Hoping for a better future
More housemanship spots key to solving contract doctor issue, healthcare experts say
on Monday, young government contract doctors took a stand for their future when they walked out from hospitals nationwide to protest against the lack of job security and career progression.
The movement, known as the “Hartal Doktor Kontrak” (Contract Doctor Strike), involved 23,000 medical officers on contract and included pharmaceutical officers and dental officers.
Their request? For career security in the form of permanent public service positions with the Health Ministry (MOH).
Health director-general Tan Sri noor Hisham Abdullah, in a Facebook post on Tuesday, has since assured frontliners affected that a special taskforce led by the Malaysian Medical Association (MMA) and MOH was looking into the plight of contract doctors.
He said he hoped that they would be absorbed into permanent employment in two years or less.
In the meantime, contract officers could still continue their postgraduate education.
The problem, said former MMA and the Medico-legal Society of Malaysia president Prof Datuk Dr NKS Tharmaseelan, dates back to 2016 when contract doctors were introduced.
“The MMA was told that it would shorten the waiting period for medical graduates to do their housemanship.
“The waiting period is still one year, unfortunately.”
He said the the service terms and conditions of contract doctors were also supposed be the same as permanent officers.
“Doctors, on completing their housemanship satisfactorily, would be given a two-year contract as medical officers which is supposed to be automatically renewed.
“But this did not happen when the first batch of doctors completed their two-year contract service last year,” he said, adding that the criteria for renewal of contracts are unclear.
Dr Tharmaseelan, a professor of obstetrics and gynecology at Melaka-manipal Medical College, said reasons must be given when contracts are not renewed.
“There must be transparency,” he told Staredu.
These doctors, he explained, cannot simply pursue a postgraduate degree or venture into private
practice if their contract is not renewed.
To become a specialist, Dr Tharmaseelan said, is tough because doctors would have to serve as medical officers continuously for several years before they are selected for the Masters course in local universities.
Their other option of specialising in varsities abroad will lead to a dead-end as they would not be able to fulfill the requirements of working in Malaysia.
“We have more junior house officers and medical officers but very few specialists.
“This ratio widened with the introduction of the contract system,” he said, pointing to another disadvantage contract doctors face — their salary schemes will remain static, even if their contracts are renewed, until they retire because years of service are taken into consideration for promotions, allowances, pay rise and other perks.
“The Sword of Damocles will always hang over these doctors as the government can at any time decide not to renew their contracts.”
Dr Tharmaseelan said these young doctors also lack experience and confidence to go into
private practice because of the short housemanship stint.
“Previously, doctors had to complete at least five years of compulsory government service before they are allowed to go into private practice.
“This is to ensure that they are well-grounded in all aspects of healthcare.
“now, they are only required to do two years of housemanship and six months in a specialty, before they are allowed to venture off on their own,” he said, adding that turning the country’s many district hospitals into training centres could improve the housemanship system and quality of doctors.
During a recent virtual meet held by Malaysian Medics International, some 200 medical students based across the world, assembled to produce a memorandum.
The medical-student-led organisation listed four requests in a press release issued on Wednesday for the improvement of the country’s housemanship training system and the welfare of house officers, namely: Have six bimonthly house officer intakes per annum post the Covid-19 pandemic; address the quality of housemanship training; enable and enhance specialisation pathways; and ensure full transparency in the selection process for permanent positions in MOH hospitals.
Calling for more hospitals to be gazetted for housemanship training, Malaysian Association of Private Colleges & Universities (Mapcu) deputy president Prof Dr Pradeep nair said the housemanship period was extended to 24 months in 2009 without proportionately increasing the number of posts required for the extended training period.
Excluding Universiti Malaya Medical Centre, Hospital Universiti Kebangsaan Malaysia and Hospital Universiti Sains Malaysia, there were 48 MOH hospitals for housemanship training in 2019 but the number of graduates requiring housemanship places was many more, he said in a statement on Tuesday.
Echoing Mapcu’s call for more medical facilities to train housemen, MMA president Prof Datuk Dr Subramaniam Muniandy also proposed that a “competency list” be introduced to better prepare graduates for housemanship duties.
Many house officers, he said, struggle to cope when transitioning from medical school to hospital.