Unhealthy state of affairs that led to doctors’ strike

 

The problem of too many contract doctors and too few permanent places cannot be solved unless all of government and the private sector work together.

PETALING JAYA: If a pail is overflowing with water, the natural thing to do is to turn off the tap.

But in the case of the supply of doctors, the tap had been left on for more than a decade.

No government – not the Barisan Nasional (BN), Pakatan Harapan (PH) nor Perikatan Nasional (PN) – had been serious about tackling the problem as a whole and at its source.

Based on statistics from recent years, there were 5,000 to 6,000 medical graduates starting their housemanship at government training hospitals every year, with more than two-thirds of them produced in private medical schools in Malaysia and overseas.

This number of medical graduates is way too many for the country.

It’s mind-boggling how the government could let the free market run wild and the private sector produce a massive number of doctors and healthcare workers – and then leave them all out in the cold.

This was the predicament of more than 23,000 contract doctors in the country which led them to carry out a strike on Monday. Their problem was shared by other healthcare workers, too.

The doctors were frustrated that they were overworked, had no job security, no promotion or increment, no holidays, and no chance to advance their careers while being pushed around. Worse, now they are called to sacrifice their lives as frontliners during the Covid-19 pandemic.

If there is one unspoken fear for this huge number of contract doctors, it is the loss of jobs – especially in the field they are trained in – after their contract with the government ends.

With 8,000 GPs in the country, it’s not likely that many of them will be hired while they lack the funds to set up new clinics. Private hospitals cannot absorb all the 23,000 contract doctors.

They have given a huge portion of their lives to be trained as doctors, some for up to 10 years. Now, it is shortlived.

Yes, no one owes anyone a living but bad policies and manpower resource planning harm doctors as well as patients.

Several parties need to be held accountable on this issue.

Firstly, private medical schools have a social responsibility too and should commit to reducing intakes. What kind of commitment are they willing to give to reduce intakes, especially for those that do not have their own private hospitals to train or absorb the graduates after the doctors’ contracts end?

Then, there’s the higher education ministry. Former Malaysian Medical Association (MMA) president Dr Ashok Philip said a test of the government’s resolve and sincerity in tackling the issue would require that it cut down places in private medical schools by 50% over the next five years.

He said the government should also raise standards by improving lecturer-student ratios, raising entry requirements and ensuring that schools have their own teaching hospitals.

“If this is not done, we are fighting a fire without turning off the fuel,” he said in a Facebook post on July 26.

There have also been suggestions that private medical schools that have few students should merge.

Judging from the burnout that healthcare workers are suffering from currently, and the long wait time for patients even before the Covid-19 pandemic, there is obviously a need for more hospitals, doctors and other healthcare workers.

For this reason, the Public Services Department (JPA) should increase the number of permanent doctors and specialists, and attract more of them to serve in rural areas.

While the finance ministry finds ways to increase funding for the public healthcare sector, there is also an urgent need to start plugging the hole in the wastage.

Hospital construction delays and cost overruns

Why is no one made accountable for project delays and cost overruns?

In a webinar titled “Corruption in the Supply Chain” by CBI-IDEAS on June 22, former deputy health minister Dr Lee Boon Chye pointed out that millions were wasted on cost overruns in hospital construction delays.

According to Lee, work on Hospital Petrajaya Sarawak, a 300-bed hospital costing RM495 million, began in 2013 and was to be completed in 2016 but that did not happen, and the contractor was terminated in 2018.

A re-tender was done and the cost was expected to exceed RM2 million per bed (RM600 million in total), he said.

Lee added that the 80-bed Hospital Lawas in Sarawak initially cost RM175 million when construction started in 2012 but the earliest it can be completed will be 2023 – at a cost of RM240 million – or a whopping RM3million per bed.

Hospital Bera in Pahang, a 40-bed hospital, was initially budgeted at RM88 million in 2015 but the project was delayed by five years and the cost went up to more than RM120 million (also RM3 million per bed).

All that money wasted could have gone towards hiring more permanent doctors, even if not all could be absorbed.

Next, what is the Cabinet and the government doing about the oversupply of doctors?

While the health ministry has been criticised for not taking the lead to solve the issue, it also needs the support of the Cabinet and the government as a whole.

Over the years, various health ministers have brought the matter up to the Cabinet but no one had committed to tackle the issue seriously, which led to the contract doctors’ strike on Monday.

Prime Minister Muhyiddin Yassin has postponed the problems by allowing an additional two-year or four-year contract extension (for those taking up a specialty).

Incompetent medical graduates

Besides the huge number of medical graduates being churned out, there is also the issue of quality.

For many years, senior doctors have complained that some incompetent doctors had gotten into the system and most tend to be from certain schools.

The higher education ministry may have imposed a moratorium on new medical schools, medical programmes and capped the number of students but it has not seriously tried to weed out incompetent medical graduates.

Doctors have suggested a higher entry-level and aptitude test for potential students. They would like to see candidates sitting for a medical qualifying examination before entering housemanship.

However, in the last decade, both requests have not been entertained. It may also be time to delist some of the medical schools overseas which do not meet standards.

The higher education ministry, the Malaysian Qualifications Agency (MQA) and the Malaysian Medical Council (MMC) will have to work on these quality issues.

Ultimately, the doctors’ employment problem cannot be left to the health ministry alone to solve.

While it should take the lead, it requires the support of the whole of government as well as the private sector. - FMT