Imagine spending a fortune to study only to end up with no job security. Being a doctor was once a profession every parent dreamed their child would pursue. Today, it is one of the most overstretched and underpaid jobs in Malaysia. Over the last three years, a staggering 3,346 contract doctors have resigned. What led to this drastic change? In this article, we'll do a breakdown on why being a doctor is the worst job in Malaysia and the challenges we face to rectify it.
History
It all started in the early 2000s, many doctors left government practice to work for the higher pay offered by private sector. Instead of addressing the root cause, the government chose to produce more medical students. This led to the establishment of 32 local medical schools by the late 1990s and early 2000s—more medical schools than Australia has.
The Contract System
In December 2016, the Ministry of Health introduced a contract system as a temporary measure to manage the backlog of medical students, the shortage of permanent positions, and the lack of training programs. Under this contract, junior doctors received a five-year contract: three years as housemen and two years as medical officers (MOs). The starting pay for a houseman is RM 2,947, increasing to RM 3,397 as an MO—that’s a mere RM 400 increment. Imagine spending so much money to become a doctor only to be given a five-year contract with no job security!
This system left many junior doctors without job security, let alone adequate training. Getting certified to treat the sick isn’t sufficient to be a doctor. To be a good doctor, you need hands-on experience and guidance from senior doctors. However, because of the excess of contract doctors, there was a lack of guidance from senior doctors. Many junior doctors are forced to face high-pressure working environments alone, with a steep learning curve and limited opportunities for career progression. This is especially concerning as Malaysia becomes an ageing society with increasing demands for specialised medical care. According to experts, Malaysia needs 23,000 specialists in the next six years, but the current system limits the number to 8,972 specialists. This shortfall affects everyone, not just doctors. The lack of specialists means longer wait times and reduced access to quality care for patients.
The Impact of the Covid-19 Pandemic
Speaking of high-pressure working environments, when the COVID-19 pandemic hit Malaysia, the flaws in the contract doctor system became glaringly evident. Contract doctors worked tirelessly on the front lines which led many of them to burnout and tender their resignation. Many doctors expressed their frustration and mental health struggles, which led them to initiate the "Hartal Doktor Kontrak" rally on July 26, 2021. They demanded equitable treatment, better working conditions, and career progression opportunities. Despite risking their lives during the pandemic, these doctors still faced job insecurity and limited career prospects.
Madani Government’s Response and Ongoing Challenges
In response, the Madani government has attempted to address some of these issues. The Budget 2024 allocated RM 41.2 billion to the Ministry of Health, with more than half designated for increasing contract doctors' pay. Prime Minister Anwar Ibrahim announced the creation of 12,800 permanent positions by 2026, with 6,000 to be absorbed by 2025. On-call allowances have also been increased to RM 80 per hour. To boost specialisation, the ministry has incentivized junior doctors with full-paid study leave and Federal Training Allowance under the Hadiah Latihan Persekutuan program.
Experts suggest several long-term solutions, including extending contracts to ten years, matching salaries with permanent counterparts, and maintaining the quality of medical school graduates. Some even propose a clock-in, clock-out policy for better work-life balance.
However, these reforms face significant challenges due to legacy issues and inadequate funding. Adequate funding is crucial for implementing necessary improvements, and Malaysia's healthcare expenditure is only 5.1% of GDP, below the recommended 6-7%. Insufficient funding limits the Ministry of Health's budget for doctor salaries and allowances.
Another significant challenge is the quality of medical schools. With too many schools and students entering the profession for the wrong reasons, the system churns out low-quality doctors. These poorly trained doctors, once they become seniors, perpetuate the cycle of inadequate training. Ensuring high-quality education and training is essential for improving the medical profession in Malaysia.
I've made a video that explores this topic further. You can watch the full video here:
The Bottom Line
Reforming Malaysia's healthcare system is going to be a monumental task for the Madani government. It requires political will, adequate funding, and a commitment to quality. The current government is attempting to make strides, but given the current economic state of Malaysia, the journey is going to be a long one.
What are your thoughts on this? If you have any insights or suggestions on improving the medical system in Malaysia, please let us know in the comments!
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