Covid ICU in hospital may 7Contract doctors face a bleak future without the certainty of permanent positions in the public sector, even though Malaysia is struggling with the lack of medical professionals, a gap made stark by the Covid-19 epidemic.

Their five-year contract is insufficient to complete postgraduate specialty training in the public health care system. Contract doctors also face discrimination in wages, benefits like allowances and tax reductions, and leave, besides ineligibility for the Hadiah Latihan Persekutuan study grant for local master’s programmes.

Only 789, or just 3.4 per cent, of 23,077 contract medical officers appointed from December 2016, when the contract system began under the Barisan Nasional (BN) administration, to May 31 this year were given permanent posts. This leaves 22,288 government doctors still under contract.

Health Minister Dr Adham Baba said Wednesday that the government has increased the salary and grades of contract doctors from UD41 to UD43, almost at par with their UD44 permanent counterparts. Clearly, a promotion isn’t enough to resolve job uncertainty for contract doctors who face the prospect of not being able to practice medicine soon.

Hence, the planned July 26 strike by a group led by Dr Mustapha Kamal A Aziz until the remaining 22,288 medical officers receive permanent posts. However, demanding the instant creation of more than 22,000 jobs is unrealistic, given that MOH only received a marginal 4.3 per cent increase in its budget for 2021 from its 2020 budget.

MOH’s 2021 budget of RM31.9 billion goes mostly to operating expenses at RM27.2 billion. Of the ministry’s RM27.2 billion operating budget, emoluments made up the biggest portion at RM17.1 billion. In other words, staffing costs comprised more than half of MOH’s overall budget.

Where does Dr Mustapha’s group propose cuts to fund the annual wages of 22,000 extra doctors until retirement? Which part of MOH’s budget does the group suggest diverting to new jobs? If not MOH’s budget, then which ministry’s budget does it plan to cut? Covid-19 severely affected the national economy, as government aid falls far short of the needs of people on the ground entering poverty.  

Although I tweeted previously on June 28 that budgets of other ministries should be cut to fund the creation of permanent posts for contract doctors, I realise that there isn’t much room for maneuvering. Diverting funds from the Education Ministry, which received the largest budget for 2021 at RM50.4 billion, for example is unfair when children would have lost nearly two years of schooling by year end.

The Covid-19 epidemic took a turn for the worse this week, with 30,505 cases reported nationwide from June 27 to July 1, an 18.5 per cent increase from 25,732 cases the same five-day period the previous week (June 20-24). The country is also witnessing an increase of coronavirus patients turning up seriously ill or when they’re already dying.

A strike by doctors on July 26 – when the health care system is almost certain to collapse – will most likely lead to the deaths of patients. Even though the #HartalDoktorKontrak group promised not to recruit contract doctors from Covid-19 hospitals, the increasing severity of the epidemic will necessitate the mobilisation of most public health care facilities and staff.

As it is, overworked and underpaid government health care workers are burned out more than a year into the epidemic (and yes, this includes contract doctors). Getting colleagues to cover the duties of contract doctors during a strike – which organisers threaten to extend beyond one day – only adds to exhaustion (and possible mistakes in clinical care). 

#HartalDoktorKontrak is not punishing the government with their strike, but ordinary Malaysians. Far be it for me to remind doctors about their “first, do no harm” maxim, but to abandon the care of patients (whether Covid-19 or otherwise) at the height of a crushing epidemic seems unconscionable to me.

I sympathise with the plight of contract doctors who face job insecurity in the near future. However, many Malaysians can’t even put food on the table right now, driving some to suicide. What makes doctors so special?

To be forced to stop practicing medicine after spending hundreds of thousands of ringgit and years on medical school is gut-wrenching, I’m sure, but many people switch careers throughout their life. None of us are entitled to our preferred job. The world doesn’t owe us a living.   

The problem with the contract system for government health care professionals – not just for doctors, but also dentists and pharmacists – was more than a decade-long in the making. Consultant physician Dr Pagalavan Letchumanan foresaw back in 2006 that Malaysia would face a surplus of doctors from 2009 due to an increase of medical schools. Malaysia has among the highest number of medical schools per capita population.

Yet, Malaysia is facing a shortage of specialists at only 3.9 specialists to 10,000 population as of June 30 last year, according to the Academy of Medicine of Malaysia, more than three times fewer compared to the OECD average of 14.3 specialists to 10,000 population.

The burden on Malaysia’s public health care system significantly increased, even before the pandemic. Patient visits to government hospitals and clinics rose to about 77 million in 2019, about 4.5 times higher than the 17 million visits in 2008.

Even as Covid-19 further strains the public health care system, the true burden will only be seen later as the clinical needs of non-Covid patients, ignored during the epidemic, surface and many more Malaysians, left poorer from economically devastating lockdowns, switch from private to public health care.

Malaysia’s dual public-private health care system and health care financing are in dire need of reform. Paradoxically, even as Covid-19 exposes large gaps in our health care system, any funding reform – such as social health insurance or raising patient fees at government health facilities – will be put on the backburner when we pick up the pieces to rebuild years of progress undone by the pandemic.