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I was informed today via my blog by a senior houseofficer that shift hours may be introduced for houseofficers as one of the measures to overcome the overcongestion of doctors in wards!! It seems that our new DG has picked certain hospitals to run a pilot project to see whether it will work. The person who gave me this info asked for my comment and thus I thought it is better that I write about it as a fresh blog posting.

Even though I am not totally surprised with this move, there are pros and cons in introducing shift work duties. Whether this system will work, depends on the size of the hospitals and the total number of housemen in each discipline. Usually there will be 3 shifts; am, pm and night shift. In big hospitals such as JB hospital which has 8 medical wards of 30-40 patients each, you will need at least 4 housemen for each am and pm shift followed by 1-2 housemen for night shift. This means a total of 10 housemen/ward with an additional 2-4 housemen to cover for the off day (which is given for the housemen who does 2 continuous night shift). This works out to be 112 housemen per medical department!! Currently, as far as I know, the total number of housemen in JB medical department is about 50. Of course, with the current increasing number of production of doctors, we may reach the magic number of 100 housemen per department within the next few years. For smaller hospitals which has only 2-4 medical wards of about 40 patients each, the number may be adequate to start shift hour work. However, it is not going to be an easy task. We must also understand that not all wards are active and admitting patients all the time. So, it is going to be very difficult to coordinate this shift duties.

Working shift hour means passing over the management of the patient to another housemen every shift. This will definitely cause a lot of problems in the continuity of care of the patient. The responsibility of the housemen will also reduce, making the doctor more complacent. The housemen who is not interested in being a doctor( you are seeing a lot of these nowadays) , may just take his own sweat time to do all his work so that he can pass over the problems to the next housemen who takes over. This will go on and on untill the patient may not get the treatment that he needs. Politics will become the main issue among the housemen. The hard-working ones will continue to suffer and definitely it will be more difficult for the consultants to monitor these housemen as they will keep changing every shift. The medical officers will begin to complain as they will end up doing all the work but they will not be doing shift work. I feel that in order to introduce shift hour duties, the entire team should change, from housemen to medical officer to consultants, like in some countries. Only then a proper shift duties can be introduced without compromising the care of the patient. This is impossible at our hospitals and with our current system. Introducing shift hour work during housemanship will also compromise the training of the housemen. Less working hours with less exposure to emergencies.

Furthermore, working shift hours means you are NOT entitled for “On Call” allowance. Currently, with housemen required to do 10 “on-calls” per month, this adds on another RM 1000-1200 per month to their salary. Indirectly, shift hours means less responsibility, less work and definitely a pay cut. If these system is successfully implemented in all hospitals, which I am sure will happen sooner or later when the glut reaches a umimaginable level, the JPA would not hesitate to stop the “Critical allowance” of RM 750. Another pay cut , a total of RM 2000/month!!

There is also going to be a lot of headache to each department in organising these shift duties, especially those departments which needs housemen in running outpatient clinics. I wish the department heads, best of luck. As usual, the instruction always come from the top without prior consultations with the people on the ground, the typical Malaysian style!!