The recent HARTAL movement has reignited a number of ongoing, fruitless discussions surrounding the welfare of contract doctors in Malaysia.

Since the contract system was announced in the 2017 Budget¹, and subsequently implemented, numerous issues including unequal pay and benefits along with the lack of job security and career advancement has left a majority of junior doctors hopeless, leading them to leave the Ministry of Health or seek jobs elsewhere.

Faltering discussions related to the welfare of contract medical officers have directly contributed to the unfortunate circumstances of a nationwide doctors' strike which MMI believes is a zero-sum choice between the welfare of Malaysian doctors and the well-being of the rakyat in the midst of a pandemic.

MMI calls on the MOH to consider and address the root issues aggravating and perpetuating the injustices of the current contract system — a key catalyst in the HARTAL movement — by taking the following steps.

1. Equal opportunities for competency-based career progression for all Malaysian contract medical officers

Consistent with the statement dated June 26, 2021 by the Malaysian Medical Association Section Concerning House Officers, Medical Officers and Specialists² (MMA SCHOMOS), MMI stands firm in advocating for the welfare of all contract medical officers, irrespective of race, religion, ethnicity, gender orientation, political leanings, and/or personal and professional backgrounds.

We strongly emphasize the need to consider all contract medical officers equally for opportunities in career progression, as an inclusive and diverse workforce is needed to attend to the health needs of a multicultural population.

2. Extended contract system for currently contracted doctors

Our previous statements dated — August 26, 2020³ and November 5, 2020⁴, have called for the provision of permanent positions to our current contract medical officers.

However, MMI now recognizes that the introduction of an extended contract system presents greater opportunities for the development of the Malaysian healthcare workforce, compared to simply providing permanent positions to contract medical officers, partly due to the need to increase the number of competent specialists within the country.

Nevertheless, our original intentions remain unchanged, and our efforts in advocating for improvements to the welfare of contract medical officers will continue — encompassing equal pay, benefits such as allowances and tax reductions, eligibility for leaves (including study leave), and Hadiah Latihan Persekutuan (HLP).

MMI believes that previous suggestions for contract medical officers to finance their own specialty training abroad — made by the Malaysian Minister of Health YB Dato' Sri Dr. Adham bin Baba — are untenable, due to the ineligibility of contract medical officers to apply for study leave, the relative financial inaccessibility of undertaking specialty training abroad, as well as potential issues with local accreditation of overseas specialty training programs.

The direness of this situation is further accentuated by the fact that only 61% of the MMA's projected national requirements for specialist doctors is being met, with a shortfall that is in excess of 4000 specialists across the public and private sectors⁵ — a message echoed by the MOH Medical Development Division, in the 2016-2020 Specialty and Subspecialty Framework⁶.

MMI now calls upon the MOH to implement an extended contract system for medical officers, to provide some much needed job security to medical officers, and provide them with sufficient time to complete their postgraduate specialty training.

Considering the important role that specialists play in both tertiary healthcare provision and medical education, it is clear that this shortfall must be bridged imminently.

Granting contract extensions to medical officers permits these specialists-in-training to continue developing professionally, while incentivizing them to prioritize their professional development due to the competitive selection process.

3. Complete transparency in selection criteria

While MMI commends the MOH's recent assertion (dated June 27, 2021) that medical officer contracts will be awarded based on merit and performance⁷, we strongly recommend that the MOH considers making the full selection criteria for awarding contracts available on the public domain, so as to ensure full transparency in the selection process.

Additionally, to enable candidates to be systematically compared, we recommend that the existing selection criteria be modified to reflect objective measures of candidate performance (e.g. number of procedures performed, evidence of interest/involvement in specialty training), instead of the current system that is heavily reliant on the subjective assessment of candidate performance by their supervisors, as laid out in the Laporan Penilaian Prestasi Tahunan (LNPT) document⁸.

Further suggestions include the publication of selection scores and competition ratios for contracted positions, and the institution of national-level postgraduate assessments prior to contract extension being awarded, expanded in our statement dated August 26, 2020³.

MMI also recommends that these selection criteria are communicated to all candidates under consideration, ideally by the heads of the selection panels (i.e. Ketua Jawatankuasa Teknikal Pelantikan Tetap), either through official correspondence (i.e. surat pekeliling) or seminars.

This would help ensure that candidates are well-versed in the selection criteria and well-supported throughout the period they are being assessed (tempoh penilaian), while dispelling any purported unfairness in the selection process, increasing self-perceived job security among candidates.

The publication of fair, robust, transparent selection criteria would set all candidates in good stead to compete for contracted positions, thus raising the overall quality of the Malaysian medical workforce, while minimizing candidate dissatisfaction.

In conclusion, MMI urges MOH to take immediate consideration of the aforementioned issues, to avoid the aggravation of systemic issues such as the chronic lack of specialists, brain drain, and the maldistribution of healthcare workforce and resources between urban and rural areas — all of which will ultimately condemn the health of our rakyat.

We are overworked and underpaid, yet remain at the frontlines of the fight against COVID-19 to uphold the health of the nation, out of patriotic duty. We have pledged to serve the best interests of the rakyat. However, if this situation persists, we will continue to see the deterioration of an already collapsing Malaysian healthcare system. Inevitably, we, the graduating medical students and junior doctors, will be forced to turn our backs on a system that has failed us, in pursuit of greener pastures where our well-being is a priority.

Malaysian Medics International

References: 

¹ The 2017 Budget Speech. Mof.gov.my. 2021 [cited 29 June 2021].

² Healthcare is Color Blind. MMA Schomos Facebook. 2021 [cited 29 June 2021].

³ Press Statement "A Call for Resolution on Issues Faced by Contract Medical Officers". Static1.squarespace.com. 2021 [cited 29 June 2021].

⁴ Press Statement "A Call to Provide Permanent Positions to All Contract Doctors". Static1.squarespace.com. 2021 [cited 29 June 2021].

⁵ Doctors Need Longer Contracts, Malaysia Lacks Specialists, Medical Groups Say. CodeBlue. 2021 [cited 29 June 2021].

⁶ Specialty & Subspecialty Framework Of Ministry of Health Hospitals Under 11th Malaysia Plan (2016-2020) [Internet]. Ksm.moh.gov.my. 2021 [cited 29 June 2021].

⁷ PENJELASAN MENGENAI SALAH TAFSIRAN BERHUBUNG KENYATAAN MEDIA KEMENTERIAN KESIHATAN MALAYSIA TERHADAP KERATAN AKHBAR BERTAJUK "TELITI SEMULA URUSAN PENGAMBILAN PEGAWAI PERUBATAN". Facebook. 2021 [cited 29 June 2021]. Available from: 

⁸ LAPORAN NILAIAN PRESTASI TAHUNAN (LNPT). Docs.jpa.gov.my. 2021 [cited 29 June 2021].