Speaking to FMT, he said that he understood the hard times the junior doctors were going through without being absorbed into permanent service since 2016.
“The health ministry had already anticipated the current problem and had requested for bigger budgets each year but this was denied,” he added.
Subramaniam said the government should ensure that contract doctors are given the same perks, allowances and opportunities as their permanent peers, adding that there should not be any discrimination between two groups of doctors who are doing the same type of work.
On the government rejecting the health ministry’s request for bigger budgets, the former MIC president said this had affected the development of the health infrastructure, resulting in the slowing down of the construction of hospitals and clinics, with some being abandoned for various reasons.
“A few hospitals faced delays while a couple did not even start on the construction, which I believe was related to a lack of funds. This should not be the case,” he said.
He added that the country needs more hospitals and health clinics as Malaysia heads towards becoming an aged population.
Speaking on the thousands of doctors graduating every year, Subramaniam said it boils down to supply and demand.
“The proliferation of private medical education and the increase in the number of public medical schools led to an increase in the number of medical professionals graduating annually.
“For our given population, we have too many medical schools.
“Unfortunately, the capacity within the health ministry is not enough to absorb all graduating doctors for housemanship training. Consequently, thousands of doctors have to wait for up to a year to start their internship,” he told FMT.
Subramaniam, who was health minister from 2013 to 2018, was commenting on the current imbroglio involving the fate of 23,000 contract doctors who started a 12-day “Code Black” campaign on July 1 calling for the government to absorb them into permanent service.
He said the contract system became “a necessary evil” to solve an acute systemic weakness and to allow for gradual rationalisation between supply and demand.
“Such policies are dynamic and can be changed according to the supply-demand equation.”
Solutions to resolve the impasse
Subramaniam said it is the right of all doctors to pursue postgraduate specialisation and they must be given the opportunity to achieve it, because doctors who are not holding permanent positions will not be able to become specialists.
“It will be difficult for them to get no-pay leave or paid leave or scholarships to undertake postgraduate courses in local universities. Even if they want to pursue postgraduate programmes affiliated with overseas colleges, they will not be able to fulfil the training requirements for these programmes.
“The health ministry must therefore address these issues by working with the higher education ministry and the Public Services Department (JPA) to relax these criteria. In short, provide all doctors with the means to become specialists,” he said.
Subramaniam, who was also a former human resources minister, said the process of recruitment of permanent doctors should also be transparent without any form of discrimination due to human bias, adding that the selection process should be visible to the doctors and be based on objective, measurable criteria.
“I have been told that some doctors who had passed the first part in the postgraduate examinations were denied a permanent post. This is deplorable.”
On the demand side, Subramaniam said the ministry should look at the human resource projections which have been made a few years ago and reconcile them with current requirements.
He added that the Covid-19 pandemic revealed some weaknesses and gaps in this area and the government should use this opportunity to realign future demands.
“This will enable JPA to increase the number of permanent posts over a period of time. There is a definitive need for a larger amount of public health facilities. We need more hospitals, health clinics and specialist centres.
“For this to occur, the budget allocation has to be increased tremendously. The public health sector expenditure is currently at 2-3% of GDP. The total health expenditure shared between the private and public sectors is about 4-5% of GDP.
“The government has been repeatedly asked to increase its share to 6-7% of GDP in the past but it never occurred,” he said.
He said as a long-term solution, the current moratorium against the setting up of new medical schools should be continued, with the capacity within each medical school carefully controlled to prevent oversupply.
According to Subramaniam, in order to control quality and quantity, the current minimum requirement to pursue a course in medicine, which is a minimum of 5Bs at SPM level, has to be raised.
“During my time, we proposed to the higher education ministry to raise this requirement to 5As but unfortunately it was rejected,” he said.