There are enough doctors in Malaysia but specialist for certain disciplines are limited, says APHM president 

by NURUL SUHAIDI / pic MUHD AMIN NAHARUL

Dr Kuljit says the shortage of doctors is less critical compared to the nurse shortages (pic: TMR)

THE shortage of doctors is not the real problem for Malaysia’s healthcare system, instead, the problem is the lack of positions for medical talents and the reduction of supporting workers such as nurses and specialist doctors in the field. 

According to the Association of Private Hospitals Malaysia (APHM) president Datuk Dr Kuljit Singh, the shortage of doctors is less critical compared to the nurse shortages. 

“There are enough doctors in Malaysia but doctors for certain specialities are limited such as psychiatrists and physiotherapy, especially in the private sector,” he said. 

To make matter worse, Dr Kuljit highlighted that Malaysian nurses are frequently relocated overseas due to their high demand abroad, particularly in the Middle East, and this resulted in the insufficient availability of nurses locally to meet the demand. 

Similarly, Tunku Abdul Rahman (TAR) movement chairman Dr Aiman Alias opined that the country is not having any manpower shortage as thousands of medical graduates are entering the system in a year alone. 

“But the real problem we are facing is lack of positions that are offered by the Health Ministry (MoH) and lack of funding to train new specialists and most importantly unconducive working environment,” he told The Malaysian Reserve when contacted. 

Toxic, Inefficient Healthcare System Environment

The healthcare system has created a toxic and inefficient environment which includes a systemic dysfunction in the management and leadership. 

Last year’s contract doctor fiasco was evidence of the crippling system that pushed many doctors to their breaking points and demanded better rights. 

When the public and private systems are uncoordinated, that’s why we have this problem, says Amrahi

“On July 25, 2021, a large number of doctors participated in the ‘Hartal peaceful demonstration’ as a direct reaction towards the contract system that they have to serve in, which clearly cause a wide disparity among the contracts from the permanent medical officers,” Dr Aiman said. 

Not only that, he said doctors also face the issue of bullying as evidenced by the 2018’s data of Doctor Only Bulletin Board System that showed 80% of MoH staff are dealing with bullying at work and even 7% are having suicidal thoughts as a result of it. 

He revealed that TAR movement, an independent mass movement involving medical doctors and health officers, was formed in response to the death of a houseman in Penang Hospital in the middle of this year as they believe in one way or the other, it is caused by workplace bullying. 

The movement’s role is also to ensure the Healthcare Work Culture Improvement Task Force, which was founded to investigate and improve the system, reports the work culture in the MoH. 

In both cases, bullying and doctor placement, Dr Aiman said although there were promises that change will be made, at the same time, there are still a lot more that can be done. 

“As a result of the of the hartal movement, MoH Minister Khairy Jamaluddin Abu Bakar highlighted that not all medical officers will be offered and guaranteed a permanent position and most of us can accept that, and around 4,186 new posts were created,” he said. 

As part of the solutions, Khairy also announced that the Cabinet had agreed to open up at least 1,500 permanent positions for doctors every year from next year to 2025. 

In addition, 800 specialist posts and 70 dental specialist posts would be opened up every year from 2023. 

Career Advancement Support

Regardless, Dr Aiman said doctors also need to be supported in their career pathway upgrades, their mental health and their work balance lifestyle need to be protected by law. 

“We know Malaysia is facing a brain drain, especially among medical professionals. Not just the pay is much better, the working environment is also way better, thus, compelling our medical professional to migrate, some return back and some don’t,” he said. 

“Therefore, alternative career pathways need to be presented to our doctors so that they can choose for themselves what is best for them. 

“People are going to move to a greener pasture and that is not a selfish move but mere a human nature that wanted a better life for their family,” he added. 

Concurring with Dr Aiman, a representative from the Gerakan Hartal Doctor Kontrak Dr Syed said experienced doctors tend to leave their workplace when they’re offered better opportunities elsewhere especially abroad. 

“Although we employ junior doctors to join the healthcare industry, if the seniors continue to leave, there will only be young doctors left in the system. 

“Furthermore, if we are going to continue giving almost ‘free’ healthcare, we need to take care of the quality as well. MoH should improve but the improvement costs are something that they don’t have which resulted in them stretching their resources to the max and risk subpar management for patients with an illness,” he added. 

On July 25, 2021, a large number of doctors participated in the ‘Hartal peaceful demonstration’ as a direct reaction towards the contract system that they have to serve in

Medicine Supply Shortage

Separately, commenting on the country’s medicine supply, Dr Kuljit noted that there has been improvement after an acute shortage in the last two to three months. 

“It is getting slightly better, not as bad as two to three months ago. Although it is slowly stabilising, it is not the best yet. 

“This issue of medicine shortage is not unique to Malaysia only as it is influenced by the external factor as the source and raw material mostly come from overseas,” Dr Kuljit said. 

Dr Kuljit added that the local suppliers and manufacturers are not that many which causes us to be still very much dependent on the external supplier and the issue has been hampered by the Covid-19 pandemic that causes a lot of industries abroad including healthcare and medicine manufacturers to stop production for a while and experience a lack of workers. 

“Usually, the supplies are depending on what type of medicine and source from various countries, hence it is hard to identify where they get the supply.” 

Commenting further on this, Malaysian Pharmacists Society president Amrahi Buang believes that the uneven impact of medicine shortages in the country point to a “systemic problem” in Malaysia’s two-tier healthcare system where public and private healthcare providers compete with each other in a complex market. 

“When the public and private systems are uncoordinated, that’s why we have this problem,” Amrahi said. 

According to him, this issue needs to be addressed in the future with a clear vision, and the government’s upcoming White Paper on health reform needs to coordinate and encompass both the public and private systems. 

Dr Aiman stated that the majority of medical experts are leaving for countries with higher wages and that Malaysia is a developing country, makes it difficult to produce its own medicine without the assistance of foreign suppliers. 

He added the lack of political will to make the improvement and inconsistent policy is also part of the factor toward these issues. 

“If we are not making necessary concrete measure in the healthcare system, we will face the consequences in years to come,” he concluded.

• This article first appeared in The Malaysian Reserve weekly print edition