The Contract Doctor Crisis: Challenges and Thoughts on Malaysia’s Healthcare System

By Tham Wen Ywik

Regardless of how strong, resilient, or supported by healthy lifestyle practices our body may be, it is not entirely immune to infectious diseases, chronic illnesses, or a decline in mental well-being. This highlights the essentiality of universal healthcare.  Healthcare services range from providing basic screening services for early detection and diagnosis, mandatory nationwide vaccination programs that act as prevention measures and treatments for coughs and flu to those that are severe, such as complications of pneumonia, dengue virus, influenza, sudden strokes, or severe injuries that leave one bedridden. While access to these services is influenced by socioeconomic status and geographical location, the roles of policymakers are crucial in designing and implementing a healthcare system that ensures long-term quality care for all individuals.

However, some policies, along with their implementation and aftermath, frustrate both healthcare workers and consumers while also raising concerns from the public. In December 2016, the announcement of a contract system to tackle the influx of medical graduates by the Ministry of Health (MoH) left the future of the medical workforce in ambiguity, uncertainty and fragmented. Instead of integrating these medical graduates as permanent doctors into the local healthcare system, they were given a five-year contract, with the beginning of three years working as housemen and the remaining two as medical officers. Nonetheless, this policy has its loopholes. In the absence of thorough planning of policies by the government, contract doctors often find themselves receiving an extended contract rather than permanent placement. 

While this contract system may seem harmless, its imprints on contract doctors bring more adversities than benefits, even leading to a strike, known as Hartal Doktor Kontrak, during the height of the COVID-19 pandemic. 

Image source: Malaysiamuda

To put this into perspective, contract doctors struggle to enjoy the same rights compared to their permanent counterparts, with lower wages and limited access to leaves, housing loans and career promotions as they are not considered official civil servants. This leaves them severely underpaid and overworked. To make matters worse, they are ineligible for further medical postgraduate pursuits, which require them to be a permanent doctor for study admissions. As such, their time, wages and education opportunities are unjustly stripped away, trapping them in a system that offers little hope for professional growth. Their contributions to the healthcare system are immense yet underappreciated by the system. 

Though the systematic flaws of the contract system have been addressed, the question of how many contract doctors are affected and its impact on public healthcare remains. While some were fortunate enough to be selected as permanent civil workers, not all of them accepted this long-awaited career opportunity. Statistics from news publishers highlighted this troubling trend. For example, Berita Harian revealed that in the span of seven years, from 2016 to 2023, a total of 4310 contract doctors resigned, while Free Malaysia Today reported that the resignation of contract doctors continued to rise in recent years, accounting for 3046 contract doctors departing from 2021 to 2024. To exacerbate the severity of this situation, the number of permanent positions announced annually by the MoH varies. According to an article by CodeBlue, 8704 permanent positions were drafted between 2022 and 2023, and 6000 were planned for 2024 and 2025, marking a decline in job opportunities for contract doctors. This fluctuation places more medical graduates in uncertainty, making them accept offers that are deemed more lucrative, such as entering the private sector or working overseas.

The consequences of doctor resignations extend far beyond staffing issues. First, as the number of available doctors shrinks, the workload for those who remain in public hospitals proliferates, which worsens healthcare efficiency. This leads to long waiting times in emergency departments and rural states far from the capital. To name a few examples, The Straits Times reported that patients can wait up to several hours in cities such as Kuala Lumpur, while in Sabah, extended waiting times can span for days. Excessive diagnostic delays as a result of this not only diminish the possibility of early and prompt intervention but also heighten the risk of mortality and other complications. This surging resignation trend not only frustrates the public and doctors but also reinforces a cycle where more medical staff are compelled to resign due to excessive workloads, perpetuating the issue of understaffing. 

Moreover, restricting contract doctors from medical postgraduate studies directly limits the number of specialists available to contribute positively to the healthcare system in Malaysia, which already faces a specialist shortage. CNA reported that the country’s population-to-specialist ratio stands at 10,000 to 4, far lower than the Organisation for Economic Co-operation and Development’s (OECD) recommended ratio of 10,000 to 14.3. This situation could reduce efficiency and deteriorate the quality of care in critical fields, such as oncology, cardiology, obstetrics and gynaecology. 

Furthermore, stronger career advancement opportunities in private healthcare sectors inevitably encourage contract doctors to seek careers in said sectors, reflecting the reality of public healthcare. This circles back to the ongoing issue of doctor shortage in public healthcare. Public healthcare remains the only available for many due to its affordability. Hence, without a sustainable system to retain doctors in public healthcare, this gap would eventually diminish the accessibility to quality care among those who are impoverished.

Image source: Utusan Malaysia

Issues surrounding the contract system should no longer be neglected, and it is time to call for immediate actions to address its instability and the adversarial effects. First, policymakers should establish a fixed multi-year placement plan rather than announce annual allocations, providing confidence and trust for contract doctors in securing a permanent placement. Multi-disciplinary collaboration should also be involved, primarily between the MoH and the Ministry of Finance, to increase budget allocation for public healthcare investment that aligns with international standards. In addition, MoH should work closely with private companies that are pivotal in shaping private healthcare to enhance quality and accessibility. For instance, initiatives such as building more hospitals or expanding its current compound and increasing the number of hospital beds should be prioritised. With these improvements, doctors can manage patient load better and, in turn, ameliorate overcrowding in emergency units, thereby increasing healthcare efficiency. Most importantly, a holistic needs assessment should be conducted among Hartal Doktor Kontrak members and medical students to ensure that policies align with real-life challenges faced by contract doctors. 

However, improving our nation's healthcare system stretches beyond financial planning and private-public collaboration. Policy planning should aim to refine the current contract system by offering structured postgraduate opportunities within a defined time frame before their contract ends. This should be accompanied by predefined performance-based criteria, ensuring that contract doctors who meet professional standards are eligible for specialisation. Additionally, the placement of contract doctors in city outskirts and rural areas should come with accommodation and higher incentives. 

Systemic problems require innovative and feasible solutions. While Malaysia's private healthcare industry develops rapidly with comfortable facilities and shorter waiting times, public healthcare must accelerate its reform efforts to remain competitive, as failure to act could lead to catastrophic consequences. Politicians and professionals must take proactive measures to address the existing challenges in the healthcare system. The voices of young contract doctors, who represent the fundamental pillar of Malaysia’s future frontline medical workforce, should not be sidelined. Instead, they should be heard and valued to ensure a stronger and more sustainable healthcare system for all.

About Author

Tham Wen Ywik is a psychology undergraduate who is trying to step out of her comfort zone little by little.