The Dilemma Of Retaining Specialists and Subspecialties Service In MOH
As a dedicated government doctor, specialist and senior consultant, and currently retired, i have served the health ministry for more than 35 years.
I was born in the generation of baby boomers, thus becoming a doctor was a service with the ability to earn a good living and respect from the community.
I realised that 20 to 30 years back, it didn't cost the government so much of expenditure to sustain the service.
The reason being most of us were in hardship, and the drs were service oriented with minimal expectations on monetary benefits. We served with the joy of caring for patients and assisting their healing process.
Besides, the government then had to fork out one-time lump sum payment for the salary and instruments. There were minimal expenditure on disposals like sutures or medications. Also, there were no fancy investigation tools at that time and treatment was solely dependent on the drs or the specialists' ability to treat the condition with whatever minimal that was available.
Hence, the government was able to sustain public service with minimal charges of RM1 and RM5. Patients who stayed for long admissions or underwent major surgeries could get away with RM100 or less.The populations then were not that high and were much less demanding as they understand the situation at that time.
However, if we fast forward to the past 10 years to current times, the advancement in the medical field has changed the notion from labour intensive service to technology intensive service. Technological advancement is so rapid that it is advancing even as I am writing this article. With this rapid change in the mode of medical healthcare, how is it possible to maintain the service with minimal charges like decades ago and to retain the drs in the public service.
We need to understand if our medical treatment depends on technological assistance to treat, then it will incur the government a large sum of money as health is free in our country.
Also patients nowadays expect the latest and the best treatment since all information regarding updated treatment is available at the click of the finger.
It is inappropriate to give substandard treatment in government just because it is free.
In regards to retaining the specialist in government service.
The current medical and surgical services uses lots of technology like advance radiological investigations, minimally invasive surgery,robotic surgery and many time saving tools to treat the patients. Unfortunately, most of this are available in the private healthcare enticing the doctors and specialists to join the private sector.
Here in government hospitals, they are expected to give the treatment which were done 20 years back as the government lacks the budget to provide for the advancements as the health service is free in Malaysia.
Current generation become a doctor because they want to treat the patients to the best availability of their knowledge and technology available and also expect a reasonable income to provide them a safety net for their living.
However, the government can't fulfill what they want but instead pressure the doctors to stay and serve. On the contrary, the ones pushing the doctors to stay are sitting in a high chair and ordering people around
What do we expect from these doctors and specialists who face high pressure from the authorities, heavy loads of patients and meagre earnings?
On the other hand, mushrooming of private hospitals with state-of-the-art facilities and good benefits provide better opportunities and career advancements for these doctors.
To be honest, how can we retain them in public service ,even if they are keen.
As such, my suggestion is to upgrade the service in all major hospitals according to the latest technological intensive service and introduce some form of social insurance to bear the brunt of financing the healthcare service.
This will enable us to render service that is equal to the private sector.
Otherwise, there will always be a disparity between the public and private health services. Also forsee heavy drain of well trained and dedicated specialists to the private sector and to neighbouring countries if we do not resolve these burning issues.
I fully agree with your insights. Healthcare has shifted from service-based to tech-intensive, and the millennial mindset is different—they seek both purpose and fair compensation. Many are burdened with study loans, rising living costs, and family commitments—yet there’s been no real upgrade in pay or system support. Without proper investment and sustainable reforms, retaining them in public service will only get harder.
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DeleteMorning Sir, I think you missed out the major factor part of the management and placement system that disregards doctors as a human, a son/daughter, a father/mother, a husband/wife.
ReplyDeleteGovernment just ignore the impacts of separate a family apart for more than ten years with the noble reason of “for service”.
Look at thee number divorces, extramarital affairs amongst doctors. For current generations, many happened during sub specialty posting and junior consultant years.
GenY and GenZ parenting are very different, the emphasis is always the quality time.
Like our dear Axxxx, simple thinking surgeon who just want to serve the public, and he just left due to bad, rigid placement.
And now Sxxxx will have himself in Kota Bharu, wife in KL and daughter in Klang, family in BM. If he’s not back to Pg by the time daughter going primary school, even the latest CTC surgery robotic arm cannot retain him in GH…
And definitely he will miss a happiness of teaching and shaping the character of the kindergarten girl. And possibly the chance of having second kid.
This is major, isn’t it
The way i see it is, KKM must ascertain and admit to public the purpose and extent of our free healthcare. Kkm must know, what is the vision n mission of KKM.
ReplyDeleteDoes KKM aspire to provide world class cutting edge medical healthcare
Or does KKM aim to provide wide complete coverage at near to zero cost to patient like how it is now.
If kkm wants to provide free, nationwide coverage, and cutting edge health. How much is the cost. Do we have the resource for that, and, on top of that does KKM wants to spend resources on training and research.
or,
KKM wants to just provide free nationwide coverage, with a quality capped by our nations available resources. Which means, most patients will never get cutting edge, newest therapies, minimal waiting time, and comfortable ward environment.
In my opinion, as a Malaysian who grew up in a low middle class family of civil servant salary, if i get to vote for it, i will vote for KKM to aim to be the latter.
KKM should be pure service oriented, minimal spending on research and training. KKM should err on nationwide fair healthcare coverage rather than trying to provide cutting edge world class therapies. The quality of KKM therapies should be limited by the amount of resources that KKM are provided with by the government. Most importantly, healthcare should remain free for malaysians, with minimal payments as you expounded. If KKM take this aim, government must not implement any policy that would incur additional healthcare tax or national insurance scheme. And B40 group must be entitled to get totally free healthcare.
The downside of this path is… the strain of medicolegal and public perception and complains. Probably no one can get world class therapy with short waiting time in this path. And if public compares it to private practice or international guidelines, definitely KKM would not be up to par.
This is the bitter pill i am willing to swallow. Because i know, if we want government to provide free healthcare to people in rural areas, we cannot expect MRI in 24 hours for people in big cities (who may demand for it). The people must accept this in order for this path to work. And the government must be willing to tell the public, to admit that KKM is not aiming to provide world class cutting edge treatment, or follow latest international guideline of treatment, KKM can only provide the best therapy based on availability of resources. KKM has to turn a deaf ear on the public who compares and complains about it. IQNORE IT, because KKM has its clear aim and clear conscience that KKM is providing the best treatment it can based on all resources it has, with clinicians and public health specialists to distribute the resources, not any one else.
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ReplyDeleteOf course many people may disagree, and wants KKM to provide world class treatment based on international cutting edge guidelines. And the people may want KKM to respond to every complain n comments to the rabbit hole and make everyone happy. I really think this should not be the way for KKM to work but it seems like government at the moment is letting it happen.
And if the rakyat is to continue this trend and expectation, its just a matter of time before KKM runs out of resources to maintain its overall service. And gov will implement reform, and rakyat has to pay up!
It can be a pay monthly national insurance, or a new healthcare tax on every living soul in the country.
I loath at this option because of this. Healthcare choice of therapy, mode of treatment delivery (in or out pt) and extent of care will be reliant on the coverage and extent of the insurance policy, which is decided by the premium that the patient has been paying.
When that happens, healthcare will be limited by the resources each and every patient can afford.
Which means, healthcare becomes a priviledge, not a right.
I love Malaysian healthcare as how it is now.
If the patient is low to middle class, just go to gov hosp which will provide safe enough healthcare in my opinion. Nothing luxury nothing cutting edge, but acceptable.
And anyone who happen to be privileged financially, can opt to get comfortable and swift and cutting edge treatment at private hospitals.
Maintain our free nationwide healthcare limited by our resources, let the doctors decide how much resource to spend on each patient rather than insurance company or anyone else.
The thing we need is for the public to understand and accept it that we do already have the best of both worlds. With ever increasing complain comment or demand, the result is excessive resources poured into providing unnecessarily luxurious healthcare to a small group of population, resulting in eventual unsustainable overall healthcare, and need for increase funding to KKM, which will be paid for by the public eventually.
Doctors in KKM should be better remunerated based on vacancy and need. special allowance may be given to specialties which are lacking specialist, or doctor who is willing to go to certain unfavored hospital locations, in order to keep them in public service.
if doctors are kept at minimal wage, forced to move to unfavourable locations, with no renumeration despite their extra effort to specialise or sub specialise, doctors will be the ones blamed for the collapsed of KKM