70-hour workweek for junior MDs? How about 42.5, asks exco

Penang state health committee chairperson Norlela Ariffin has called on the Health Ministry to review the maximum 70-hour workweek of house officers, per the ministry’s guidelines.

She compared this to public hospitals in Australia, in which doctors are required to work 85 hours in two weeks or 42 and a half hours a week.

She added that junior doctors in Australia work from 50 to 55 hours a week and are required a minimum of eight-hour rest along with a shift system.

“Before we look at burnt-out doctors, we need to take a step back and look at the condition and environment of the healthcare system,” she quoted from the proposal.

This was among the 13 suggestions she submitted to the Health Ministry to be considered by its task force investigating the death of a junior doctor in Penang and allegations of bullying in the medical fraternity.

In a statement yesterday, Norlela (above) said the suggestions were made by doctors who have contacted her.

Lack of funding

She said that she had discussed the 13 proposals with the Penang state health department, and was told she could apply to the state health director and health minister to invite these doctors to attend a health committee meeting.

The proposal touched on the lack of funding in the public healthcare system, which Norlela attributed to a heavy reliance on public coffers.

“What Malaysia needs is a ‘Medicare’ or insurance system like in Australia or Singapore.

“However, it carries the risk of huge political backlash. Hence, it must be modified to ensure the poor are not deprived of quality healthcare and the rich don’t get away scot-free after paying just RM1,” she said.

Australia’s ‘Medicare’ is funded by an income tax surcharge, which is currently two percent of a resident taxpayer’s taxable income.

Norlela also said there was a shortage of hospitals in the country, highlighting that Seremban only had one government-owned public hospital to cater for the entire city.

Seremban has only one government-owned public hospital

Too many house officers

She added that this goes hand in hand with too many house officers, with them landing them placements after a year of hiatus, and affecting their adaptability within the workplace.

“What we have now is neither an oversupply of doctors or lack of demand but lack of hospitals to accommodate both,” she said.

This also leads to an issue with management, she said, whereby medical officers are already overburdened with clinical duties and now they are expected to guide house officers who are somewhat deskilled.

“Medical Officers are expected to manage juniors in a high-stress environment.

“(The) problem is, they receive very little formal or informal training regarding human resource management both on the job and in medical school,” she said.

Norlela also said that some senior doctors discriminate against graduates from certain medical universities in countries such as Ukraine and Indonesia. They say these graduates lack a “good” medical education.

The proposal also suggested increased efficiency of medical diagnostic devices, pre-hospitalisation diagnostics to reduce patient overload and waiting time, and bringing hospital equipment closer to wards to prevent house officers from being treated as hospital attendants.

Bullying

Yesterday, Norlela and Negeri Sembilan state health exco S Veerapan sent the names of seven alleged perpetrators over to the Health Ministry over bullying cases at government hospitals.

S Veerapan

In her proposal to the ministry, she called for psychiatric evaluation of senior doctors, specialists and administrators who bully their juniors.

“Bullying still happens in the whole world and across all professions, but what sets us apart is the enablers - people who stand silently and let things happen - and the lack of acknowledgement, education, prevention and support by all concerned parties.

“Do a psychiatric evaluation of senior doctors, specialists, and administrators who are bullies, because it's almost like the victims who were abused have become the abusers. It looks like a vicious cycle going on for years.

“I get this excuse from senior doctors and administrators that it's part of the tough training to become resilient doctors,” Norlela said.

Lack of compassion

The Penang exco claimed there was a lack of compassion for colleagues in the workplace, including a lack of protection of meal breaks for junior doctors.

“Nurses have protected meal breaks but we doctors seldom care whether our juniors have had their meal breaks,” she said, recounting that she had once fought for a house officer to get a meal break but faced repercussions for it.

On the issue of contract doctors, Norlela said there was a need for clearer career advancements for people in the government sector.

“I still fail to understand why the government chose to force doctors to go through contracts. The government dare not do this to any other career officer under the Public Service Department (PSD).

“The stress of working without a career prospect, adds to disillusionment across the board.

“Now, it has come to the point of watching one’s own back for survival. The specialist tries to satisfy the head of department. The medical officer tries to please the specialists and the head of the department. Everyone wants to show that they can get the impossible job done. At whose expense?” she questioned.

Norlela also called for a symbiosis between public and private healthcare to reduce the burden on government doctors, as well as an independent service commission for medical and healthcare services.

“Until we fix the system, the brain drain will continue, and occasionally, someone will end his or her career or worse, their lives.

“There will be unsung heroes who continue to toil in the Health Ministry and deserters being labelled ‘pengecut’ (coward) and ‘khianat’ (betrayer). Even those who have left for private practice still carry so much emotional baggage in them that they can’t feel for the younger generation.

"What we need is nothing short of a paradigm shift,” she said. - Mkini