17 May 2024
OPEN LETTER TO THE TOP BUREAUCRAT IN MOH
Dr Musa Mohd Nordin, Paediatrician
As a doctor, I am utterly distressed by the daily news about the apparent state of the nation’s healthcare services and workforce in the recent months, let alone witness the unfortunate events of doctors having their contracts terminated after working longer hours and under poorer working conditions.
The Ministry of Health’s effort to go the extra mile to support contract doctors by leveling 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 MRCPCH paediatric professional exams and has a contract due this month. It was easy for everyone to come to the wrong side with MOH, but the doctor has actually declined a permanent post offer by the JPA a few years back. Even with the cries and wrong blames of cruelty, MOH has tried to negotiate with JPA to renew a 2-year contract for this doctor.
The 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 here: https://tinyurl.com/38ttyc6u
MOH 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 and better allocate medical personnel accordingly.
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 MOH leadership can refer to: https://tinyurl.com/y86r7ecw
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.
To paraphrase a leading clinician, now in retirement but upset by the failure of healthcare leadership of today:
“Honestly brother, the present MOH leaders at the top, both medical and administration (Pegawai Tadbir Diplomatik, PTD officers) are really weak. Serious! Pengarah2 in Putrajaya or in the states are seriously non-productive. Dare not speak out! All yes man (wonder who gestated this MOH culture?). They bend backwards for a guy to leap from UD54 to Khas Untuk Penyandang Jusa B and don’t give a hoot for the mass resignation of doctors at the grass roots. Their standard answer to these junior doctors, susah la! JPA tak approve bla bla bla”
Considering the uncertainties and disorder in the healthcare human resource department, which is at a critical juncture, here are three critical priorities that the top bureaucrat in MOH needs to address immediately:
1. 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 MOH Human Resource Planning and Development Task Force.
Using the technology, we shall have live access to a dashboard that maps the under or oversupply of doctors in every state, hospital, district hospital, and health centres.
The dashboard will be displayed on the screen in the Health Minister’s office for his attention and action. The Taskforce can then analyse and advise the Minister on the baseline number of specialists, medical officers, and house officers required to run the MOH services satisfactorily, and sound alerts when a potential human resource crisis is detected (abnormal high attrition, festive or maternity leave, etc) before it emerges.
With this, the Minister can negotiate with Jabatan Perkhidmatan Awam (Public Service Department) to stem the issue of random and indiscriminate terminations of doctors’ contracts.
This will correct the gross maldistribution of HCPs plaguing the MOH that has severely undermined the future and morale of junior doctors.
2. Harmonise the Postgraduate Medical Education system
The public display of heated arguments and egocentric behaviour among senior doctors on the Parallel Pathway and the Master’s Program is shameful. It has jeopardised the trustworthiness of the medical profession and created unwarranted public fear of the quality of specialists in MOH.
The situation is spiralling into a circus parade with the upcoming Great Parallel Pathway Debate on 25 May 2024. I have declined to participate as my colleagues and I have already provided the solutions to this conundrum in more civilised fashion.
Therefore, before the Minister of Health proposes to the Parliament on the amendments to the Medical Act in the June 2024 sitting, I would recommend we allow the “power of the Minister within the Medical Act” to instruct the Malaysian Medical Council to act on all the proposals of the “Jawatankuasa Khas” to “mengemaskini senarai kelayakan pakar perubatan yang diiktiraf dan proses pendaftaran dalam daftar pakar”.
This standing is based on the Section 8 of the Medical Act, which states, “Menteri boleh, dari semasa ke semasa, mengeluarkan arahan am yang tidak berlawanan dengan peruntukan Akta ini atau dengan mana-mana peraturan-peraturan yang dibuat di bawahnya dan Majlis hendaklah melaksanakan arahan itu.”
The “Jawatankuasa Khas” (Special Committee) actually comprises 15 distinguished members of the medical fraternity who are very familiar with the complexities, historical perspectives, and legal nuances of the National Specialist Registry (NSR).
Committee members includes:
- Master, Past Master, Deputy Master, and Scribe of the Academy Medicine of Malaysia
- Past senior members of the Malaysian Medical Council
- Founding chairperson, and members of “Jawatankuasa Penilaian 2” or the Evaluation Committee for Specialist Medical Qualification (JKP2/ECSMQ)
- Former Deputy Director General,
- Director and Deputy Director of the Medical Development Division of MOH
- President of Akademi Kedoktoran Keluarga Malaysia
- Chairman of the Deans Council
- Chairman of Malaysian Medical Association
- Chairman of the “Jawatankuasa Bersama Ijazah Lanjutan Perubatan”
- Lead of the National Postgraduate Medical Curriculum (NPMC)
- Lead of Family Medicine training program
The recommendations of this Special Committee will resolve virtually all of the pressing issues regarding the two training pathways, which warrants them immediate attention at the next MMC sitting.
3. Recognise the roles and functions of the Academy of Medicine, Malaysia
The Academy of Medicine Malaysia (AMM) has contributed much to the medical landscape in the country by pioneering the National Specialist Registry in 1999. It was launched with the MOH in 2006. Specialist registration was mandated by the Medical Act in 2013. MMC only came into the picture in 2017. (https://www.acadmed.org.my/view_file.cfm?fileid=1073)
Since then, AMM has collaborated with MOH on the Parallel Pathways for 14 medical specialties with pre-existing MOUs with Royal Colleges overseas.
The isolated incidents with one or two surgical specialties must not be allowed to discredit the years of progress and harmonious collaborations between the trainers of the Master’s Programs and the Parallel Pathways.
MOH’s top bureaucrat, and by default the President of MMC, must request AMM to continue its function as the secretariat of the NSR.
To be fair to doctors who have gone the extra mile to seek specialisation, registrations for specialists must continue until the internal problems within MMC is resolved.
Strong leadership is critical within MMC now to mitigate any further damage, revive their broken reputation and increase public confidence. This means getting a level-headed CEO who will revamp the system’s structure, and live up to MMC’s mission to “ensure the highest standards of medical ethics, education, and practice, in the interest of patients, public and the profession”.
In conclusion, there is no time to lose, as our best brains in the public medical facilities are leaving in droves. No healthcare reforms can be possible if we do not first get our house in order for a progressive healthcare system.
