They say nothing in life is a black and white affair but in Malaysia, these two colours have become prominent all of a sudden. They involve campaigns held for people on opposite ends of the spectrum.
On Tuesday, a group launched a campaign asking households who are in dire need of help in the form of food or cash to fly a white flag, which is used in war as a sign of surrender. A few did that and help came their way.
And the Malaysian Medical Association (MMA) has declared 12 days of solidarity with the contract doctors by using black colour.
More than 23,000 contract doctors have been struggling to get permanent posts in the government service. Only 789 have been offered so far.
The MMA campaign, called “Code Black”, begins today. The association has urged members to show their solidarity through various ways and asked them to change their personal profile pictures to black or monochrome.
We really have to worry about this problem because more than 4,000 medical graduates apply for housemanship every year. If you think this problem will spill out of control, you are wrong because it already has.
This is currently being debated hotly in the medical fraternity and the media. Many are asking, “Does the government owe these doctors a living?” Some say it has no such obligation to any professional in any field. Others say doctors are an exception because of Covid-19.
Rewind 10 to 20 years and you will see families rushing to get at least one of their members to do medicine by hook or crook. With limited medical seats in public universities, coupled with preferential treatment, many were forced to go abroad to achieve their ambition.
Because of the better currency rates, it was much cheaper for them to do their medical degrees in Indonesia and Russia mainly. Some chose the Czech Republic and also India and paid slightly more.
At about the same time, there was a sudden mushrooming of local medical schools, obviously brought about by the sudden demand and the huge profits the colleges were raking in. With fees reaching as high as RM400,000, every college wanted to open a medical faculty.
Surprisingly, the education and health ministries were licensing many local institutions of higher learning left, right and centre. Some accused these institutions of being linked to senior civil servants and politicians but that was mere hearsay.
By about 2010, Malaysia had 32 medical schools, 11 of them in public universities and the others in private colleges. It was reported that Malaysia had more medical schools per capita than the US, UK and Australia.
In addition, there are more than 300 recognised foreign medical schools under the Medical Act, with an estimated 1,000 medical graduates returning home every year.
While all this was happening, the government failed to build enough training hospitals or increase the number of permanent positions for medical and dental officers.
Before the contract system came into place in December 2016, the health minister then had warned of this problem and asked the relevant ministries to raise the minimum entry requirements for doing medicine.
But the higher education ministry rejected the request. One can only speculate on the reason since the idea was to control the number of doctors and maintain quality at the same time.
Under the Medical Act, medical graduates must complete a compulsory internship of at least two years and serve another two as medical officers.
Before December 2016, most of these doctors were absorbed permanently into the service after their housemanship. After that, both offers were based on contracts which were at the most for five years.
With more than 4,000 making it annually, this number is set to grow and pose a bigger problem as the years go by.
Some feel that the government does not owe these junior doctors a living once they finish the internship and obtain their full practising certificate.
With the call to offer all these contract doctors and also future graduates permanent posts, many argue that the burden will be just too huge for the government. It would cost at least an additional RM1.5 billion a year. If you include EPF, pension, gratuity and the new appointments annually, it will add up to much more.
“After all, most of them opted to do medicine knowing pretty well that a glut was expected,” said one doctor in private service.
“The government neither encouraged them nor stopped them because it was their basic right of choice. So, it is not right to put the blame on the government squarely. There were parents who forced their children into this as it was then a lucrative profession and a job was guaranteed,”
One specialist doctor said the responsibility stops once the government has facilitated their getting the full practising certificate, which is after two years of housemanship. They can then choose to go into private service or open up their own practice.
“Sure, it won’t be as lucrative as it used to be, but that is the reality in a country with 33 million people. In the meantime, the government must seriously think of asking private colleges to limit the intake or suspend the medical courses for now.”
But the problem of specialisation will arise, as under the act a doctor has to be in government service if he or she wants to do a post-graduate programme.
The specialist said one solution would be to allow contract doctors to specialise, thus keeping them in service to become specialists in fields in which Malaysia is facing a shortage.
And the old suggestion of tightening entry requirements may have to be revisited to ensure Malaysia has quality healthcare with doctors of substance.
In a nutshell, the present glut was caused by the government’s lack of foresight to control the mushrooming of medical schools, depriving qualified students a place in public institutions , and not building enough training hospitals.
Of course, the many parents who wanted their children to do only medicine despite their not having the aptitude and requirements should take part of the blame.
The bottom line is, in my opinion, no one owes anyone a living.
The views expressed are those of the writer and do not necessarily reflect those of FMT.