KINIGUIDE | This instalment of KiniGuide looks at the problems faced by contract medical officers in the public health sector and their recent call to strike.
When did the problems start?
The contract system for medical doctors was introduced in December 2016 as a plan to address the glut of medical graduates in Malaysia.
These graduates were offered a five-year contract, starting with three years of housemanship and two years as junior medical officers.
Medical graduates returning from overseas and who already completed their housemanship abroad are offered a two-year contract as medical officers.
The contract appointments allow the government to bypass restrictions under the Public Service Department for permanent positions and hire more medical graduates.
Why is there an oversupply of medical graduates?
Former Malaysian Medical Association president Dr Ashok Phillip said the problem could be traced even further back to about two decades ago when the government attempted to increase the supply of doctors by awarding licences to operate medical colleges.
The government, however, did not build enough training hospitals or increase the number of permanent positions for medical and dental officers.
"Finally, the inevitable happened. New doctors were no longer employed as permanent staff," Ashok said in a Facebook post.
Where are the graduates coming from?
Malaysia has 32 medical schools - 11 public universities while another 21 are private colleges.
According to public health specialist Dr Khor Swee Kheng, Malaysia has more medical schools, on a per capita basis, than Australia, United Kingdom and United States (19, 33 and 179 medical schools respectively).
Additionally, there are over 300 recognised foreign medical schools under the Medical Act 1971 Second Schedule with annual returning graduates.
How many contract medical officers are there so far?
According to Health Ministry's data, there were 23,077 contract medical officers recruited since 2016, of which only 789 have been absorbed as permanent staff.
Health Minister Dr Adham Baba said the government has not stopped appointing contract doctors to permanent positions, but the number remains limited to fill vacancies left by retired doctors.
There were also recent concerns raised over opaque criteria used to assess whether a contract doctor will be offered a permanent position.
What happens at the end of their contract?
The government previously announced that the first batch of recruits whose contracts are due to expire this December has been granted an extension until December 2022.
Beyond that, their future in the public health sector remains uncertain, unless they applied and are accepted to serve in health facilities operated by other ministries.
Outside the civil service, they would need to look for opportunities in the private sector.
Who initiated the medical officers strike?
The main organisers comprise a group of contract medical officers who has so far remained anonymous but with a growing following on Twitter.
They continue to carry out their daily duties in Covid-19 and non-Covid-19 wards at various government hospitals.
Most of their updates and messages from supporters were shared on Twitter at #HartalDoktorKontrak.
Are they allowed to strike?
Sources said a group of junior medical officers from the Sultanah Nur Zahirah Hospital in Terengganu were informed they risk facing disciplinary actions if they participate in the strike.
A source said junior medical officers were not prevented from participating in the strike, but they were cautioned there would be a risk of immediate termination or non-extension of their contracts.
The Congress of Unions of Employees in the Public and Civil Services (Cuepacs) on Sunday recommended for the strike to be cancelled, with its president Adnan Mat reportedly offering assistance to act as a "mediator" between frustrated contract doctors and the government.
What exactly are they planning to do?
A member of the organising committee told Malaysiakini there are plans for contract doctors to stage a one-day walkout on July 26 at their respective public healthcare facilities. They would also stop work for 24 hours, leaving patients under the care of senior doctors.
The doctor previously said the strike would be "inevitable" unless the government met their demands, as detailed in an open letter sent to the Malaysian Medical Council and the Health Ministry.
Online portal CodeBlue quoted another member of the organising committee as saying that there would likely be a symbolic protest, akin to the "Code Black" online protest initiated by the Malaysian Medical Association’s (MMA) Section Concerning House Officers, Medical Officers, and Specialists (Schomos) that will be launched on July 1.
Why are they unhappy?
The Covid-19 pandemic has increased the overall burden on the public health sector and the group of frustrated contract doctors are finally speaking up on their pressing circumstances.
Much of the burden was attributed to a heavier workload for junior doctors due to limited personnel, despite the government's refusal to expand the available number of permanent positions.
What are their demands?
More permanent placements and equal opportunities.
Organisers said that a lack of job security and career development opportunities in the health system are among the reasons why they are proposing the strike.
At the end of five years, there are few options for the contract doctors to pursue their studies in a specialist field, unless at their own cost.
This is because such offers for further studies under government scholarship are only awarded to permanent doctors.
Aren't we in the middle of a pandemic? How would the strike affect patient care?
Several members of the organising committee had assured that they do not want their patients to be affected.
"We don't want to hurt anyone in this process, but we want those who are responsible to do something," said one doctor as quoted by CodeBlue.
Are there any proposed solutions?
Ashok in his Facebook post highlighted two options:
First, the number of private medical colleges and the number of students enrolled in them must be reduced, despite the licences granted will have conditions favouring these private institutions.
"However, the demand for seats has dropped. Some colleges have gone bankrupt.
"Their licences should be terminated and not reissued. The standards for students must be raised, and an aptitude test should be part of the entry requirements," said Ashok.
On the issue of limited opportunities for specialisations, Ashok cited a suggestion from the Malaysian Medical Association to give the doctors a 10-year contract.
"If at the end of that time they have become specialists (or are well on the way) they can be retained.
"If not, they will be well trained enough to safely become general practitioners, who are also an integral part of the healthcare system, and who must be well trained," he said.
This instalment of the KiniGuide is prepared by Alyaa Alhadjri.