From Dr Musa Nordin
As a doctor, I am utterly distressed by the daily news about the apparent state of the nation’s healthcare services and workforce in recent months, let alone witnessing the unfortunate events of doctors having their contracts terminated after working long hours and under poor working conditions.
The health ministry’s (MoH) 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 (MRCPCH) professional exams and has a contract due this month.
The doctor declined an offer for a permanent post by the public services department (JPA) a few years ago, and the health ministry tried to negotiate with JPA to renew a two-year contract for this doctor.
Such 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 MoH.
I had earlier raised the “grave issue of doctors’ maldistribution in the MoH” and offered some solutions to this chronic problem.
The health 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 (HIS) empowers MoH with data-driven forecasts of medical manpower needs to better allocate medical personnel.
MoH 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 to the health minister in November 2019, offers a range of solutions on human resource development that the ministry’s leadership can refer to.
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.
Considering the uncertainties and disorder in MoH’s 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:
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 specialties. This team should be recruited to form a task force focussed on human resource planning and development.
Using technology, we can 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’s services satisfactorily and sound alerts before a potential human resource crisis (abnormal high attrition, festive or maternity leave, etc) is detected.
With this, the minister can negotiate with JPA to stem the issue of random and indiscriminate terminations of doctors’ contracts.
This will correct the gross maldistribution of healthcare professionals plaguing MoH that has severely undermined the future and morale of junior doctors.
Harmonise the postgraduate medical education system
The public display of heated arguments and egocentric behaviour among senior doctors on the parallel pathway programme and the Master’s programme is shameful.
It has jeopardised the trustworthiness of the medical profession and created unwarranted public fear of the quality of specialists.
There will be a debate on the matter on May 25, but I have declined to participate as my colleagues and I have already provided the solutions to this conundrum in a more civilised fashion.
Therefore, before the health minister proposes amendments to the Medical Act in next month’s Parliament sitting, I would recommend we allow the “power of the minister within the Medical Act” to instruct the Malaysian Medical Council (MMC) to update the list of recognised medical specialist qualifications and the registration process in the specialist registry.
This is based on Section 8 of the Act, which states that the minister may issue general directions, provided they are not inconsistent with the Act or any regulations made under it. MMC is obligated to comply with these directions.
Recognise the vital roles and functions of AMM
The Academy of Medicine of Malaysia (AMM) has significantly contributed to the medical landscape of the country by pioneering the National Specialist Registry in 1999, which was later launched with MoH in 2006. Specialist registration became mandatory under the Medical Act in 2013, while MMC became involved only in 2017.
Since then, AMM has collaborated with MoH on the parallel pathways for 14 medical specialties, establishing pre-existing memoranda of understanding (MoUs) with Royal Colleges overseas. It’s imperative not to allow isolated incidents within one or two surgical specialties to discredit the years of progress and harmonious collaborations between trainers of the Master’s programmes and the parallel pathways.
The top bureaucrat of MoH, and by default the MMC president, should request the AMM to continue its function as the secretariat of the National Specialist Register (NSR). To ensure fairness to doctors who have pursued specialisation extensively, registrations for specialists should continue until internal problems within MMC are resolved.
Strong leadership within MMC is critical at this juncture to mitigate further damage, restore its reputation, and bolster public confidence. This entails appointing a level-headed CEO who will revamp the system’s structure and uphold 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 medical minds in public facilities are leaving in droves. Without addressing these issues first, meaningful healthcare reforms cannot take place to establish a progressive healthcare system.
Dr Musa Nordin is a consultant paediatrician and a former president of the Perinatal Society of Malaysia.
The views expressed are those of the writer and do not necessarily reflect those of FMT.