Broken Rice Bowl By Dr Kevin Ng, Chairman SCHOMOS

Medical issues today. I received these two pictures and the article from THREE different people - two of whom are doctors (both are my cousins) and the article from someone else.  Do read my comments.

Picture above : Only the DPM Dr Wan Azizah, YB Hannah Yeo and a few other YBs are attending this Parliamentary session.

Broken Rice Bowl

Today we have been informed regarding a new circular that once again looks at reducing one of the incentives given to the hardworking and ever sacrificing healthcare professionals, which are part of the 33 critical professions involved. 

The circular dated 20th December 2019 signed by the new KPPA states that after careful review, the JPA with the approval of the Jawatankuasa Khas Kabinet Pembaharuan Perkhidmatan Awam JKK-PPA, chaired by the Most Honourable Prime Minister, has decided to remove the Critical Allowance for all newly hired staff. 

All existing staff receiving the critical allowance will continue to enjoy this incentive till retirement or leaving of service. 

This would lead to a reduction of RM 750 from the pay of our newly recruited junior doctors, already reeling from the lack of job prospects within the Ministry of Health and the Malaysian Civil Service followed by the demeaning lack of promotion upon completion of Housemanship. 

The latter issue was supposedly resolved as announced by YBMK and SCHOMOS has the assurance from YB Minister of Finance that the Ministry would look favourably upon any request made by the MOH but till today there is no formal announcement of the U43 promotions for all contract medical officers.

A little bit of history….

The critical allowance was given by the government to incentivize the positions within the civil service that was deemed to be critical to the country as well as being a position that was difficult to fill or being of low demand. 

This is as explained in the circular and the attached FAQ below. The 4 criteria are as outlined below

1. The profession selected should be within a field or area of interest as determined by the government to be of critical importance to the growth and development of the nation.

2. The profession should be one in which there is great competition for candidates with the government needing to incentivize the positions to attract the best talents

3. The profession should be one with specialized skills and expertise

4. The profession exposes the candidate to a variety of dangers and risks

Looking at the 4 criteria above, it would seem that the healthcare sector should not be affected. 

The healthcare sector has been earmarked as one of the pillars of growth and an area to develop and drive the economy. 

There is a clear need for specialized skills and expertise within all levels of healthcare, from the nurses to the HOs, MOs and specialists. All healthcare staff are specially trained to deal with the care of the Rakyat to ensure their continued wellbeing. 

The dangers and risks that all healthcare professionals and support staff undertake is immense. Daily we deal with a variety of infectious diseases like TB, influenzas and blood borne infections, with sharp and dangerous instruments, with a threat to our mental and physical health by way of the immense workload and stress imposed on us by the need to provide the services demanded upon by the patients, our clients.

I have said it once and will state again, all healthcare professionals have worked through illnesses like high grade fevers, cough and flus which would have seen most office staff scurrying for the nearest doctor for a medical day off, which we do not have the luxury to take due to the tight scheduling problems we all face. 

The current “oversupply” is again not one of too many doctors or nurses, but one of the lack of available positions to properly get the job done without taking a toll on the physical and mental well being of the healthcare professional involved. 

This Christmas and holiday season once again will see many a Doctor or Nurse who wished to celebrate with their loved ones, instead sacrifice those precious moments to answer a higher call, one to serve and save the lives of those patients under our care.

The one area that can be disputed is criteria number 2. The fact that there is a mismatch in the number of available newly trained healthcare professionals to the positions the Civil Service has on offer. This I do agree would paint a picture of a “glut” and somewhat justify the removal of the critical allowance for newly employed healthcare staff. 

However, given that we still meet the other 3 criteria, wouldn’t an employer seem more compassionate to continue with this critical allowance? Every elected representative we have met has stated that they are sympathetic to the calls and laments of the healthcare staff, but being sympathetic is not enough in this case. 

Again, a serious injustice has occurred, affecting the junior staff, and with the simple aim of reducing the wage burden on the country. While I will always support prudence, I will never agree that the prudence would come at the expense of any organization’s greatest asset, namely their staff / human resource.

I do have to be thankful that the JKKPPA had the wisdom not to pull back the entirety of the incentive from the entire government service, which was what has been “implied” during our various meetings with JPA in the past few years. 

The spirit in which the incentive was started for the healthcare professionals was in reward for the sacrifices and risks that we take daily in the discharge of our duties. I call upon the Ministry of Health to appeal to the JPA again to reconsider this revocation of this incentive for our junior colleagues in medicine, nursing, dentistry and pharmacy. The healthcare profession is still one that is growing and developing. With all the reasons outlined above, I do feel that the “critical” nature of our work cannot be disputed.

To the junior healthcare professionals, the rice bowl may be broken but we in the associations are working hard to practice the art of kintsukuroi to repair it and hopefully ensure a better future for all healthcare professionals in the future. Do stand with us to lend us your voice so that we can go further to protect your futures.

Dr Kevin Ng
SCHOMOS Chairman 2019

My comments :  There are not enough doctors in Malaysia.  

Here is some info from 2015 :

• The targeted doctor-to-population ratio for Malaysia is 1:400
• Malaysia's doctor-to-population ratio 1:633  (2014)
• Sarawak's doctor-patient ratio is 1:1104  [as of April 2015]
• Sabah's doctor-patient ratio is 1:1,500   [as of May 2014]

There are not enough doctors in the country. This is for certain. 

Most of the doctors are concentrated in the Klang Valley, Penang and major urban centers.

I believe there are also the old ketuanan politics still playing a role in determining the number of doctors in Malaysia.

To be a recognised medical specialist in Malaysia the doctors must have a Master's degree in Medicine ONLY from a local government university or IPTA. 

And access to a Master's program in medicine is highly controlled.   

Agree or not this is also for the bumiputra quota purposes.  

But way, way before that - any brand new graduate doctor must do a compulsory TWO YEARS housemanship at a government hospital before the doctor can earn his "license" to practrise medicine in Malaysia. This applies for ALL graduate doctors, from government universities, private universities, foreign graduates etc.

Then AFTER doing his housemanship the same doctor must serve another TWO years as a Medical Officer at a government hospital BEFORE he can practise medicine in Malaysia.

So everything is controlled. Despite Malaysia, Sabah and Sarawak facing a huge shortage of doctors the Health Ministry says there are not enough places for housemanship and for Medical Officers.

But Malaysia still does not have enough doctors. 

There is an acute shotage of doctors in Malaysia. 

Especially in Sabah and Sarawak.

Malaysia's doctor to population ratio is around 1 doctor for every 633 population (2015).  

That means we are about 58% short off the targeted 1 doctor for every 400 population (633 - 400 * 100%)

So why does not the Ministry of Health work overtime to increase the number of slots for housemanship training? 

Why doesnt the Ministry of Health work overtime to increase the number of slots for Medical Officer training?

There are more than enough hospitals and senior doctors to handle this. 

Here is an outsyed the box suggestion : Why not allow (meaning recognise) the private hospitals to train housemen and also employ Medical Officers?  It will help to increase the number of doctors in the country.  Malaysia's acute shortage of doctors will be decreased.

Ok here is the other story.

Suka tak suka there are ketuanan issues involved. 

• The majority of medical students at government universities are bumiputras.
• The majority of medical students at private universities are non bumiputras.
• The majority of medical students graduating from India, Indonesia, Russia are also non bumiputras.
  

By default this means that most bumiputra medical graduates from local universities will get places for housemanship and placement as Medical Officers in government hospitals.

Non bumiputra medical graduates may not be as fortunate.

So the quota mechanism is still pretty much in place. 

The 'ketuanan' arithmetic is still in place. 

There are other issues too. 

For the past six months (or so) there are not enough antibiotics in many government hospitals. 

The Minister of Health is NOT a medical doctor. 

Does he understand what is an antibiotic? 

He may not know the name Augmentin. 

The supply of medicines to government hospitals is still under a 'ketuanan' monopoly which seems to be never ending.  

Government hospitals are being supplied with generic antibiotics. 

Don't get me wrong, this is known and accepted by the government. 

Generic drugs are usually below 80% strength of "full strength" drugs - which makes them less effective.

The patients recovery is directly affected by the effectiveness of the antibiotics that are used. 

So to reach a higher strength of effectiveness, doctors at government hospitals are being forced to use a "cocktail of anibiotics" to treat their patients. 

Here the skill level of the specialists and Medical Officers at the government hospitals is important. 

But there are not enough specialists in the government hospitals  because the production of medical specialists is controlled by the 'ketuanan policies' - just like the places for housemen and medical officers (who will also become in short supply soon.)

So the head bone is connected to the neck bones which are connected to the shoulder bone which is connected to the backbone etc etc. 

They are screwing everything up - right across the board.