Code Black! Justice for junior doctors

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The present phenomenon affecting junior doctors must fall into everyone’s deaf ears. After years of hard work, many excellent Malaysians who have graduated as Medical Officers are treated miserably. I don’t have any family members who is a junior medical officer but as a former educator, I can feel the pain many of the doctors are going through as contract doctors. I have educated form six students and know what it is like, studying and preparing to score excellent results in STPM. It is not a piece of cake. It is drudgery; which means hard work, monotony, time-consuming and repeated reading countless times. It is injustice and I empathize with them.

Modern times are very unique. There is a wide range of options to pursue a career. This is true, even if comes to choosing a field to study as at one point of time in a students life, they have to choose their career. Many students who are keen to save lives will choose to become a doctor. To qualify as a doctor, students have to be highly motivated as well as possess excellent results in pre-medicine exams. Apart from that, there must have compassion for fellow humans, possess critical thinking, and problem-solving skills. Students believe there is never a dull moment in medicine and it is fascinating. The human body itself is an incredible thing to study and doctors have the opportunity to further examine it with the latest innovations. Modern medicine is one of the most awesome subjects to study in the world. But, what matters most in medicine is, there is no room for mistakes. A life can be lost if a doctor is careless and makes a wrong decision. However, with all these challenges, many students aspire to become doctors and accept the challenges.

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When a student is finishing high school and looking at careers, it can be frightening to choose a job that requires gruelling training to become a doctor. They have to absorb dense medical knowledge and make right the diagnosis. But, with also compassion and resilience. Such is the scene for a medical student in any part of the world. They have to go through very stringent training and tests. In Malaysia, it is even more difficult. Students who aspire to become doctors have two choices. If they have excellent results, they can be absorbed in public universities. But, if they fall short academically but still don’t want to lose their ambition, they have no choice left other than to private universities. This is the only avenue for them. However, there is a big hurdle for students who want to pursue medicine in private universities. It’s the fees. The medical fee is very high. It is not fair to say the fees are exorbitant as the costs incurred to set up medical schools, to buy the right equipment, and to employ proficient teaching staff can run into hundreds of millions.

So, most students dream of securing a seat in public universities as the fees are affordable to most parents and at the same time financial assistance is easily available. The universities also enjoy full accreditation by the relevant authorities in Malaysia. But, it is a humongous task. As there are limited public universities, the intake for medicine which is considered a critical course is very competitive. Students have to score a CGPA of 3.8 to 4.0 which is the maximum. In terms of percentage, it must be between 94% to 100%. It also depends on each ethnic group in Malaysia. For the Chinese and Indians, it must be between 98% to 100%. It is actually a tremendous task but sadly many top scorers will not make the cut even if they meet the grades required, due to the limited seats available. Therefore, they will have to opt for private medical schools locally or overseas. Indonesia, Ukraine, India and Russia are popular overseas countries for medicine. However, fees in private universities are not cheap. it can range between RM250,000 – RM500,000 for the entire course. The fees in developed countries like the UK or Australia can even reach a million ringgit or more. Students with big ambitions but with average results have to cough out a lot of hard cash. Parents in order to help their children achieve their ambitions take all kinds of effort to raise the money for a medical course. Many spend their lifelong savings. Additionally, there are parents who sell their property such as houses and land. Those without savings or property depend on loans. Some go begging, practically climbing the stairs of political parties and NGO’s. As a last resort, they apply for loans or advertise in the mass media appealing for help. This is the long and difficult journey medical students go through.

After finishing one of the pre-medical programmes such as matriculation, A-Levels or form 6 in a government school, undergraduates undergo a 5-year degree programme. The path towards becoming a doctor is challenging and a very long course. Medicine as a whole is very broad and multidisciplinary. The course consists of classroom lectures which are called pre-clinical. This is where they study the theoretical aspects of medical science followed by clinical training. Undergraduates will go through clinical rotations in all the medical disciplines and health clinics. This is where they get hands-on training. That’s not all, as they move along they have numerous assessments, practicals and exams. They are required to attain a certain grade to advance further and finish their 5-year programme. That is not all, as once they have achieved their white coat, they undergo 2 years of housemanship. It is a compulsory internship for all aspiring doctors. Newly qualified doctors work under the supervision of senior doctors and medical specialists in designated hospitals in Malaysia. They will be posted to all the major departments in hospitals. They will also do elective postings. This is the time they go through a hard time. They work long hours, sometimes as much as 12-14 hours a day. Although they are entitled to a day off each week which may not be on a weekend, many don’t get their leave approved. Some housemen complain of being bullied by senior doctors who call them all sorts of names. Sexual abuse has also happened in training hospitals. Many complain that the the training is inhumane. Lately, MMC has stated that the average time to finish houseman has increased. In 2009, it was about 22.8 months but it increased to 27.8 months in recent years. In 2016, a big number of 3,402 trainee doctors could not finish their horsemanship in the stipulated time. A parliamentary report stated that more than 850 medical graduates left their training in the last three years. The worst-case scenario is of reports of housemen killing themselves with an overdose of drugs and also jumping from buildings.

Medical students who make it through all 5 years of the gruelling medical course will be proud owners of MBBS or an MD degree. And, with the two years internship and registration with the Medical Council of Malaysia, they become a full-fledged medical practitioner. When they are raring to go they get a shock of their lives. They are only offered a job on a two-year contract basis. Their parents are devastated. Individuals who had so much hope of becoming a doctor is given such a raw deal, breaking their heart. The contract system was first introduced in 2016. No one knows the guidelines on who is given a contract job and who are given permanent jobs. This is shocking as the criterion used to decide is so secretive giving opportunities to practise favouritism. There are many setbacks for contract doctors. All doctors do the same job but those on a contract basis are paid less. This is grossly unfair. How on earth can the government practise double standards? Has this become the norm for the present government? That’s not all, contract doctors will not be given a chance to become a specialist which is the ultimate dream of many students who aspire to do medicine. They are also short-changed in other aspects too like entitlement for government house loans and car loans.

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The treatment given to junior doctors is simply insane. Since the beginning of the contract system in 2016, some 23,077 have been appointed as contract doctors. The contract system was initially supposed to be a stop-gap measure to cope with the influx of medical graduates. However, without long term planning, this problem has not been solved. Of the total contract doctors, only 3.7 % or 789 individuals have been given permanent positions. But, I believe most hospitals and health centres simply do not have enough doctors. These doctors should be hired to serve in hospitals and clinics. The evidence can be seen in the waiting time for patients to see doctors. It could even be worst in rural and the interior areas of Sabah and Sarawak. A recent study concluded that Malaysia has more than 6,000 new doctors every year but there are not enough jobs to cater for all the new graduates. There were medical organisations voicing concern over the increasing number of doctors each year and the lack of job placements but all the opinions turned to deaf years. It can be assumed the present predicament is because of the government’s refusal to listen to public opinions. It’s a shame. It’s a pity to see the cream of the country’s intellectuals going to waste. If they have been well guided these elite students would have done well in other careers too. We have a humongous government but sadly justice is not served to our top scorers. We have some 70 ministers and deputy ministers as well as heads of Government Linked Agencies earning tens of thousands of ringgit monthly. So, if the government can’t afford to create a permanent job for doctors because of financial constraints, they should rationalise the pay of high-earning officials and channel it to KKM.

It is a sad day for the students who struggled and successfully achieved their ambition. With no rights to job security, study leave and perks, many contract doctors are forced to resign. Many have resigned lately with a heavy heart. Another solution for them to seek greener pastures is migration overseas. Many countries out there are already thanking Malaysia for rejecting brilliant students and soon they will be thanking Malaysia for producing excellent doctors to serve their countries.

Palaniappan Karuppan is a content writer under Headliner by Newswav, a programme where content creators get to tell their unique stories through articles and at the same time monetize their content within the Newswav app.
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Palaniappan Karuppan
Author: Palaniappan Karuppan

Retired teacher with a passion for critical writing.