Public Sector Doctor Exodus Fuels Calls for Overhauled Pay and Incentives
The persistent outflow of government doctors to the lucrative private sector is highlighting a critical need for a more competitive and equitable public sector remuneration structure, according to Dr. Michael Jeyakumar Devaraj, Chairman of Parti Sosialis Malaysia (PSM). This ongoing trend, which has been a concern since the 1980s, was recently underscored by the departure of 13 doctors from a public hospital in Perak to a private facility in Ipoh, enticed by higher salaries.
Dr. Jeyakumar has put forth a compelling proposal: the establishment of an independent commission, separate from the Public Service Department (JPA), to oversee various aspects of health service management, including the salary scales for its estimated 250,000 staff members. He suggests this commission could adopt a pay model similar to that of the National Heart Institute (IJN). Although government-owned, IJN operates as a private entity under the Ministry of Health, allowing for greater financial flexibility in its remuneration packages.
“A dedicated health commission can devise specific provisions for doctors that are more financially sustainable,” Dr. Jeyakumar, a former Member of Parliament for Sungai Siput, explained.
The government has acknowledged the urgency of this issue. In April 2024, Health Minister Datuk Seri Dr. Dzulkefly Ahmad indicated that a proposal to establish a health service commission was in its final review stages. However, a subsequent development saw the parliamentary special select committee on health shelve this proposal in August of the same year. The committee expressed reservations about the potential effectiveness of the proposed commission, noting that critical decisions regarding staffing and positions would still remain under the purview of the JPA.
Beyond salary adjustments, Dr. Jeyakumar advocates for enhanced privileges for specialist doctors within the public service. He suggests the introduction of mandatory sabbatical leave to facilitate the acquisition of new techniques and professional development.
“Many doctors are also passionate about conducting research. We should create avenues for them to secure research grants once they have attained specialist qualifications,” he added.
Restoring Pensions: A Key Draw for Public Health Professionals
Azrul Khalib, CEO of the Galen Centre for Health and Social Policy, echoed the sentiment for improved incentives, proposing the reinstatement of pension schemes for healthcare professionals. This call comes in the wake of reforms that transitioned new civil servants from a defined benefit pension system to a contribution-based scheme through the Employees’ Provident Fund (EPF).
“Removing pensions for healthcare professionals was a self-inflicted wound. Expecting individuals to work for less will inevitably drive them to seek opportunities elsewhere,” Azrul remarked.
Dr. Jeyakumar concurs, placing the restoration of pensions at the top of a list of benefits that could significantly encourage doctors to remain in the public service.
“A sabbatical, research opportunities, and a pension would all contribute to retaining personnel, even if their salaries are lower than those in the private sector,” he stated.
The Ethics of Recruitment: Lawful but Questionable Practices
Both Dr. Jeyakumar and Azrul acknowledge that private hospitals are legally permitted to extend job offers to public healthcare professionals. “Malaysia operates as a free-market economy, where doctors and nurses are free to pursue employment opportunities as they arise,” Azrul clarified.
However, Dr. Jeyakumar raises concerns about the practice of some private healthcare groups “buying out” the training bonds of government-sponsored doctors and nurses. He deems this approach “unethical,” given the substantial public investment in training these essential professionals who form the backbone of the public health service.
He highlighted a significant disparity: “Only about 25% of doctors in the civil service, who have more than five years of experience post-specialty training, are available to fulfil the nation’s specialist roles. The remaining 75% are currently serving in the public sector. Yet, government hospitals cater to approximately 75% of inpatients, while private hospitals serve only up to 25%. This represents a considerable mismatch.”
