AT a meeting with the Ministry of Health (MOH) recently, the Malaysian Medical Association (MMA) proposed the government switch to a shift system for doctors in public healthcare – similar to the European Working Time Directive (EWTD) to prevent burnout among doctors and further brain drain.
The EWTD requires the working week to be an average of 48 hours, while doctors in Australia generally work between 35 to 38 hours a week.
Doctors in Malaysia’s public healthcare system doing active on-calls (in departments such as medicine, surgery, obstetrics & gynaecology, orthopaedics, paediatrics and anaesthesiology) work an average of between 60 to 84 hours per week depending on manpower resources.
To mitigate burnout and further brain drain, the MMA is proposing that the government adopt a shift system for all doctors doing active on-calls in public healthcare – three shifts per day while introducing a flexi-allowance for MOs, Specialists and Subspecialists.
In Malaysia’s public healthcare system, housemen work on a shift system until they complete their training. Medical Officers (MOs) and Specialists (in the six departments stated above) work on an on-call system where those put on active on-call duty work their normal working hours from 8am to 5pm and then begin their on-call hours from 5pm to 8am the next day.
This is then followed by normal working hours from 8am to 5pm – a total of 33 hours straight!
On a regular basis, due to the heavy workload, MOs and specialists work beyond their on-call hours. Certain departments permit post on-call time off in the afternoons at the discretion of the head of the unit.
This must not go on. We cannot expect doctors to perform at their best and deliver the best outcomes when they are clocking in these unreasonable hours. At the rate we are going, if the status quo remains, more public healthcare doctors will leave to either private healthcare or to pursue opportunities abroad.
It needs to be noted that burnout among healthcare workers increases the risk of medical errors.
Long working hours can also increase the risk of heart disease, stroke and death.
According to the World Health Organisation’s (WHO) first global analysis of the loss of life and health associated with working long hours released in 2021, between 2000 and 2016, the number of deaths from heart disease due to working long hours increased by 42%, and from stroke by 19%.
The study concluded that working 55 or more hours per week is associated with an estimated 35% higher risk of a stroke and a 17% higher risk of dying from ischemic heart disease, compared to working 35-40 hours a week.
The number of doctors leaving public healthcare should also not be taken lightly as over 70% of the population depend on public healthcare for their health needs.
It was reported that from 2017 to 2022, contract MO resignations rose by a staggering 1,131%. It was also reported that 890 specialists resigned from government service between 2018 and 2022.
The harrowing realities of the Malaysian brain drain is further corroborated with the recent release of a study by the Department of Statistics Malaysia (DOSM). If left unchecked, our public healthcare would be facing impending collapse. – February 28, 2024
Dr Azizan Abdul Aziz is president of the Malaysian Medical Association, the main representative body for all registered medical practitioners in the country
 work an average of between 60 to 84 hours per week depending on manpower resources. ){kind=link}