KUALA LUMPUR, MALAYSIA — An anonymous movement of junior doctors in Malaysia reiterated its commitment to proceed with a nationwide strike at the end of this month if the government continues to fail to tackle issues concerning the current contract-based employment system.
In a memorandum published on Thursday night (1 July), Hartal Doktor Kontrak said that Health Minister Adham Baba’s response to the issue was “concerning” and “disappointing”, particularly when contract doctors and medical staff have been integral and essential in managing the COVID-19 pandemic situation in the country.
Dr Adham said on 23 June that permanent positions are offered to medical officers who pass the relevant criteria for such roles in line with the stipulated memorandum on the matter.
The appointments, he added, are also made based on job vacancies for such permanent positions from time to time, in tandem with the employment and financial rules that govern such appointments.
“Permanent appointments that exceed the overall available permanent positions are not allowed and may be flagged by auditors,” Dr Adham said.
“Time after time, we are only told that all appointments are contingent upon the discretion of the Public Service Commission. Worse, our own Ministry appears to be handling the matter in a trivial manner, resulting in negative responses from many parties,” said MMA and SCHOMOS.
The current model of contract terms for junior doctors, said Hartal Doktor Kontrak, does not provide a real, clear direction for their career progression.
Contract doctors are also exempted from work benefits offered to public servants in permanent positions such as study leave, the ability to apply for housing loans, and entitlement to time-based promotions.
The absence of rights for study leave often leaves contract doctors in a situation where they have no choice but to resign and fund their own training.
The contract system was only originally put in place as a stop-gap measure in the face of a large number of medical graduates and the government’s lack of capacity to take in the high number of new medical officers, said the movement.
Hartal Doktor Kontrak noted that there have only been 786 medical officers who have been appointed to a permanent role since 2016. The rest remain on a contractual basis after the end of their housemanships.
“According to figures given in the Health Minister’s feedback, only 3.4 per cent (of junior doctors) were hired as permanent staff. The last of such appointments were made in the 2017 appointment cohort,” they said.
Hartal Doktor Kontrak stressed that the issue of the contractual work arrangements junior doctors are subjected to is a crucial one to attend to, as it concerns the future of Malaysia’s healthcare system.
The movement reiterated two of its demands from the government, namely:
- Offering permanent positions to all medical officers on contract; and
- Releasing a detailed explanation of the criteria for such permanent appointments.
“If these demands are not met and there is no black-and-white regarding the matter within three weeks, we will have no option but to make the drastic move of going on ‘leave’ until our demands are met, starting 26 July,” said Hartal Doktor Kontrak.
‘Hartal’ is a Gujarati word for ‘mass protest’ or ‘strike’.
The Malaysian Medical Association (MMA) and Section Concerning House Officers, Medical Officers, and Specialists (SCHOMOS) last month said that the contract system has “exacerbated” burnout syndrome among healthcare personnel in the country.
“With this Sword of Damocles hanging over their heads, is it any wonder that many of them are growing increasingly disillusioned and thinking of leaving the country for greener pastures?” they said in a statement on 23 June.
MMA and SCHOMOS said that while the Health Ministry had informed them that a proposal of an extended contract was in the works, no decision or outcome has been announced to this date regarding the matter.
“Even while warding off death in the COVID-19 wards, our junior doctors are still waiting for a fair decision and clarity from the government if they are able to continue working when their contract expires and if they are able to undergo training for their specialisation,” they said.
The current contract system, said MMA and SCHOMOS, is “messy, biased and a failure”, as it feeds into the anxieties of junior doctors by giving them “uncertainty in their employment in the government service and in their future as healthcare professionals”.
In a statement on Monday, the Malaysian Health Coalition (MHC) said that the issue of contract doctors “require joint solutions by the Ministry of Health, Public Service Department (JPA), and potentially the Prime Minister or Cabinet”.
“Five years of the contract system have led to discontentment, departures from the civil service and Malaysia, and an exhausted health workforce,” the coalition said.
The coalition added that if the Health Ministry is the only ministry with contract positions for “professional-grade civil servants”, it would be an “unfair anomaly”.
“The contract system must be drastically improved with durable and fair solutions to recognise all doctors and health professionals for their service,” said MHC.
While MMA and SCHOMOS said that they would not endorse the impending strike in view of the pandemic, they are currently advocating the “Code Black” and “Black Monday” campaigns.
From 1 July to 12 July, social media users are urged to change personal profile photos and even company or institution logos to black or monochrome in solidarity with the Code Black campaign.
On 12 July, members of the public are encouraged to show up to work in black clothing for Black Monday.
MMA also called on individuals to hold a placard stating “We stand with Contract Healthcare Workers” and to post photographs on social media using the #saveMYcontractHCW, #CodeBlackMY, and #BlackMondayMY hashtags.
Should the country-wide strike by contract doctors on 26 July take place, it will become one of such strikes to be organised during the pandemic.
Reuters reported in late August last year that close to 16,000 intern and resident doctors in South Korea went on a three-day strike over the government’s plans to increase the number of medical students over several years.
This is in addition to setting up public medical schools, allowing government insurance to cover more Eastern medicine, and introducing more telemedicine options.
The doctors who protested stressed that the extra funding should be channelled into providing better pay for existing medical trainees, among other possible improvements.
The Korea Medical Association was reported as saying the same month that it would go ahead with a nationwide strike for an indefinite period unless the government drops its reforms.
Most of the intern and resident doctors “form the backbone of healthcare services in emergency rooms and intensive care units, and major hospitals have reported delays and disruptions since the walkout”, Reuters noted.