As Malaysia ’s health system heaves under the weight of a Covid-19 daily caseload that remains stubbornly high, thousands of young contract doctors like Anthony John are volunteering at virus response centres to ease the pressure off counterparts with permanent jobs.
The task at hand is grim, with these centres and hospitals operating at near capacity and doctors on some occasions required to triage patients based on their chances of survival.
Despite anxieties about the future of his career weighing on his mind, Dr John said he is putting in his all to the Covid-19 battle.
The 29-year-old doctor – who requested to use a pseudonym – is among 23,077 contract medical officers nationwide who are in limbo over a lack of pathways to obtain permanent jobs.
They were recruited following a stopgap policy implemented in 2016 that offered temporary contracts to housemen as a way to employ them without permanently expanding the national headcount for public sector doctors.
But since then, authorities have offered little clarity on plans for a long-term fix to the problem.
These doctors earn far less than counterparts with permanent jobs, face slow career progression dependent on contract renewals and cannot move to the private sector until they have served close to five years in the public health system – as it is mandated for all medical graduates.
Feeling burned out and overlooked by the government, thousands of contract doctors have planned to take part in a day-long walkout on Monday.
Prime Minister Muhyiddin Yassin ’s administration for weeks dithered on a response to demands by the strike organisers, but on Friday offered up a list of concessions, including a two-year contract extension after the doctors completed their mandatory service.
Contract dentists and pharmacists are also eligible for the deal.
The contract medical staff would also be given perks currently enjoyed by permanent workers such as fully paid study leave for those who are specialising in niche areas, Muhyiddin added.
The group spearheading the industrial action said the government’s 11th-hour set of concessions was a “half-baked solution” and vowed to press ahead with the plan.
Dr Mustapha Kamal, a spokesman for the Hartal Doktok Kontrak (Doctors’ Contract Strike) group, noted that the proposals were enclosed in a press statement rather than a government circular – which he said meant officials could go back on their word any time.
“As long as the government refuses to call [the strike organisers] to the negotiation table, we will proceed with the hartal,” he said. We want this solution to be in a government circular, in black and white.”
CodeBlue, a Malaysian health news portal, said in a June 28 report that “60 to 70 per cent” of the 23,077 temporary doctors had indicated to the protest organisers that they would join the strike.
In an interview, Dr John painted a picture of despair among contract doctors.
“No one seems willing to look at [the problem] at a policy level and understand what’s happening,” he said, referring to authorities who so far have largely demurred when asked about the issue.
“The future does seem really dark not just for [contract] doctors, but also nurses, assistant medical officers and all other health care workers.”.
Dr Mustapha’s group had earlier echoed such sentiment in memos sent to Health Minister Adham Baba, the Public Services Commission and the secretary general of the Health Ministry.
Earlier, authorities had signalled their disapproval of the planned strike and some doctors are currently under police investigation for publicly declaring support for the walkout.
Glut of doctors, really?
The current government’s critics laid blame for the situation squarely on the long-ruling Barisan Nasional alliance government that was incumbent in 2016.
Kelvin Yii, a lawmaker of the opposition Pakatan Harapan alliance in power from 2018 to last March, said he believed the problem stemmed from a “glut” of doctors in the country dating back to the 2000s.
He, however, said that the latest proposals represented a “good initial step” to deal with the matter and urged Muhyiddin’s government to implement the changes without delay.
Meanwhile, Dr Mathen Nair, a member of the newly-minted Malaysian United Democratic Alliance, said “there was no drastic political will to make the right decisions” and that authorities “let it linger too long and I feel that was causing it to burst right now.”
Nazihah Noor, a research associate on public health policies at the Khazanah Research Institute, said it was debatable whether the country did in fact have an oversupply of doctors – and if that is at the centre of the contract doctors’ woes.
The government has previously said the current ratio of one doctor for every 454 residents meets the World Health Organization (WHO) standards, and that it is mindful of an official “right sizing policy” for the medical workforce.
But Nazihah argued that the overall figures were unlikely to provide a clear picture of shortages in specialties, such as psychiatry. In 2018, there were 410 registered psychiatrists in the country, or 1.27 psychiatrist per 100,000 people – below the WHO requirement of 1 psychiatrist per 100,000 people.
Nazihah said: “Given the distressing effects of the pandemic, it is likely that the demand for psychiatrists would only rise for years to come – how can we produce enough psychiatrists to meet the needs of the population if we do not give junior doctors the opportunity to specialise?”
And even “if we take it to be true that there is an oversupply of doctors in Malaysia beyond the needs of the population, then it is a matter for the government to address the underlying cause, such as by looking into policies surrounding the production of medical graduates,” the researcher said.
Are the contract doctors acting in an entitled manner with their strike threat in the midst of the pandemic?
Doctors like John say their critics are being hyperbolic in suggesting the collective action would have a severe effect on the health care system. Dr John said his fellow colleagues were continuing to work long hours, in some instances non-stop for 24 hours, in personal protective equipment.
Dr Abdul Hazim, another contract doctor who agreed to speak to This Week in Asia on condition of using a pseudonym, said the entire ordeal had made him have second thoughts about staying in the Malaysian health system.
The 30-year-old, part of the first batch of medical graduates put on contracts in 2016, is now exploring opportunities to work in either Singapore or Britain.
He said the most humiliating aspect of the dual track system was the pay disparities between contract doctors and counterparts – even those with lesser experience – who had permanent jobs.
“We were working with our fellow colleagues doing the exact work but we were getting paid less than our juniors,” Dr Abdul said.
With some signs of increasing public support for the contract doctors’ cause, Dr Abdul said he hoped the strike call would be a “small win” that would alter the government’s position.
Dr Mustapha, the public face behind the planned strike, said the effort had become more than just about contract doctors. “We are fighting for the nation’s health care,” he said on Friday.
Officials from the Malaysian Medical Association and its section concerning house officers, medical officers and specialists have previously said Health Minister Adham conveyed to them that the Malaysian Medical Council – the country’s oversight body for doctors – may pull the practising licenses of those who abstain from work on July 26.
Adham’s office did not respond to This Week in Asia’s comments and the government statement on Friday did not specify if punitive action would be taken against those who participate in the strike.
This article was first published in South China Morning Post.