Recently, we came across some doctors working non-stop in a certain hospital in Sabah. I agree that every human being needs to have adequate rest and days off; we are not machines. It is considered unethical.
How does this happen? Why aren't there enough doctors in government settings?
The answer is simple. The government is unable to retain doctors and is unable to know which hospitals truly lack doctors.
The main workforce in tertiary hospitals (for doctors) consists of house officers, medical officers, master's students, specialists, subspecialists, and lastly, consultants. It is a pyramid-shaped structure where house officers should make up the majority of the population.
Unable to retain workforce or realize what we are lacking
Due to multiple issues in the failing healthcare system (contract issues, welfare issues, inability to select placement/department, difficulties in entering master's programs), many medical officers decide to quit KKM after the compulsory service (which can be reduced to only 1 year). The same goes for new postgraduate students who choose to work overseas rather than in Malaysia due to the above reasons. Specialists will leave for private practice due to better welfare provided. These issues are not limited to doctors but nurses as well. Singapore and private hospitals offer better welfare to them.
Can you imagine how horrifying it will be in the long run for government hospitals?
Those who stay will get burnt out or stressed out and eventually leave. Communities will be unable to obtain good quality healthcare due to a lack of manpower and overworked doctors/nurses.
Malaysian healthcare is promoting global surgery, where communities should be able to get healthcare services without much delay.
It is a good initiative, but our fundamental healthcare system is too weak. It's like having Standard 1 basic mathematics knowledge but needing to take a Standard 6 exam. It's a rather peculiar phenomenon.
For those who are not in the healthcare system, it may be difficult to understand what government doctors are facing. I think I need to explain it in detail.
Graduates apply for houseman-ship via an online system. This is when you need to fight for your preferred placement, but of course, some hospitals may not open slots depending on the vacancy. You can either wait for your 1st choice hospital in the next opening (1-2 months) or choose the other hospitals.
Does KKM really know our situation whereby house officers are lacking?
- I am not sure. But a lot of hospitals are facing a lack of house officers.
Is it that the applicants are lacking? Such as 20 applicants for 100 empty slots.
Or do graduates insist on not choosing certain hospitals? Hospital A opens 20 slots, but only 1 slot is filled.
By the way, not all hospitals have house officers. Some district hospitals are comprised of medical officers with or without specialists.
- Do district hospitals have enough MOs?
After you complete the housemanship, you need to complete 1-2 years of compulsory service (previously it was 2 years, now you can apply for shortening). This is the time when you will be sent to any department or location. Some people may be able to retain themselves in their own hospitals. For now, you are still a contract MO. You can select 3 states you would like to embark on your MO-ship. But you may be given a 4th choice if your selections are all hot states (such as KL, Johor, Pulau Pinang, Selangor) - these are all hot spots.
- Let's say you are interested in the surgical department, but the surgical department has a "relatively" sufficient workforce compared to the medical department. You will be sent to the medical department first.
- Let's say some district hospitals are lacking MOs, you will be sent to those district hospitals without being able to appeal much as you are a Contract doctor.
Hence, recently there was a case about a house officer in his 6th posting who got an urgent transfer letter for his MO placement in "Hospital Beloh" because of a viral Facebook post about the lack of MOs in Hospital Beloh. KKM took very quick action after the news went viral on Facebook. The action was swift but without going through proper channels. The HO was the one who suffered and was forced to transfer in a short period of time.
Bear in mind, we are not living in past decades, where the old generation (70-90s) would do whatever it takes to earn a living. They treated their boss as a superior and their teacher with respect. But the current generation (00s) is greatly different. They cannot work long hours, they cannot withstand high stress, and they will speak up and ask for what they want.
KKM is still using old tactics towards their employees. Hence, a lot of people are leaving KKM. In the end, those who stay in the system keep getting burned out.
KKM never wants or is willing to investigate the reason they cannot retain talented doctors in their service.
- I think I have written quite a lot of articles to express my opinion on KKM about our welfare.
- Healthcare is very crucial in a country; if you cannot maintain it, it will be a disaster.
Still, there will be people telling us that we are "not grateful" and do not appreciate what we have. If you still have this kind of mentality, you will never improve. You will see doctors leaving the government and working in private practice (current phenomenon). Professionals such as engineers, programmers, petrochemists, and accountants have salaries that are way higher than government doctors.
It's time to change your mentality.
There's no need to play around with religious issues. Focus on country development and welfare.
Again, to become a doctor in Malaysia:
- You need to choose between personal life, money, and serving the nation.
Only kids make that choice.
Why can't we have all of them? It's possible if and only if our healthcare system changes!
Be positive. Life is fantasy!
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