Government medical brain drain

The Minister of Health, in reply to a question by my colleagues, the Member for Sungei Besi, said yesterday that since 1969, a total of 965 doctors have left the government service. If we look at the yearly figures, we will note that the number of doctors leaving the government service has been on the marked increase year after year.

Even more serious is the resignation of specialists from the government service. This year alone, some 20 specialists have resigned. The government can ill afford the loss of experienced and competent specialists suffering a great fall in the standard of medical standards in the hospitals.

As a result of the exodus of qualified doctors and specialists from the government service, we often find hospitals being manned by junior officers.

The Minister of Health should take a urgent and serious view of this ‘brain drain’ of doctors and specialists from the government service, find out the reasons and stem this brain drain.

Every year, vast sums of money are spent on the Health Ministry. For next year, the Ministry is being allocated $542 million for operating and development purposes. However, such heavy allocations for medical and health facilities have not been matched by the capacity to operate them. This because the heals of trained and qualified manpower in the health sector, both professional staff as well as middle-level technicians, has hampered the full utimisation of these facilities. the cause of this poor implementation capacity is the ‘brain drain’ of professional officers from the medical service. Unless this ‘brain drain’ is halted, the many targets and objectives of the Third Malaysia Plan to expand medical and health services, especially to the rural areas, would fail.

It is therefore important to find out why doctors and specialists are leaving the government service in droves.

It is conceded that the government service cannot compete with the private sector in terms of hard cash or incomes earnable.

However, I know of doctors who have no intention of resigning to enter into private practice, who want to remain in government service to specialise in the field of their choice, who have become so frustrated and disillusioned about the government service that they are now seriously thinking of leaving government service. Something is really wrong about the whole set-up in the medical and health service.

I know of specialists who have two years more to serve before optional retirement, who resigned from government service to go into private practice, forfeiting all their pensions.

What make such specialists who have two more years to go to pack up their bags and leave the government service? If their motives are solely financial, they could have left long ago. It is clear that they left because of their dissatisfaction with the medical service.

I will like to know how many specialists serve on till their full retirement age and did not opt to retire five years earlier? This should give another indication of the type of relationship that exists between doctors and specialists on the one hand and the medical service on the other.

The Medical Branch of the Senior Government officer’s Association had called on the Health Ministry to conduct a study on the resignation of doctors from the government service. The Health Minister should not turn a deaf ear to this call.

It is clear that without competing with the private sector in money terms alone, which is clearly impossible, there are many areas where changes can be effected by the medical service, especially concerning chances of promotion incentives, in-job training facilities, job satisfaction, which will induce more doctors and specialists to remain in the government service.

I wish here to make some concrete proposals for the consideration of the Minister of Health.

Medical Services Commission

The Government should set up a Medical Services Commission just as we have the Police Service Commission (Suruhan jaya Pasukan Polis) and the Legal Service Commission. This Medical Service Commission will be responsible for the appointment, confirmation, promotion and other staff questions of medical officers. The principle is that in a professional service, like the medical and health service, doctors should be promoted by their peers.

Under the present system, the promotion of doctors and specialists are done by people who are not the most qualified to do so. One of the biggest causes of dissatisfaction among doctors and specialists is over promotions, for irregularities of promotions often occur. A medical officer who is senior to another suddenly finds himself junior to another officer, for no reason whatsoever. Promotion is not based on merit or professional competence, but appears to be governed by racial considerations.

At present, the Promotion Board for Superscale Officers is a fully all¬-Malay committee without a single non-Malay member. This can only add to further frustration among medical officers in the service, where they see promotions clearly not based on -merit or seniority repeatedly taking place.

Promotional prospects for medical officers and specialists are also very poor compared with the civil service.

There are more medical officers than M.C.S. officers, but the Number of M.C. S. officers to superscale posts is 1.8:1; while the ratio of medical officers to superscale posts is 7 to 1.

I am sure it is not difficult to understand the frustration and bitter-¬mess of professional officers in the medical service to find that although they have to go through a longer and more gruelling, course in the university than their counterparts, who take Arts degree, one out of every two arts graduates in the M.C.S., are in the superscale posts, while one out of 7 of the doctors and professionals are in superscale posts.

Furthermore, it takes a longer time for a medical officer to be promoted to a superscale post, as compared to an arts graduate in the M.C.S.

A specialist after over 10 years of specialisation would not even automatically be emplaced on the lowest Superscale G’, while by that time, his counterpart who had taken say Islamic studies and History in Arts stream, would have already reach “E” or “F”.

Large numbers of specialists and medical officers would retire at Superscale F, while their counterparts in the MC.S would retire in Superscale A or Superscale B, if not the higher Suparscale Staff B or Superscale Staff A.

The Negri Sembilan Chief Medical and Health Officer Dr. Krishnan is good case in point. He would be retiring next year after 26 years of service and unless something is done quickly, he would retire at Superscale F, which is grossly unfair and ridiculous. At minimum, such officers should retire at Superscale ‘D’. Dr. Krishnan’s contemporary, who did arts, and who is in the MCS, would normally retire in Superscale “A” or “B”.

Time Promotion system for medical officers

The Government should therefore make promotional prospects of doctors and specialists more attractive, as an incentive to keep them in the service.

I propose that the Government introduce a time promotion system for medical officers. This will allow a medical officer to be promoted upwards after completion of n number of requisite of years.

At present, whether a medical officer would be promoted would depend not on hismerit or seniority, but depend on chance, as to whether he got trans¬ferred to a hospital where there is a higher-graded post. This means that promotion depends on being transferred to a higher-graded geographical locality.

This is a disincentive to specialists to remain in service for two reasons: firstly, promotion is dependant on a higher graded post being vacated; and secondly, on one’s going on transfer to the hospital where such vacancy exists.

I know of specialists who resign when offered such promotions subject to transfers, for to go on such transfer would completely dislocate their family life and their children’s education, and not to go on such transfer is to be passed by, and become junior to subordinate officers.

This is a irrational and bad system, and should be replaced by a time promotion system for medical officers and specialists, where promotion is not dependant on where one serves, but the number of years one serves. This will be an incentive to keep medical officers and specialists in service. It would also minimise transfers, which is another big reasons for resignations.

The medical and health service is a professional branch of the govern¬ment, and it should be headed by a professional officer, and not by a MCS officer.

This is especially important as only a professional officer would be in a better position to know the needs’ and requirements of the Professional service. I have confidence that if the head of a professional service, like the Ministry of Health, is headed by a professional officer, the conditions would be even more conducive to keeping doctors in service – for this would give them greater job prospects and job satisfaction.

Make specialist allowance pensionable

The government should make specialist allowance pensionable as another incentive to keep specialists in service. It is a great loss to the medical service for specialists who have acquired great experience and .knowledge to leave for private practice.

There should also be more attractive terms to allow a doctor to acquire higher medical degrees and qualifications.

At present, many doctors, nurses and therapists leave because of the Bahasa Malaysia examination. I am not suggesting that the Bahasa Malaysia be scrapped, but that a more practical attitude be adopted At present, the Bahasa Malaysia examination is conducted by the Public Services Department, set by some language graduates who seemed to be interested in keeping up a high failure rate.

I suggest that the Bahasa Malaysia examination should be set by the Ministry concerned, by its own examination board, to test the candidate’s knowledge of Bahasa Malaysia for practical usage relevant to his job-like ability to converse with the patient, issue instructions, etc, rather than testing them on their knowledge of adat or Malay proverbs.

At present, medical officers who have served four years can go on “no pay”leave for post-graduate studies, provided that they are confirmed officers, This means in effect on whether they could pass the Bahasa Malaysia examination.Higher examinations must be done by a person when he is still young, and the government should make arrangements where this could be done. If an officer cannot get “no pay” leave to do post-graduate studies, because he is unable to pass the Bahasa Malaysia test, his only alternative is to resign which is to the country’s loss.

Here, I want to suggest that the government should reduce the bond it require every scholarship-holder for higher degrees to enter into from the present $70,000 whether for one-year or two-year course, to a more realistic and just figure of $20,000 or $30,000.I understand that because of the unrealistically high figure of $70,000 bond even for one-year scholarship study, there are very few takers.

I hope the various proposals that I have made would receive the serious consideration of the government, for their adoption would create the necessary at¬mosphere to induce doctors and specialists to remain in the service, and check the serious ‘brain drain.

Here, I want to note that the Universiti Kebangsaan would be turning out its first batch of medical graduates soon. As the media of instruction of Universiti Kebangsaan medical faculty is in Bahasa Malaysia, I understand that its medical degrees would not be recognised by the General Medical Council of Great Britain or any Commonwealth country. This means that the U.K, trained medical graduates would not be able to go for post-graduate courses in U.K. or the Commonwealth, as is now being done by the University of Malaya – trained doctors.

This is bound to create a serious problem. The government should seriously consider that Universiti Kebangsaan-trained doctors could meet with the requirements of the General Medical Council of U.K. and other Commonwealth countries, for this will be to the benefit of the University Kebangsaan-trained doctors themselves.

Call on Ministry of Health to provide special training programmes for Malaysian nursing students who had to cut short their nursing courses in United Kingdom because of increase of fees

Because of the huge increase of fees in the United Kingdom for overseas students, large numbers of Malaysians studying nursing in the United Kingdom would probably have to cut short their studies and return to Malaysia without completing their courses.

In view of the special circumstances, the Government should draw up a special scheme to train these students so that they can complete their nursing training in Malaysia and be of service to the country.

As Malaysia is suffering a serious shortage of nurses, this will also help to improve the medical and health service in the country.

I hope the Minister of Health would be able to respond to this problem that has affected Malaysians studying nursing in UK and work out a constructive solution which will on the one hand help the students and on the other, be of contribution to Malaysian society.

Speech by Opposition Leader and DAP MP for Kota Melaka, Lim Kit Siang, on the Ministry of Health estimates in the Dewan on Friday, 10th December, 1976