Addressing the Public Sector Doctor Exodus: A Call for Equitable Pay and Enhanced Benefits
The persistent outflow of doctors from Malaysia’s public healthcare system to lucrative positions in the private sector is a growing concern, highlighting the urgent need for a fundamental overhaul of public sector remuneration and benefits. Dr. Michael Jeyakumar Devaraj, Chairman of the Parti Sosialis Malaysia (PSM), has been a vocal advocate for addressing this critical issue, pointing to recent incidents that underscore the severity of the problem.
A stark example, as cited by Dr. Jeyakumar, involved 13 doctors from a public hospital in Perak who recently transitioned to a private facility in Ipoh, lured by significantly higher salary offers. This phenomenon, he notes, is not new, with similar trends observed since the 1980s, indicating a systemic challenge that requires a comprehensive and forward-thinking solution.
Proposing a Dedicated Health Service Commission
To combat this brain drain, Dr. Jeyakumar advocates for the establishment of an independent commission specifically tasked with managing various aspects of the health service. This commission, he suggests, should operate autonomously from the Public Service Department (JPA), which currently oversees a vast workforce of approximately 250,000 healthcare staff.
Such a dedicated commission, he argues, could develop a tailored and more competitive pay structure for medical professionals. As a potential model, Dr. Jeyakumar points to the National Heart Institute (IJN). Despite being government-owned, IJN operates as a private entity under the Ministry of Health, allowing it to implement salary scales that are more attractive to medical specialists.
“A separate health commission can set up something specific for doctors that would be more financially manageable,” Dr. Jeyakumar, a former Member of Parliament for Sungai Siput, explained. This approach would allow for salary adjustments that better reflect the skills, experience, and demands placed upon doctors, making public sector employment a more viable and attractive long-term career choice.
Government Review and Parliamentary Setbacks
The urgency of this issue has not gone unnoticed by the government. In April 2024, Health Minister Datuk Seri Dr. Dzulkefly Ahmad indicated that the government was in the advanced stages of reviewing a proposal to establish a health service commission. This announcement offered a glimmer of hope for a systemic solution.
However, the momentum behind this initiative faced a significant setback. In August of the same year, the parliamentary special select committee on health decided to shelve the proposal. The committee’s report raised pertinent questions about the potential effectiveness of such a commission, particularly noting that crucial decisions regarding staffing and position allocations would still remain under the purview of the JPA. This suggests that a mere restructuring of management might not be sufficient without a clear mandate to address remuneration and career progression.
Enhancing Specialist Privileges and Research Opportunities
Beyond salary adjustments, Dr. Jeyakumar emphasizes the importance of introducing greater privileges and incentives for specialist doctors within the public service. He proposes the implementation of mandatory sabbaticals, providing specialists with dedicated time and resources to acquire new techniques and stay abreast of the latest advancements in their fields.
“Many doctors also like to conduct research. Create opportunities for them to get research grants after they become specialists,” he added. Fostering an environment that supports research and continuous professional development can significantly enhance job satisfaction and retention among highly skilled medical professionals.
Restoring Pensions: A Crucial Incentive
Azrul Khalib, CEO of the Galen Centre for Health and Social Policy, echoed the sentiment for improved benefits, specifically highlighting the critical role of restoring pensions for healthcare professionals. He points to the reforms that shifted new civil servants from a defined benefit pension system to a contribution-based scheme through the Employees’ Provident Fund (EPF).
“Taking away pensions from healthcare professionals was an own goal. Expecting people to work cheaply will push them into other areas to work,” Azrul explained. The prospect of a secure retirement through a pension scheme is a powerful incentive that can counterbalance the allure of higher immediate salaries in the private sector.
Dr. Jeyakumar concurs, placing the restoration of pensions at the forefront of a package of perks designed to retain doctors in public service. “A sabbatical, research (grants) and also a pension would induce people to stay, even if they earn less (than those in the private sector),” he stated. A comprehensive approach that addresses financial compensation, professional development, and long-term financial security is essential for stemming the tide of doctors migrating to the private sector.
The Ethical Dimension: Recruitment Practices
Both Dr. Jeyakumar and Azrul acknowledge that the recruitment of public sector doctors by private hospitals is not illegal. In a free-market economy, professionals are at liberty to pursue employment opportunities that best suit their career aspirations and financial goals.
However, Dr. Jeyakumar raises a significant ethical concern regarding the practice of some private healthcare groups “buying out” the training bonds of government doctors and nurses. He describes this as an “unethical” practice, given the substantial public investment in training these essential healthcare professionals. The government bears the cost of their education and specialized training, and their departure, especially through such means, represents a loss of valuable public assets.
The current situation presents a stark imbalance in healthcare provision. Dr. Jeyakumar highlights that only about 25% of doctors in the civil service, after completing their specialty training and gaining over five years of experience, are available to fill the nation’s specialist roles. The remaining 75% are serving in the public sector, yet government hospitals are responsible for the care of approximately 75% of inpatients, while private hospitals cater to only up to 25%. This disparity underscores the critical need to retain and adequately compensate the doctors who form the backbone of Malaysia’s public healthcare system.
