Malaysia government contract doctors frustrated over lack of job security, benefits as COVID-19 drags on
KUALA LUMPUR: Over the last year, a Malaysian health ministry contract doctor, who wanted to be identified only as Dr Yeo, spent most of his working hours wearing full personnel protective equipment.
Each time he was on the frontline handling COVID-19 patients, his spectacles behind the face visor were fogged up by his breath. Dr Yeo could barely see, his head damp with sweat.
Despite the physical discomfort, he soldiered on to serve his country as a medical frontliner.
However, what bothered him was the fact that despite the long working hours, he had failed to land a permanent contract.
“During this pandemic, all doctors are overworked, both permanent and contract doctors,” said Dr Yeo in a phone interview with CNA.
“But what saddens me is that how contract doctors, even though they work equally hard, have no job security and get few opportunities to pursue specialisations,” he added.
After finishing medical school in 2016, Dr Yeo started work as a contract doctor under the Ministry of Health at a hospital in Selangor. He figured that it would be a stepping stone to eventually convert into a permanent doctor and pursue his dream to become a pediatrician. But things did not go as planned.
Dr Yeo was among the thousands of contract doctors in Malaysia's public healthcare system, who were offered only contractual positions by the government under a system introduced in 2016.
Local media reports have said the system was initially meant to be a temporary solution to the government's inability to offer permanent positions. But the issue has persisted and doctors on temporary contracts kept getting extended without being converted to permanent status.
Many of them who are at the forefront of Malaysia’s battle to combat COVID-19 have expressed their frustrations over unfair treatment, such as less benefits, fewer opportunities to specalise in specific medical tracks and a lack of job security.
An online campaign called #HartalDoktorKontrak or (Contract Doctors' Strike) has gained traction recently.
Health Minister Adham Baba has acknowledged that this problem exists and he said in a recent press conference that a Cabinet paper is being prepared to amend the scheme for contract healthcare workers so that they receive more benefits.
He outlined that as of May 31, there were around 35,000 contract health care workers across the country, comprising around 23,000 doctors, 5,000 dental officers and 7,000 pharmacists.
Dr Adham pointed out that some of these healthcare officers would be awarded permanent positions based on merit and their performance during their housemanship. He has appealed to them to “remain patient and calm”.
He added that the government has also recently made salary adjustments for some contract medical officers.
"The adjustment is nearly the same pay and grade as those appointed as permanent doctors. There is not much difference,” Dr Adham reportedly said.
The Malaysian Medical Association (MMA) has put forth a contrary view. It noted that only around 790 out of the 23,000 contract doctors have been given permanent positions in the country's public healthcare system.
The figure is “way too low” said Dr Yeo, who quit from the ministry in June to work alongside a general practitioner.
“After my first three years of housemanship, I received good performance ranking and marks and I thought that will give me good chance to be a permanent staff. They offered me an extension of another two years as a contract doctor instead,” he recounted.
He explained that being a contract staff made it impossible to pursue a specialisation programme to become a pediatrician.
Most specialisation programmes require four years of experience in a particular department, not taking into account the housemanship period.
A typical contract doctor would be given a tenure of around five years, of which two to three years will be the housemanship period.
The doctor would then not have sufficient time to complete the specialisation programme.
An alternative way for doctors to pursue a specialisation is via a Masters degree programme.
However, Dr Yeo said that contract doctors are ineligible for the Masters programmes, because the federal scholarship, or Hadiah Latihan Persekutuan, which allows permanent doctors to take leave from their work to be trained, is not extended to contract staff.
He added that with many of these doctors now deployed to the frontline to help with COVID-19, these training do not count towards the specialisation training required.
“The biggest problem was the uncertainty,” said Dr Yeo. “I was unable to map out my career progress and there was no guarantee that I would have a stable job at the end of the pandemic.”
READ: ‘If not us, then who?’ - Malaysian doctors overcome fear of infection in country’s battle against COVID-19
LOWER PAY, FEWER BENEFITS
A contract doctor who is currently employed with the health ministry at a hospital in Kuala Lumpur, who spoke to CNA on condition of anonymity, said those on contract also suffer in terms of renumeration.
He pointed out that these doctors are typically pegged to lower grades, and grade revisions only happen after two to three years, when the contracts are renewed.
However, permanent doctors get grade revisions automatically, based on the years of service.
“I am earning only half of what some of my colleagues who are permanent doctors earn, even though they join the service only slightly earlier than me,” he said.
He added that he wants to specialise as a surgeon but can't see any avenue where he will be able to complete the specialisation programme.
“When I finished medical school, I had lofty dreams of being successful, earning a lot of money, living in a bigger house and driving fancy cars. So far, it is nothing like that,” he said.
Another Health Ministry contract doctor who recently resigned told CNA that he was seeking "greener pastures”. He now works in a university hospital.
“My new job gives me the security of career progression that comes with a permanent contract. Also, guaranteed training to become a specialist,” said the doctor who only wanted to be known as Dr Tham.
During his tenure with the health ministry, Dr Tham was deployed to different hopsitals across several states. He served in COVID-19 wards, assessment centres as well as treatment centres.
Dr Tham was also deployed to Sabah late last year amid a spike in COVID-19 cases there.
“I think in the midst of a pandemic, every single one of us in the healthcare system are working at maximum capacity. In general, contract and permanent doctors are putting in the same shift,” he said.
“However, one difference between permanent and contract doctors is that contract staff are given an end-date to their tenure, and there are no assurances from the government that it is going to be extended. The permanent staff don't have this immediate concern."
Dr Tham also pointed out that contract doctors are not entitled to certain leave benefits such as breastfeeding leave and hazard leave, which are given to permanent doctors in the radiology and psychiatry departments.
To protest on behalf of the contract doctors, MMA’s Section for House Officers, Medical Officers and Specialists (Schomos) has launched a social media campaign termed “Code Black”. They asked all Malaysians to wear black on Jul 12 for a "Black Monday" movement.
During "Black Monday", participants were encouraged to go to work dressed in black. They were also encouraged to upload photos with the hashtags #CodeBlackMY #saveMYcontractHCW #BlackMondayMY.
Dr Tham was one of the doctors who participated in the campaign. He said it was an opportunity for all Malaysians to show solidarity with healthcare workers across the country facing issues.
“Why black? We would like to mourn the talents which have left (the health ministry) for greener pastures, and also the slow death of hope for contract healthcare workers in the country,” said Dr Tham.
In a press conference on Monday, MMA president Dr M Subramaniam said he was very pleased to see the number of Malaysians who are standing with the contract doctors.
“It’s a struggle to make these healthcare professionals go from contract to permanent, it doesn’t matter which sector. We have been trying our best to negotiate with the authorities for five years … we are fighting a very big battle.”
In the MMA press conference on Monday, Schomos chairman Dr Vijay Ganasan said the association will wait for what the government will announce to resolve the matter.
“I don’t think we want a one-year extension as a solution to the problem. It is the same as treating an illness, we are not going to just take it but will look into it closely and treat it properly,” said Dr Ganasan.
“Similarly, with the nation’s healthcare system, in order to treat it, we need a proper long term solution by giving the contract healthcare workers a permanent post. This will benefit not just the individuals but the nation’s healthcare system as well,” he added.
On Tuesday (Jul 13), Prime Minister Muhyiddin Yassin said he will discuss with the Cabinet on the appeal by the contract doctors to be appointed permanent positions in the civil service.
However, he added that fulfilling this request will cost the government more than RM2 billion (US$480,000), and that in the current situation, there are "a few limitations".