Implement shifts for doctors to prevent burnout, brain drain, says MMA

PETALING JAYA: To prevent brain drain and burnout involving doctors at public healthcare facilities, Putrajaya should consider switching to a shift system, says the Malaysian Medical Association (MMA).

MMA president Dr Azizan Abdul Aziz said that the proposed shift system was similar to the European Working Time Directive (EWTD) which requires the working week to be an average of 48 hours, while in Australia, doctors work an average of between 35 to 38 hours a week.

According to Dr Azizan, doctors in Malaysia’s public healthcare system generally work between 60 to 84 hours per week.

“To mitigate burnout and further brain drain, the MMA is proposing that the government adopt a shift system for all doctors doing active on-calls in public healthcare - three shifts per day while introducing a flexi-allowance for medical officers, specialists and subspecialists,” said Dr Azizan.

Dr Azizan also said that under the public healthcare system, medical officers (MOs) and specialists work on an on-call system where those on active on-call duty work their normal shift from 8am to 5pm and then begin their on-call hours from 5pm to 8am the next day.

“This is then followed by normal working hours from 8am to 5pm - a total of 33 hours straight,” said Dr Azizan in a statement on Wednesday (Feb 28).

“This must not go on. We cannot expect doctors to perform at their best and deliver their best outcomes when they are clocking in these unreasonable hours.

“At the rate we are going, if the status quo remains, more public healthcare doctors will leave to either private healthcare or to pursue opportunities abroad,” added Dr Azizan.

Citing figures from the World Health Organization (WHO) in 2021, Dr Azizan said deaths from heart disease and stroke associated with working long hours increased by 42% and 19%, respectively.

“The study concluded that working 55 or more hours per week is associated with an estimated 35% higher risk of a stroke and a 17% higher risk of dying from ischemic heart disease, compared to working 35-40 hours a week,” added Dr Azizan.

Dr Azizan said that between 2017 and 2022, contract MO resignations rose by 1,131% and 890 specialists resigned from the government service between 2018 and 2022.

“The harrowing realities of the Malaysian brain drain are further corroborated by the recent release of a study by the Statistics Department.

“If left unchecked, our public healthcare would be facing impending collapse,” added Dr Azizan.

When contacted, Hartal Doktor Kontrak spokesperson Dr Muhammad Yassin said the numbers provided by the Health Minister may not reflect the actual situation of doctors leaving the civil service.

“We feel that the numbers are way off than what we are seeing there could be some errors in the numbers,” she said.

To resolve the issue of doctors leaving the public service, Dr Muhammad Yassin proposed that government doctors be paid salaries and on-call allowances which are more competitive than the private sector.

“Create clear and attractive career development paths in the government sector by offering opportunities for specialisation and postgraduate education. This can help doctors build their expertise while working in the public healthcare sector,” he said.

Concurring with the MMA, Hartal said the issue of overworking and bullying allegedly involving healthcare workers must be addressed. He added that the working conditions must be improved to create a supportive and respectful work environment.

“Doctors should be encouraged to engage in research and professional development within government hospitals. This can provide opportunities for growth and recognition in the medical field,” he said.

Health Minister Datuk Seri Dr Dzulkefly Ahmad told the Dewan Rakyat on Tuesday (Feb 27) that more than half or 54% of the 1696 medical officers in the country left the public service sector in 2022, with wanting to work in the private sector being the main reason.

The ministry also found through a survey, that some 4.5% of the doctors who quit the civil service are currently working abroad.

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