When doctors say no, listen

As a doctor, people will trust you, confide in you, and appreciate your efforts.  You can do amazing things for people if you don’t let the system get you down.

Something is terribly wrong when a permanent government job, once regarded as the prize contract doctors fought years to obtain, is no longer attractive enough to persuade doctors to report for duty. When hospitals in Sarawak and Sabah wait for desperately needed medical officers and many of the expected faces do not appear, Putrajaya should stop treating the problem as an administrative hiccup.

The early numbers are disturbing, although the Health Ministry has rightly cautioned that the reporting exercise remains open until Oct 7 and final figures are therefore not yet available. In Sabah, the Malaysian Medical Association said only 47 of 138 medical officers from outside the state expected at hospitals had reported when its information was compiled.

Sri Aman Hospital reportedly expected 20 medical officers on Sept 28 but had received only six by 10.45am, while Kanowit Hospital was reported to have received none and was left with only three MOs running the facility. In Sabah, Keningau, Beluran and Sipitang were among hospitals initially reported to have received no new MOs.

Do not shoot the doctors; ask why they are voting with their feet. If young doctors who spent years demanding permanent appointments are prepared to reject those appointments rather than accept certain postings, then the message could hardly be clearer: the employment package, working environment, family disruption, career prospects and compensation are failing to match what is being demanded of them.

This is particularly serious for East Malaysia because distance is not an abstract line on a map. A doctor transferred across the South China Sea may face substantial relocation costs, separation from spouse, unfamiliar surroundings, inadequate quarters, poor connectivity in remote areas and uncertainty over how long he or she will remain there.

Then comes the workload. When departments operate with single-digit numbers of MOs and those who remain must absorb the duties of colleagues who never arrive, a staffing shortage becomes exhaustion, exhaustion becomes burnout, and burnout eventually threatens patient care.

Malaysia cannot expect doctors to work 60 to 80 hours a week, shoulder life-and-death responsibility and accept hardship as though sacrifice itself were a salary. Pay them properly, compensate difficult postings generously and recognise that retaining a trained doctor in Kanowit or Kapit may require a very different incentive from retaining one the Klang Valley.

The Regional Incentive Payment is an obvious place to start, and the MMA is right to call for restoration of the previous percentage-based system. If the fixed BIW of RM360 can effectively leave an MO only RM60 better off after the loss of the RM300 Bantuan Imbuhan Sara Hidup, nobody should pretend that this is a powerful incentive to uproot a life and cross the sea.

Make the incentive meaningful: RM1,000 or RM1,500 extra may be a starting point, but the government should calculate what genuinely compensates for distance, hardship and disruption. Relocation money should be paid before relocation, decent quarters must actually be decent, and doctors sent to remote facilities must have reliable water, electricity, internet access.

There must also be certainty, because an open-ended hardship posting can feel like a punishment rather than public service. Tell doctors clearly how long they will serve, create a transparent pathway for transfer afterwards, and make rural or East Malaysian service count substantially towards postgraduate training, specialist opportunities, promotion and preferred future placement.

And please stop expecting patriotism to pay the bills. Doctors should serve with dedication, certainly, but dedication is not permission for the system to work them in what I call a Kunta Kinte condition, as though we had somehow wandered back into the brutal world of eighteenth-century America where human endurance could simply be demanded without fair regard for dignity or reward.

The comparison is deliberately harsh because polite warnings have been made for years and apparently have not travelled far enough up the administrative staircase. Our doctors are highly trained professionals, not an inexhaustible labour pool, and every extra shift imposed because posts remain vacant carries a human cost for the doctor, the family waiting at home and the patient waiting in the ward.

Recognition matters too, and Malaysia should broaden the way it honours public service. When federal and state awards are considered, do not concentrate so heavily on politicians, senior administrators and the usual familiar circles that doctors, nurses and other frontliners who spend years serving difficult communities become an afterthought.

A doctor who gives the prime years of his or her life to an interior hospital, takes punishing calls, handles emergencies with limited manpower and stays when others leave has rendered distinguished service to the nation. Honour that service visibly, because medals cannot replace salary or manpower, but a society that asks for sacrifice should at least know how to say, publicly and sincerely, that the sacrifice matters.

We must also look further upstream at how Malaysia selects and trains doctors. Medical school places should go to students with the academic ability, aptitude, temperament and genuine desire to practise medicine and serve society, through a fair system that gives every qualified Malaysian a meaningful opportunity rather than allowing race-based considerations to override merit and suitability.

Medicine is too expensive, too demanding and too important for university selection to become a box-ticking exercise. Vet applicants properly for ability and commitment, widen opportunity fairly, and remember that every publicly supported medical place carries a national purpose: producing a competent doctor who actually wants to practise, not merely somebody who possesses an impressive qualification.

At the same time, government should invest aggressively in doctors already inside the system. Sponsor qualified MOs for recognised postgraduate and specialist training, attach reasonable service bonds to publicly funded advanced training, and build a career pipeline in which doctors can see that staying in public healthcare leads somewhere other than another punishing roster.

A bond, however, must be part of a fair bargain rather than a chain. Government funds further qualifications, the doctor returns a defined period of service, and the system in turn provides proper supervision, career progression, competitive remuneration and humane working conditions; obligation must run both ways.

Sarawak, especially, should never be treated as inconvenient destinations to which manpower is dispatched and forgotten. The people of Borneo pay taxes, contribute enormously to the federation and deserve hospitals staffed to safe levels, while doctors asked to serve them deserve conditions strong enough to make accepting the posting a respectable career choice rather than a personal penalty.

That is why this episode is bigger than a few empty chairs on reporting day. It exposes a structural failure in workforce planning: Malaysia can announce thousands of permanent appointments, but an appointment on paper heals nobody if the doctor declines it, and a staffing allocation is meaningless if the hospital roster remains empty.

I have written before about the shortage of doctors and the need to treat healthcare workers better, and I am tired of watching the same warning return wearing a different headline. The perennial headache will not disappear until those in charge understand one simple truth: you cannot order commitment into existence; you must create conditions in which good people choose to stay.

So pay doctors what their responsibilities deserve, reward hardship properly, provide decent housing, give certainty on transfers, open credible specialist pathways and recognise exceptional service. Above all, stop asking the doctors who remain to compensate endlessly for a system that failed to retain those who left, because eventually even the loyal ones will decide that enough is enough.

But this time, Putrajaya must listen.

The views expressed here are those of the columnist and do not necessarily represent the views of Sarawak Tribune. The writer can be reached at [email protected]