LETTER | The distressing state of M'sia's healthcare

LETTER | As a doctor, I am utterly distressed by the daily news about the apparent state of the nation’s healthcare services and workforce in the recent months.

I have also borne witness to the unfortunate events of doctors having their contracts terminated after working longer hours and under poorer working conditions.

The Health Ministry’s effort to go the extra mile to support contract doctors by levelling the training opportunities is commendable and widely acknowledged.

However, the younger generation is not motivated to stay on and apply for permanent posts, with unappealing terms of serving in far-flung districts with mismatched disciplines.

Some would have heard about the doctor who passed the Membership of the Royal College of Paediatrics and Child Health and has a contract due this month. It was easy for everyone to come to the wrong side of the ministry, but the doctor had declined a permanent post offer by the Public Service Department (PSD) a few years back.

Even with the cries and wrong blames of cruelty, the ministry has tried to negotiate with PSD to renew a two-year contract for this doctor.

Too little, too late?

The valiant efforts to retain doctors and improve the uptake of permanent posts are perhaps too little, too late. The core of the problem is really the poor human resource planning and development at the ministry.

I had earlier raised the “grave issue of doctors maldistribution in the Health Ministry” and offered some solutions to this chronic problem here.

The ministry can learn from the paediatric fraternity, who virtually solved their manpower distribution with an ingenious data-driven, doctor-to-workload norm, which can be further improved, refined, and digitalised for other disciplines.

Using artificial intelligence (AI) and algorithms, the movement and rotation of doctors can be fairly and promptly resolved. This health information system provides the ministry with data-driven forecasts of medical manpower needs and better allocates medical personnel accordingly.

The ministry must learn from global multinational corporations on manpower distribution, such as the stringent safety culture of the aviation industry where there is no room for error.

The “Sihat Bersama 2030 Concept Note”, prepared by the Health Advisory Council for the ministry in November 2019, offers a range of solutions on human resource development that the ministry leadership can refer to.

A dysfunctional legacy

One thing is for sure: the mess in which the healthcare workforce finds itself today is, in many ways, a legacy of the dysfunctional health leadership of the preceding years.

To paraphrase a leading clinician, now in retirement but upset by the failure of the healthcare leadership of today:

“Honestly brother, the present MOH leaders at the top, both medical and administration are really weak. Serious! Pengarah2 in Putrajaya or in the states are seriously non-productive. Dared not speak out! All yes man (wonder who gestated this MOH culture?). They bend backwards for a guy to leap from UD54 to Khas Untuk Penyandang Jusa B and don’t give a hoot for the mass resignation of doctors at the grassroots. Their standard answer to these junior doctors, susah la! JPA tak approve bla bla bla.” (It’s hard! The PSD has not approved)

Considering the uncertainties and disorder in the healthcare human resource department, which is at a critical juncture, here are three critical priorities that the top bureaucrat in the ministry needs to address immediately:

1. Deploy AI to correct the maldistribution of doctors

The paediatric fraternity’s proactive and forward-looking initiative of creating a data-driven model for human resource planning places them at the forefront of solutions for workforce distribution of other specialities. This team should be recruited to form a ministry Human Resource Planning and Development Task Force.

Using the technology, we shall have live access to a dashboard that maps the under or oversupply of doctors in every state, hospital, district hospital, and health centre.

The dashboard will be displayed on the screen in the health minister’s office for his attention and action. The task force can then analyse and advise the minister on the baseline number of specialists, medical officers, and house officers required to run the ministry services satisfactorily, and sound alerts when a potential human resource crisis is detected (abnormal high attrition, festive or maternity leave, etc) before it emerges.

With this, the minister can negotiate with the PSD to stem the issue of random and indiscriminate terminations of doctors’ contracts.

This will correct the gross maldistribution of healthcare providers plaguing the ministry that has severely undermined the future and morale of junior doctors.

2. Harmonise the postgraduate medical education system

The public display of heated arguments and egocentric behaviour among senior doctors on the parallel pathway and the Masters programme is shameful. It has jeopardised the trustworthiness of the medical profession and created unwarranted public fear of the quality of specialists in the ministry.

The situation is spiralling into a circus parade with the upcoming Great Parallel Pathway Debate on May 25. I have declined to participate as my colleagues and I have already provided the solutions to this conundrum in more civilised fashion.

Therefore, before the health minister proposes to Parliament the amendments to the Medical Act in the June sitting, I would recommend we allow the “power of the minister within the Medical Act” to instruct the Malaysian Medical Council to act on all the proposals of the special committee to update the list of certified medical specialists and the registration process in the list of specialists.

This standing is based on Section 8 of the Medical Act, which states, “The Minister may, from time to time, issue general directions not inconsistent with the provisions of this Act or any regulations made thereunder and the Council shall give effect to such directions.”

The special committee actually comprises 15 distinguished members of the medical fraternity who are very familiar with the complexities, historical perspectives, and legal nuances of the National Specialist Registry.

Committee members include:

- Master, Past Master, Deputy Master, and Scribe of the Academy of Medicine of Malaysia (AMM)

- Past senior members of the Malaysian Medical Council

- Founding chairperson, and members of the Evaluation Committee for Specialist Medical Qualification (JKP2/ECSMQ)

- Former deputy director-general

- Director and deputy director of the Medical Development Division of the Health Ministry

- President of the Malaysian Family Doctors Academy

- Chairperson of the Deans Council

- Chairperson of the Malaysian Medical Association

- Chairperson of the Joint Committee on Advanced Medical Degrees

- Lead of the National Postgraduate Medical Curriculum

- Lead of the Family Medicine training programme

The recommendations of this special committee will resolve virtually all of the pressing issues regarding the two training pathways, which warrant them immediate attention at the next MMC sitting.

3) Recognise AMM’s roles and functions

The AMM has contributed much to the medical landscape in the country by pioneering the National Specialist Registry (NSR) in 1999. It was launched with the ministry in 2006.

Specialist registration was mandated by the Medical Act in 2013. MMC only came into the picture in 2017.

Since then, AMM has collaborated with the ministry on the parallel pathways for 14 medical specialities with pre-existing memorandums of understanding with royal colleges overseas.

The isolated incidents with one or two surgical specialities must not be allowed to discredit the years of progress and harmonious collaborations between the trainers of the Masters programmes and the parallel pathways.

The ministry’s top bureaucrat, and by default, the MMC president, must request AMM to continue its function as the secretariat of the NSR.

To be fair to doctors who have gone the extra mile to seek specialisation, registrations for specialists must continue until the internal problems within MMC is resolved.

Strong leadership is critical within MMC now to mitigate any further damage, revive its broken reputation and increase public confidence.

This means getting a level-headed CEO who will revamp the system’s structure, and live up to MMC’s mission to “ensure the highest standards of medical ethics, education, and practice, in the interest of patients, the public and the profession.”

In conclusion, there is no time to lose, as our best brains in the public medical facilities are leaving in droves. No healthcare reforms can be possible if we do not first get our house in order, for a progressive healthcare system.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.