs has to be put in place. These decisions should not be driven by corporate interests, but must be based on evidence and serve the benefits of the healthcare sector and public interest
- There should be serious consultation with the medical profession, the affected parties, as well as concerned citizens’ groups on all these issues before final decisions are taken.
The People’s Health Forum calls upon the MoH to have urgent discussions with the young doctors so that industrial action that might disrupt services can be averted, especially in these crucial times when our public sector medical personnel are stretched even more than ever.
The problem is real and it has to be addressed holistically. Attempts to ‘bully’ these young doctors into submission must be resisted. They are not the cause of this problem. Even though this problem has arisen due to the poor governance of a previous administration, the Perikatan Nasional government of the day has to handle it responsibly and fairly. – People’s Health Forum