Doctors’ dilemma


INSUFFICIENT permanent posts and uncertainties in specialist progression pathways due to contract employment status have reportedly led to a medical brain drain in the country, as medical graduates seek job opportunities abroad where they also stand to gain from higher financial remuneration, better healthcare systems, and improved work culture and work-life balance.

The extent to which some of these medical graduates are willing to go to secure jobs overseas indicates the dire need to address the issue of employment among doctors in the country.

While graduates from a few local medical schools with recognised degrees can apply to work at countries such as Singapore, Australia and the United Kingdom without taking additional examinations, others are required to take expensive licensing examinations recognised by the desired country’s local medical council in order to obtain a medical licence allowing them to practise medicine at that country.

Fees for such licensing examinations can range from RM6,391 (£1,189) for the United Kingdom’s Professional and Linguistic Assessments Board (PLAB) test, up to RM10,813 (US$2,415) for the first two of the three-step United States Medical Licensing Examination and RM20,060 (AUD$6,650) for the Australian Medical Council Multiple Choice Question and Clinical Examination.

Applicants who pass these examinations and fulfil other requirements for licensing could then proceed to apply for jobs at hospitals with vacancies and attend interviews, with no guarantee of securing a job offer in the end.

Commenting on the issue, United Nations University principal visiting fellow Dr Indra Pathmanathan said the crux of the dilemma is the large influx of doctors applying for permanent positions in the country.

“The problem began during the 1990s when large numbers of medical schools were established in both the private and public sectors, from six in 1995 to 30 in 2011, along with a large increase in the number of scholarships for students to attend foreign medical schools.

“A decade later, we suddenly had a large number of new medical graduates – from 780 in 2001 to 3,565 in 2011,” she told StarEdu.

These graduates, she said, are of very varied quality but all are equally expected to become house officers in the government sector, since this is a prerequisite for being registered as doctors.

Limitations in vacancies for non-specialists in the private healthcare sector and the need to be in the government sector for specialist training, she added, lead to the expectation that most doctors would get employed in the government sector.

The reality, however, is that there are financial challenges to expanding the number of posts every year.

“The Health Ministry has routinely requested for a budget and posts only for the historically expected numbers, not for the sudden almost four-fold increase in new graduates.

“It takes time and budget provision to create additional posts,” said Dr Indra.

The situation became even more dire during the height of the Covid-19 pandemic, when there was an overwhelming demand for more doctors but at the same time, there was a large number of unemployed new medical graduates.

Dr Indra asserted that the only speedy option available to the Health Ministry is to create temporary or contract positions to meet the crying need for doctors during any period of medical emergency.

Malaysian Medical Association (MMA) president Dr Muruga Raj Rajathurai said with the contract system, which was introduced in 2016 to address the glut of medical graduates, there is no job security or clear career pathway.

“There have also been no clear selection criteria provided for absorption into permanent posts.

“Difficulty in applying for housing loans with banks is also another issue as there is no proof of secure employment,” he said.

With more permanent posts committed for each year, Dr Muruga said the country would be able to reduce brain drain to some extent.

He shared that the MMA had also requested the Health Ministry and the Public Service Department to look into better remuneration, selection criteria for permanent posts, subspecialist allowance, JUSA grades for senior doctors, maldistribution of doctors causing burnout among healthcare workers, and improving the work environment and culture.

A fair, transparent, competitive, merit-based system for getting postings and career progression, noted Dr Indra, would go a long way to retaining doctors and ensuring a better distribution of doctors throughout the country.

“Typically, doctors look for career progression, job satisfaction and family lifestyle such as living conditions and education opportunities for their children.

“With a supportive ecosystem that encourages them to develop their talents, in terms of how they are supervised, supported and encouraged, and also the facilities and technology available to them, all of this would help reduce the brain drain,” she said.

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