Comment: A glut and a freeze that’s waiting to explode

Urgent mismatch: It is ironic that while some doctors cannot get permanent posts, public hospitals are swamped with patients who have to endure a long waiting time due to staff shortage.

IN THE last two weeks, doctors and housemen have expressed a deep frustration over the way newly trained doctors are being treated, particularly contract doctors.

Already facing an uncertain career future, the contract doctors feel that they are being sidelined, given lesser pay, shuffled from one facility to another and deprived of opportunity to specialise.

“Many house officers who worked hard and performed well did not get a permanent doctor’s post after their internship. They are frustrated and are losing hope, ” said Malaysian Medics International (MMI) chairman Dr S. S. Vikkineshwaran.

Despite the Health Minister Datuk Seri Dr Dzulkefly Ahmad’s explanations in Parliament on Oct 31 and in a press conference on Nov 8, the MMI has demanded that the ministry and the Public Services Department give more solid answers.

The ministry has introduced contract positions for doctors (and for pharmacists and dentists too) beginning December 2016 to cope with the huge number of medical graduates being churned out.

The Malaysian Medical Association (MMA) and a few other medical and dental associations have also lent their support to MMI and asked that the ministry disclose the criteria for the selection of permanent doctors, increase the number of permanent medical/dental posts yearly in line with population growth, and provide contract officers similar pay and benefits that permanent doctors get.

It is ironic that while some decent performing doctors cannot get permanent posts, public hospitals are swamped with patients who have to endure a long waiting time due to staff shortage.

A friend, for instance, took her mother to the emergency and trauma department (ETD) of a university hospital on Wednesday night after a vomiting episode and they had to wait for four-and-a-half hours before they got to see a doctor.

In a Facebook post on Sunday (Nov 10), Health director-general Datuk Dr Noor Hisham Abdullah, in response to a report by The Edge in July on the National Audit Department’s findings which revealed the conditions of the ETD at Malaysian hospitals, repeated a previous statement: “We are currently underfunded, understaffed, underpaid, overworked, overstretched and with facilities overcrowded with patients.

“We all need to try harder to improve the public healthcare system, to increase the funding, to increase the number of healthcare workers, to improve the salary scale and availability of job and posts in our health facilities; all of which are beyond the control of Health Ministry, ” he wrote.

Yes, the government has repeatedly stated that funds are lacking and the intake of civil servants has been frozen since 2015. However, while this is happening, the number of medical students graduating locally and from abroad continues to increase.

Quoting Health Ministry’s figures, MMA revealed that the number of medical graduates accepted into housemanship has increased by almost five fold from 1,049 in 2005 to 4,924 last year.

With the government leaving it to free market forces, the ministry is stuck between the devil and the deep blue sea with no additional civil service posts to offer.

The issue has snowballed since The Star raised the alarm in 2010 when doctors, as well as the then Health Minister, Datuk Seri Liow Tiong Lai, cautioning that there were too many medical graduates with limited number of training hospitals to train them.

Another concern raised was the the quality of some housemen who lack basic medical knowledge and skills, especially from certain schools abroad.

Until now, only ad hoc measures have been taken. One was a five-year moratorium on medical schools and medical programmes by the former Higher Education Ministry as an immediate measure to prevent the houseman glut from worsening. The moratorium was renewed for another five years after the first phase ended.

Senior doctors proposed that all medical graduates sit for a common local competency examination before they are accepted as housemen, which was taken up by Liow, but in June 2011, he said that the Cabinet has decided not to adopt it. Subsequently, contract posts for doctors were introduced.

Despite the moratorium and contract job measures, the issue continues to worsen. The houseman glut problem led to medical graduates waiting for more than four months for their housemanship placement, and in the last few years, the wait has increased up to a year.

Subsequently, housemen who completed their training have to wait for doctors to retire or vacate their posts in order for them to take over the posts and be officially called a “medical officer.”As the issue becomes more acute, the government introduced contract doctors’ post to reduce backlog. This is where we are now. And the glut does not affect just doctors, but also pharmacists and dentists.

On Nov 8, Dzulkefly said that between January and November this year, 6,307 medical graduates have been offered the position of contract-based doctors. There are 1,152 people on the waiting list. It has also been reported that 50% new doctors will not be absorbed into permanent post.

He said that last year, the ministry had proposed to the federal agency to create 21,741 new posts to meet the need at new and upgraded facilities. The ministry has submitted an application for 10,675 various permanent posts to the Public Service Department. But more needs to be done if the country is to avoid ending up with many jobless doctors, dentists and pharmacists.

For a start, the MMA has suggested that another 2,000 doctors be hired to meet the needs of the growing population and to prevent burnout among the serving doctors. Allowing for more permanent posts should also help as a stop-gap solution.

The MMA and Islamic Medical Association of Malaysia have also suggested that the outpatient consultation fees at government hospitals/clinics be increased from RM1 to RM5, which could provide a potential revenue of RM300mil, to fund more permanent doctors.

For better control of the number and quality of doctors produced, screening should be done even before students take up medical studies. Introducing a higher qualification entry level and an entrance examination to gauge potential medical students’ aptitude is the first step towards ensuring only suitable candidates are allowed to enter the field.

Health Minister Datuk Seri Dr Dzulkefly Ahmad has suggested that one possible solution is getting public universities to lower their intake of medical students.This is not a good solution. The medical course is beyond the means of many Malaysians and the government should provide adequate places for Malaysians to study medicine in public universities.

The government should instead reduce intake of students from private schools that do not have their own hospitals for practical training. Private schools affected may need to merge to maintain profitability, said some doctors in the past.

After all, MMA president Dr N. Ganabaskaran has pointed out that Malaysia has a 33 million population but has 34 medical schools and 43 programmes, the highest number in the world.Moreover, it was previously reported that some of the students who lack knowledge and clinical skills tend to come from certain schools. The government should investigate and de-list those schools. Why do we need to recognise more than 300 schools from abroad?

If standards are upheld and the number of universities are limited for better quality and quantity control, medical graduates may not even need to sit for a qualifying examination to ensure that they are fit to practice. However, if all else fails, the last cut needs to be done at this level.

Above all, this is not a job just for the Health Ministry but requires the government as a whole, with all the relevant ministries, to cooperate.

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