With regards to the chronic rather dynamic problem of staff shortages in the public sector in Malaysia, the following are some of my humble opinions.

1. Shortage of public sector staff. As said in your publication in April, there are about 300-400 public service doctors who resign every year.

Main problem? On call arrangement and working conditions. Many of the doctors both local and overseas are distraught over the on-call commitment that they have to make in order to maintain public service. We have anecdotal evidence that doctors from houseman level to specialists and consultant levels are required to do calls ‘every other day’, or one in one, if one of them goes on holiday. This is inhumane and unworkable, even if one is paid a hefty sum of salary.

How to address this on-call issue when the fact lies with doctor shortages? The following steps must be undertaken:

1 : Ensure good salaries.

2 : Limit working hours. eg, After twenty-four hours on duty, give time off the following day after handing over patients.

3 : Employ locums within the public sector in order to ensure a workable on-call rota arrangement.

As regard to point (3), locums within the public sector can be obtained from the following:

1. Doctors from other hospitals within the public sector.

2. Doctors from other hospitals within the private sector.

3. Malaysian overseas doctors (see below)

Locum rates must be attractive enough for a doctor to work, especially on weekends.

As per Malaysian overseas doctors:

1. Please facilitate and encourage experienced Malaysian doctors overseas to get registered with the Malaysian Medical Council.

At the moment, there are too many conditions to be met in order be enrolled into the register. Sometimes, the requirements can be rather impossible. For example, the need to have an offer letter from the hospital administration in Malaysia. You can minimise the requirement by applying only the following conditions:

a. Malaysia citizens.

b. Graduate from a recognised university.

c. Recognised postgraduate degree.

d. Certificate of good standing.

e. Certificate of internship.

By facilitating this register, you will open up the door for doctors to return home. This will also enable overseas Malaysian doctors to work and cover the shortage that is rife in the public sector and hence enable the issue of on-call cover to be addressed.

Of course, the covering doctor must be paid a locum rate and this may sound unfair to the local doctor. Neverthless, this will alleviate the burden of the local doctors working in impossible conditions, which , in my opinion, is far more damaging and demoralising.

2. Of course, the next question will be, how to get funding for these locum doctors?

Problem A : We have two health systems - a private health system which generates income and

a public health system which drains income. The private health system gains income because they have the luxury to ‘cherry pick’ their patients. They also do not cover accidents and emergencies, hence cases are predictable, and therefore, workable.

The public health care system does not enjoy this luxury. Hence, their work is unpredictable and the scale of cost is also more difficult to forecast. By virtue of this, the private healthcare system ‘owes’ its profit from the public system. Hence, it is only fair that revenues from the private system be channelled into the public system. I do not have the exact numbers to quantify this but at least it will give some sense of responsibility for private hospital which thrives at the expense of its public counterpart.

Problem B :Private healthcare serves only 20% of the population while public healthcare serves 80% of the population. This is the root cause of service misdistribution. The aim should be to equalise this proportion. It is important to note that the public health system does have a major role to play besides providing health services to the rakyat.

From a doctor’s perspective, it provides a training ground for doctors to gain experience and practice. Many of procedures can be done quite readily on public patients compared to private patients because of the less litigious nature of public patients. This is by no means to say that one can afford to be ‘careless’ in treating public patients - we still have to ensure that a high standard of care and supervision is given to trainees.

3. Promote mutual respect between overseas and local graduates. As doctors, we cannot be adversarial. We need each other, especially to solve the problems that are faced by the doctors and the people. The days of blaming are over. It is time to heal the wound.

Some doctors have families raised overseas. Some doctors have made mortgage commitments overseas. They may be like kacang lupakan kulit but we still need them and if we continue to hurt each other with damaging comments, nothing will be solved and conditions will deteriorate even further.

Please give overseas doctors the chance to return, and please give local public doctors the chance to excel. If we facilitate Malaysian doctors overseas to get on the medical register in Malaysia, we may be able to get the numbers that we hope for in the government sector. These doctors can cover maybe a week or two or even more, out of their study leave, or annual leave or even career break. We just need to coordinate them and have a roster of where and what level are they willing to do.

In light of this, we may have to forego some of the requirements of compulsory services which I believe has been expedited for those who have 10 years of working experience.