THE premature miscarriage of the Waktu Bekerja Berlainan (WBB) policy was a lost opportunity, to explore a third alternative, besides the on-call and shift systems, to transform the work schedule of healthcare professionals (HCP). I concur with the Minister of Health when he lamented; “to not even try is already a failure in itself”.
A former MMA-SCHOMOS chairperson remarked: “we could have given it (WBB) a chance by piloting in a few hospitals”. It was a project designed by doctors, for doctors, to doctors, to directly address the issue of burnout, to improve the quality of life (QOL) and work-life balance of HCP.
It was targeted to be piloted in 7 departments which met the inclusion criteria, namely:
1. Paediatric Department, Tunku Azizah Hospital
2. Medical Department, Slim River Hospital
3. Obstetrics and Gynaecology Department, Putrajaya Hospital
4. Orthopaedic Department, Raja Permaisuri Bainun Hospital
5. Emergency and Trauma Department (Emergency Physicians only), Melaka Hospital and Sultanah Bahiyah Hospital
6. Oral and Maxillofacial Surgery Department, Tengku Ampuan Rahimah Hospital.
It was most unfortunate and irresponsible that the WBB document was leaked prior to its approval by the Health Minister or the Public Services Department (PSD). This has led to spurious, fake and even slanderous interpretations of the content, intent and context of the WBB system.
Leaders of the medical profession, netizens and more recently politicians, issued statements which were tainted with misinformation and suggested misleading recommendations based on a leaked document.
A novel project that has been in gestation for at least one year, since January 2024, developed by clinicians in multiple medical and surgical disciplines, working on the ground (not in ivory towers or offices nor by Pegawai Tadbir Diplomatik (PTD) officers as alleged), had hoped to shorten on-call hours, from the present 33 to 18 hours and the weekly working hours from the current 99 to 72 hours.
The endpoint was to safeguard the physical, cognitive, emotional and mental health of the HCP to deliver a high quality and safe healthcare services to the Malaysian public. Notwithstanding, the stellar leadership of Tan Sri Abu Bakar, a former Director General of Health, of the newly formed WBB Task Force, would most certainly address the key concerns of the HCP, which primarily revolves around the potential loss of income due to changes in the disbursement of on-call allowances.
A few other issues which the Task Force may need to seriously consider include:
1. To call for an increase in on-call allowances for all 3 systems as soon as possible. The Ministry of Finance must invest in the Health Resources for Health (HR-H) or risk further attrition of HCP to the private sector and/or overseas. Our Southern neighbour is already recruiting new house officers (HOs) from our premier medical schools and offering attractive remuneration to our medical officers (MOs), specialists, nurses and other HCP.
It was Tan Sri who slammed the MOH, as “being stuck in the last century”. An MOH fit for the 21 st century, is not achievable without sufficient nurses, midwives, HOs, MOs, specialists, ambulance crews and all other vital staff. In the UK, the Prime Minister and Health Secretary has pledge a whopping £25 billion to revive an ailing NHS due to 14 years of Tory neglect.
The increase requested by our doctors is pittance compared to the 22.3% rise in salaries over 2 years, in a new pay deal of the junior doctors in England secured from the new Labour government! [3,4,5]
2. Similarly, it needs to address the exorbitant and exaggerated on-call claims and clamp down on the unnecessary numbers of doctors doing on-call duties. Honest clinicians on the ground are well aware of the lousy work ethics of these doctors misappropriating tax-payers’ dollars.
3. The Task Force must ensure that it is mandatory for post call doctors to leave by 10 am after the pass over. This must be made as an exception to the PSD work rules and regulations.
4. The ideal ratio for doctor to the population as recommended by the World Health Organisation (WHO) is 1:400. The ratio for Malaysia in 2023 stood at 1:406 (see Table I). This suggests that we are not desperately short in terms of numbers. However, the acute on chronic issue of HR-H mal-distribution must be addressed immediately and urgently.
This can only be achieved with tangible and practical norms vis-à-vis work-load in either a state, major or minor hospital. The ratio of MOs/Specialist to beds in the general wards, High Dependency Wards, Intensive Care Wards, Day Care Wards, Clinics and also to take account of cover for doctors on leave must be rationalised. Only then, one can identify either the overpopulation, underpopulation or appropriate representation of MOs/Specialists in the states, districts, hospitals or departements.
5. If there are real acute shortages of junior doctors, the Task Force might recommend the Ministry of Education to increase the intake of undergraduates in the medical schools.
6. To enhance loyalty and some semblance of stability to the HR-H, the MOH must extend the contract periods to 8-10 years i.e 1 single 8-10 years contract without having to renew it 2-3 years after completing as house officers. And those who meet the KPIs are offered a permanent contract with KWSP contribution instead of a pension scheme to ease the government’s pension payments.
Dr Musa Mohd Nordin, Paediatrician, DSH
