FOLLOWING the Covid-19 crisis from 2020 to 2022, Malaysia’s public healthcare system has experienced a significant exodus of doctors, nurses, and healthcare staff at all levels. This increasingly chronic shortage of human resources has created a vicious cycle, exacerbated by the large numbers of people seeking care at public hospitals’ emergency and trauma departments, outpatient services, and congested government health clinics.

The availability of house officers (HOs), or doctors-in-training, has significantly decreased in recent years, despite an increasing demand and the continuous intake of fresh medical graduates. This shortage, affecting most district and tertiary medical centres across the country, has forced medical officers (MOs) to take on dual roles as both HO and MO. Combined with excessively long working hours, extended contract positions, mismatched salaries, increased clerical and clinical workloads, and perceived lack of transparency in career progression, the situation has left HOs, MOs, and even specialists demoralised and frustrated.

There have also been allegations of mistreatment, bullying, abuse, workplace exploitation, and accusations of a toxic work culture, contributing to mass resignations and further aggravating the situation for those remaining. Simply put, healthcare professionals—including pharmacists, medical assistants, and dentists—are not receiving the support they need to build sustainable careers, stay safe at work, or even find a reason to remain in the system.

How bad is it? The Health Ministry’s (MOH) data, reported to parliament, paints a grim picture of pain and suffering – a silent cry for help.

House officer appointments dropped by almost 50% from 6,136 in 2019 to 3,271 in 2023. Between 2021 and 2023, 3,046 contract medical officers resigned, with a peak of 1,354 resignations in 2022. Data from 2017 to 2023 shows a rising trend of resignations among contract doctors, with a drastic increase during the Covid years. Hospital departments are regularly hosting farewell parties for doctors leaving their posts. Despite permanent positions being offered to contract doctors over the past two years, the uncompromising conditions of permanent posts, especially mandatory relocations, have led to a further exodus of personnel rather than retention. In 2023, 20% of the 5,489 medical officers offered permanent posts did not report for duty, preferring to leave the profession rather than be displaced.

The number of specialist doctors employed by the MOH has also taken a hit. Resignations among this scarce group rose by 57%, from 229 in 2019 to 359 in 2023, the highest in the past five years. Specialties such as Paediatrics and Internal Medicine saw the most resignations in 2022-2023, while areas like Urological Surgery and Transfusion Medicine were the least affected.

In terms of nursing staff, Malaysia lags behind its neighbours, with a nurse-to-population ratio of 3.6 per 1,000, compared to the OECD average of 9.2. The number of nursing vacancies has steadily risen over the past five years, from 2,106 in 2020 to 6,896 in 2023. In some hospitals, entire nursing teams have resigned en masse, moving to the private sector or abroad for better pay, work-life balance, and working conditions. Resignations of MOH nurses with post-basic qualifications have doubled in the past five years, peaking at 118 in 2023. This chronic shortage of nursing staff has even led to the Ministry relocating specialist nurses to wards, causing widespread resentment.

Malaysian nurses’ salaries are among the lowest in Asean, with many nurses earning a stagnant RM2,600 even after a decade of experience, reaching RM3,800 with allowances. Recruitment teams from countries like Singapore, Dubai, and Brunei actively scout for skilled Malaysian nurses to ease their own shortages, offering sign-on bonuses and better working conditions.

In some areas, the resignation rate is nearly three times higher than the rate of workforce expansion in the public healthcare system. The battle to recruit and retain healthcare workers is being lost, largely due to inadequate human resource management practices.

The general public remains largely unaware of this crisis, reassured by politicians’ repeated claims that Malaysian healthcare is among the best and cheapest in the world. However, the system is struggling with economic pressures, healthcare inflation, and the challenge of maintaining a world-class healthcare workforce.

So, what can be done? Meaningful solutions and institutional reforms are urgently needed. It cannot be business as usual. Raising salaries and on-call rates is a good start, but addressing working conditions and workplace culture is critical.

Firstly, there is no single solution that will solve all the issues. However, the government can begin by separating the employment, welfare, and management of healthcare professionals from the Public Service Department and establishing a Health Services Commission. This commission, similar to the Education Services Commission, would be responsible for appointments, placements, promotions, transfers, and disciplinary actions, managed by individuals who understand the challenges and conditions on the ground. The commission should also have the authority to oversee healthcare professionals’ salary scales.

Secondly, the work of the Healthcare Work Culture Improvement Task Force (HWCITF), established in 2022 under former Health Minister Khairy Jamaluddin, needs to be revisited. The task force’s findings were considered incomplete, failing to fully address the issue of workplace bullying despite receiving over 14,000 pages of feedback from more than 110,000 respondents. A thorough analysis of these insights is essential for future human resource planning.

Healthcare is a public service of the highest order, and those who choose this path must be supported in their careers. The culture of romanticising sacrifice and suffering as part of the profession must end, as it only legitimises exploitation and abuse. Most importantly, the concerns of healthcare workers must be taken seriously and addressed with respect.

To transform our healthcare workforce and retain top talent, we must develop a fair, equitable, and just workplace culture.

* Azrul Mohd Khalib reads The Malaysian Insight.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.