Junior doctors say they will resign with or without Hartal

by AZALEA AZUAR / graphic by TMR

FIVE years since the introduction of contract doctors in national healthcare, more junior doctors are expected to throw in the towel.

Hartal Doktor Kontrak spokesperson Dr Mustapha Kamal A Aziz said the government always says that it has no money or no budget to hire permanent doctors, which he thought was nonsense.

“I believe that even without the hartal, many contract doctors would still resign.

“I think the long-term implications are more towards the healthcare system itself rather than the doctors, but we have to do what it takes to survive,” he told The Malaysian Reserve (TMR).

The group had planned a second nationwide protest where over 5,000 contract doctors were expected to participate on Dec 8, but it was called off.

This was in response to the government’s failure to provide contract doctors with permanent posts during the Budget 2022 announcement. The budget stated that 10,000 trainee doctors’ contracts will be extended by another two years instead.

However, on Nov 26, Health Minister Khairy Jamaluddin said their plight would be brought to the Cabinet.

Up until Nov 26, a total of 1,778 contract doctors have quit since 2017, based on the breakdown provided by the Ministry of Health (MoH) last month. The MoH introduced the contract doctor system on Dec 15, 2016, to reduce the glut of medical graduates waiting for housemanship.

According to Malaysian Medical Association president Dr Koh Kar Chai, the government has yet to create more permanent positions and are still relying on contract positions even though permanent doctors are necessary to maintain an efficient healthcare system.

“It is hoped that a longer contract position of seven to 10 years be given, so as to enable these doctors to specialise as doctors need years of training to become specialists.

“Proper projections are needed by the Public Service Department Malaysia on the number of healthcare workers required to serve the country on a permanent basis, but if we have 3,000 to 6,000 medical graduates each year, we will not see an end to the problem,” he said to TMR.

He added that since there are more than 22,000 contract doctors in the country, it would be difficult to absorb them into permanent positions, which would involve a long-term financial commitment.

“A number of positions should have been given each year, but out of the 23,000 doctors on contract, only 1,000 were given permanent posts since the contract system started in 2016,” Dr Koh explained.

He warned that a moratorium is needed or else, thousands more will be added to the contract system with no permanent positions opening up.

“The career uncertainty will affect the morale of the contract doctors. Over time, as we are seeing now, the issue will affect the standard and quality of our public healthcare.

“Those who have had enough might give up medical practice altogether or leave for greener pastures abroad. Many will also be discouraged to pursue a career in medicine,” Dr Koh added.

Despite Budget 2022 being Malaysia’s biggest yet and with the healthcare sector receiving the second-highest allocation, there is barely an increase compared to the previous budget (1.5%).

Dr Koh felt that the healthcare budget should be increased to address the growing needs of the population, regardless of there being a pandemic or not.

“Cases of non-communicable diseases are on the rise and Malaysia will also soon be reaching an ageing nation status where the demands for geriatric services in healthcare is expected to increase.”

To meet the criteria for the Universal Health Coverage, at least 5% of the nation’s GDP should be budgeted for healthcare spending.

Hence, Dr Koh recommended that Malaysia should increase the budget to 4% and aim for 5% within a few years.

“Permanent positions should be planned and created for the contract doctors wherever possible.

“This will bring stability in the system and set the foundation for specialists serving the nation’s healthcare in the future,” said Dr Koh.