The major issues causing brain drain among doctors

The major issues causing brain drain among doctors




From Dr Timothy Cheng


I read with interest the articles on the brain drain of doctors.

This issue is not a new one. I graduated from Universiti Malaya as a doctor 10 years ago. About 30 of my batchmates eventually left the system and are working in Singapore.

Four years later in 2016, the government introduced the contract doctor system — a messy, temporary “solution” to the long waiting times for housemanship and lack of permanent posts.

Rather than solving the problem, it greatly worsened the problem of brain drain and loss of Malaysian talent.

The unfairness in salaries and benefits; lack of postgraduate pathway (until recently); job uncertainty; double standards by administrators and so much more drove the sinking ship underwater.

I saw bright and capable junior doctors leave the system in search of a better future outside the Malaysian government system.

Do not blame just the health ministry, but also the finance ministry and the public service department (JPA).

Here are some of the major issues:

Subtle discrimination

Contract doctors have been discriminated against — not just by hospital directors but also state health directors. An email by a university hospital in Kuala Lumpur showed that certain duties were only to be performed by permanent doctors — despite them having the same training and seniority as contract doctors.

Another state health director repeatedly asked during a meeting: “Do you need medical officers? How about just contract doctors?”

This was the same state that insisted on the word “contract” being written on name tags of doctors. This ridiculous practice was only stopped after repeated emails to the health ministry. After that, a circular was issued to ban the word “contract” from name tags.

Benefits such as flight warrants and hazard leave were only granted recently after multiple meetings and letters.

Do not underestimate the power of such words in making contract doctors feel unwanted and thus driving them out of government service.

This also influences the way administrative staff speak to them. Very often, a contract doctor is treated differently simply because they are not permanent staff.

Salary schemes, grades and contract duration

Up till today, there is still no news on the promotional grades and salary schemes for contract doctors. What happens after UD43? Why does it not correspond to the salary scheme/grade for permanent officers?

The current system is “3 + 2 + 2 years” of contract duration; or an additional four years, should the doctor qualify for a postgraduate training programme. There is no clear pathway for those who do not qualify yet. Will they be terminated?

Remuneration

There is a long overdue review on on-call allowances and salaries. A government doctor gets paid RM220 for a weekend on-call shift. That comes up to RM9 per hour for 24 hours of work. How do we expect to retain government doctors with that?

Sub-specialists have the same salary as general specialists. This does not mean that the work done by general specialists is less important, but if we send a doctor for three years of training (many with families, some with inadequate allowances) and they come back to the same salary as their general specialist counterparts, why would they want to remain in government service?

Come this new year, we hope that our new prime minister-cum-finance minister and the health minister will look into these issues.

Many issues lie with the finance ministry and JPA, which must work together with the health ministry to retain doctors in government service for the sake of the public healthcare system.



Dr Timothy Cheng is an orthopaedic surgeon and an FMT reader