Consider This: Time to Scrap the Contract Doctor Scheme?

Summary

In this episode of *Consider This*, Melissa Idris discusses the Malaysian healthcare system's challenges with Dr. Kawinda Sincer, President of the Malaysian Medical Association (MMA). The focus is on the contract doctor system, which began as a temporary solution in 2016 to address an oversupply of medical graduates. Despite the government's recent announcement of over 4,000 new permanent positions, MMA advocates for the abolition of the contract system to ensure job security, career progression, and to attract more students to the medical profession. They also address the effects on doctor morale, patient care, and the growing need for specialists.

Takeaways

• 😀 The Malaysian government announced 4,352 new doctor positions in 2023 to address the shortage of doctors in the public healthcare system.
• 😀 The Malaysian Medical Association (MMA) advocates for abolishing the contract doctor system, which has been in place since 2016, and for reintroducing permanent posts for doctors.
• 😀 The contract system was introduced due to a sharp increase in medical graduates, but it has persisted for nearly 10 years, leading to issues in job security and career progression.
• 😀 Many young medical graduates are deterred from entering the profession due to the instability and uncertainty of contract work.
• 😀 Doctors under the contract system face delays in promotion, lower salaries compared to their permanent counterparts, and lack of career clarity and security.
• 😀 The lack of clear criteria for transitioning from contract to permanent positions has led to frustration, resignations, and a decrease in the number of doctors willing to join the public healthcare sector.
• 😀 While 4,352 new doctor positions are being created, MMA believes this is just a step toward solving the issue, calling for a permanent solution to the contract system.
• 😀 The contract system also affects the morale of doctors, their training opportunities, and their willingness to work in rural areas due to additional personal costs associated with relocations.
• 😀 Doctors working under the contract system are still expected to contribute to on-call shifts, yet their on-call allowance is minimal, leading MMA to call for significant increases in compensation.
• 😀 The lack of permanent posts and the lower wages are contributing to an exodus of medical professionals to countries like Singapore, the UK, and Australia, exacerbating the healthcare workforce shortage.

Q & A

Why was the contract employment system for doctors introduced in Malaysia?

The system was introduced in 2016 due to a sudden surge in medical graduates—from around 3,000 to 6,000 annually—which exceeded the available permanent housemanship posts. Contract employment was a temporary solution to allow doctors to start training earlier while permanent posts were limited.

How long has the contract system been in place, and was it intended to be permanent?

The contract system has been in place for almost 10 years. It was intended as a short-term solution but has lingered far longer than planned.

What are the main disadvantages of being a contract doctor compared to a permanent doctor?

Contract doctors face delays in promotions, lower salary progression, no counting of contract years toward permanent service, financial burden when relocating, lack of job security, and unclear criteria for conversion to permanent posts.

How has the contract system affected the morale and retention of doctors?

The system has led to discontentment, resignations, and lower enrollment in medical schools. Many doctors leave the public healthcare system or move abroad due to uncertain career progression and job insecurity.

What impact does the contract system have on patient care?

Overworked and under-motivated doctors may compromise patient care. Junior doctors often bear heavy workloads and long on-call hours, which can affect their ability to provide optimal care.

What has the Prime Minister announced recently regarding doctor employment?

The Prime Minister announced that 4,352 new permanent doctor positions will be created to help convert contract doctors to permanent posts.

Why does the Malaysian Medical Association (MMA) want the contract system abolished completely?

MMA believes abolishing the contract system would restore job security, improve morale, encourage students to enter medicine, ensure fair career progression, and ultimately improve patient care.

How does the contract system affect doctors seeking specialization?

Contract doctors face limited access to specialization programs because their contract years are not counted toward permanent service, and entry often requires a finite scholarship, restricting the number of trainees.

What solutions have been proposed to address the issues with contract doctors?

Proposed solutions include abolishing the contract system gradually, creating sufficient permanent posts, standardizing on-call allowances, increasing transparency in permanent conversion, expanding specialization pathways, and forming a healthcare HR governing board with authority over workforce planning.

Why is urgency emphasized in resolving the contract doctor issue?

If reforms are delayed, Malaysia risks losing more doctors to other countries, lower medical school enrollment, worsening workloads, and compromised patient care. Immediate action is necessary to prevent further deterioration of the healthcare workforce.

How does the contract system financially burden doctors?

Contract doctors who are eventually converted to permanent posts must bear the cost of relocating to new postings themselves, which can amount to significant sums, especially when posted to rural or remote areas.

What role does the MMA play in advocating for doctors?

MMA represents the interests of doctors, highlights issues affecting morale and patient care, meets with the Ministry of Health and the Prime Minister, and advocates for reforms such as abolishing the contract system and improving on-call allowances.