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!!
This is a country that likes to deal with complication of problem rather than finding the cause of the problem which is the leaders of the country themselves. they are not smart enough to lead….. you are smarter than them….i’m a fan….
Its about time, ey?
Although I may not be affected in the future – finishing HO soon, I fully welcome this new implementation with an open heart.
MO and senior doctors will play a big role to make sure the standard is at satisfactory level.There should be a separate ontake rotas and ward cover rotas. There should be an oncall team- registrar, MO and HO.
Although some may argue there will be no continuity of care, but the new doctors will encounter more cases and patients. Correct me if I’m wrong but I was told that houseman normally covers 4-8 patients a day. Its not uncommon for us here to see 24 patients a day in a ward round- sometimes on our own.
Proper documentation is vital for the next set of doctors’ referral. It always helps to have a summary at least once every week.
Dont know about you guys, but I rather have less money than have no life.
Last but not least, my offer still stands. To the new DG, *wave* I have a lot of oncall rotas in hand.
Dear Siti,
The system is different between UK and Malaysia. The main problem with the Malaysian system is lack of supervision and thus your statement ” MO and senior doctors will play a big role to make sure the standard is at satisfactory level” is not going to become a reality. You will know what I am talking about when you return home and get into the system.
Housemen here sees about 30-40 patients a day during ward rounds. These rounds are usually done together when the consultants do their rounds but subsequently, it is up to the housemen to devide their work accordingly. It is recommended that each houseman sees and clerks at least 5-10 cases a day.
Proper documentation? Hmmmm. I think you should really get back here and see our great documentation! Your idealism does not work here.
I have suggested this idea few months ago and I’m glad that it is going to implement soon. What I think is 2 shifts are enough to cover the ward.
I disagree that the hard working one will get suffer because it is just short term. The more problems you encounter in your practice, the more efficient you become. Once they become MO, the hardworking one will surface out and the ‘bad apple’ will still in the bottom.
I remembered a very good doctor who works in A&E as he requested all his friends to give all ‘RED’ cases to him. Because by attending to such complicated cases, these are the time you learn. Such behavior has created a silent healthy competition among the good MOs, most of them were grabbing the bad cases when available. The fact show that such MOs are more successful now.
Shift hour work during housemanship will not compromise the training of the housemen because it will depends on the attitude and behavior of the houseman. If they keen to know more cases, they will learn from any new and complicated patients.
By doing shift work, houseman not so tired and will able to pay more attention to the patients.
Money wise I think is give and take, as you work less of course you get less money. The A&E MOs so far also not getting any on call allowance and they have to work 6 days per week compare to other department. They are surviving well also.
Shift hour doesn’t mean less responsibility. If a houseman is responsible, he/she of course will follow up their patients, learn from the time they admitted, treated and discharged.
The lazy one will lost the golden opportunity to learn. This is their choice.
as you said, the good ones will excell in whatever system and condition. Thus, having a shift system is not going to change anything in terms of quality of housemanship training in general. Are you sure that by having shift work, the houseman will pay more attention to the patients? I don’t think so. It all depends on attitude, which is the major problem now.
A 2 shift system will be a better option.
If what they are planning to introduce in Malaysia are ED-style rosters, where everyone works 8 hours a day and rotates through, then I am totally against it.
However, if they are suggesting that most days one would work 8 hours (0800-1600, when most of the work is done), with some days working longer (0800-2200), and separate HO/MOs covering the night shift (2200-0800), then this is a workable and excellent system. It’s sort of like 2 shifts, and the HO/MOs take turns doing the night shift, 7 nights at a stretch or split into 3 and 4 nights.
With ED-style rosters, teaching opportunities will be lost. Most teaching from senior staff takes place during the 0800-1600 shift. Work after hours is acute work and many people are too busy to teach, although one may learn on the go (but you could easily be learning the wrong thing as well, if no one is there to guide you).
With the second type of roster, where everyone is in hospital from 0800-1600 (unless you’re on the night shift) and some staying till 2200, most will get their chance to be there at the right time.
It’s about time Malaysia got rid of the 24 hour shift (32 hours sometimes). It’s a legacy of the old British system. How many here would want someone who’s been awake for 24 hours at a stretch to operate on their child? I’ve personally spoken to surgeons who admit they’ve had microsleeps while at the operating table! There is also research out there that shows your mechanical and mental skills deteriorate to that of someone just over the drink-driving limit, after 24 hours of sleep deprivation. All those Malaysian (and Singaporean as well, mind you) specialists who advocate the 24+8 hour shifts because “‘it teaches you the hard way” or “we had to do it and we got though fine” are kidding themselves.
I have a sneaking suspicion though that we will see 8 hour shifts introduced because there are just too many bloody HOs out there. This will result in less training opportunities, but I suspect people will complain because their pay will be cut from $4,000 a month to $2,500 a month – a big deal if you’re trying to make ends meet!
Since you’re talking lot about MQA accreditation, I think you might be interested what questions they asked? See here
http://www.lwjuan.com/2011/05/16/malaysian-qualifications-agency-mqa-meeting/
haha, as I said, MQA accreditation is a bog joke. Most of the data they collect is what has been presented to them by the colleg/university on paper!. Then they ask some stupid questions like this and expect to get “good and realistic” answers. BTW, there is a difference between MMC and MQA accreditation. For medical MQA is of no value.
To LAV,
Gaji Permulaan P1T6 : RM2458.39
Elaun Perumahan : RM250.00
Elaun Tetap Perkhidmatan Awam : RM300.00
Elaun Kritikal : RM750.00
Elaun COLA : RM100.00-RM300.00 (mengikut lokaliti)
Without the critical elaun, HO’s pay is RM3300.
minus EPF of about RM 360 and PCB (Tax) of about RM 150, the take home salary will be around RM 2700. And if I am not mistaken, you also don’t get Elaun Perumahan of RM 250 if you are staying in housemen quarters!
Lol…look what interns earn in Australia 🙂
The approximate starting salaries in 2011
per state are as follows (Including known
allowances, excluding overtime):
Australian Capital Territory $56,183
New South Wales $56,021
Northern Territory $57,440
Queensland $60,780
South Australia $56,925
Tasmania $58,669
Victoria $58,136
Western Australia $66,360
I know of interns who have managed to make up to 100K AUD through overtime. No wonder all the government scholars are having a splash here 🙂
I presume it is per year and not permonth!
Their tax is also high!
Forgot to add the link:
Click to access AMSA%20Intern%20&%20Residents%20Guide%202011_0.pdf
Page 17 of 74
me is ud44, with gross income of 5k.but if u calculate the pay is around rm25/hour +_+ i have a friend who doing locum for living can get double than my monthly paycheck, with less working hour(9am-3pm), free time on weekends, and less headache – no more have to face with govt hosp office politics and bureaucracy (that’s what he said, i just rephrase:)
however for some personal reasons i choose to stay in govt service(no, i’m not bonded to JPA or whatsoever). yeah, pity me.
It is always what you like and want to do. Sometime the system frustrates you and force you to leave.
IJK,
The reality is not really the same as you wrote here. Yes, we are earning about 3k++ permonth excluding on call. But u need to think all other expenses. As Dr pagavalan wrote, EPF, and all the taxes already took about 800 per month. U also need to pay the car (everyone want to have their own car). Plus for those who is married, then everything need to be considered.
Yes, for those whose their family is rich (which i think quite a number), the money is not really matter, they just want to have more time to sleep.
Yes it’s the annual salary, but aren’t you forgetting all the benefits that australian citizens and PRs get…medicare etc
PLus internship is only one year in Australia, so you get another massive pay hike once you become a resident medical officer (basic pay around 80K)
On top of that, I like to use the car model when it comes to spending power. You can get a BMW 3 series in Australia for roughly 60K. What can you get in Malaysia with 60K? Perodua I presume???
Doctor, if you don’t mind me asking, what is still keeping you in Malaysia? You obviously have the qualifications to hit it big overseas, so why not take it?
Ha ha. Yup I am well aware of all the benefits in Australia as citizen and PR. What is keeping me here? family !! I should have moved when I was young but all my family members are here as well as my wife’s. The day will come when I am sick of the politics of these country!
Australia is a great place to work, worked there for a year myself … only problem is, too many Australians 😉
That’s a pity. But hey if you ever change your mind, Australia and Singapore would be more than willing to accept you with open arms.
I hope historians are taking note of this country’s slow but eventual demise…
are you sure Singapore would be more than willing to accept you with open arms ???
check http://www.singaporemd.blogspot.com and tell me what you think ! They don’t like foreignors & that includes Who ?
Hmm. I don’t think you understand what the article is trying to say. Singapore always prefer Malaysian doctors then anyone else. The reason for the communication breakdown is mainly due to doctors from China, Hong KOng and India. This occurs mainly in their polyclinics and not in major hospitals. Most Malaysian doctors who enters Singapore will work in hospitals as their idea is to do speciality. Thus Singapore depends on foreign doctors from other countries to manage and run their polyclinics.
FYI, I had been offered many times to work in Singapore. I have been contacted via email, phone and their headhunting team was even willing to come to JB to talk to me. That’s how they head hunt people. They are obsessed with human resource or knowledge based economy.
As for GPs doing aesthetic medicine to survive, it has started in malaysia as well. Many GPs have ventured into this field to survive and the situation will only get worst in the near future. Even specialist will end up with complimentary medicine one day.
I hope they implement the shift system,it sounds good.But a 3 shift system is overkill for the moment, a morning/night shift system will do for a start.
IMO,a shift system can help the Malaysian healthcare system improve in a few ways.
1.Improved morale of HOs and MOs,and specialists.
2.Potential to diminish medical errors/mistakes among medical personnel.
3.Stemming of brain drain among medical personnel.
however,many things must be improved/created:proper documentation,proper supervision,proper passover procedure during change of shifts, etc.
(pardon me if my opinion seems naive/unrealistic.)
The shift system cannot be implemented for MO and Specialist at the moment. And I don’t think it will stem brain drain. As you said, many things need to be improved and created befre implementing the system.
I agree with Dr Pagalavan: shift system can not be implemented for MO and specialist … at least for this moment.
why?The reason is simple. Although the relevant authorities are trying their level best to keep it under the carpets, till today they are still unable to keep senior doctors in service! You will be shocked if you know the statistics.
It is a sheer waste of time to mention all the reasons why it is so, since Dr Paga has already pointed out alot of solid facts in his blog.
Shift system will probably raise the morale for junior doctors or House officers, but I am sure it wont be the same for senior doctors/MO/specialist/even consultants
there is a different view that one has over financial status when one is single and has no committments versus those with family.
most doctors who serve the government diligently over the years would probably have their own families to feed, their own children’s education to think about now.
pay is utterly pathetic, with the cost of everything rising month to month and some occasional carrots being thrown at doctors to keep them silent. Education is not cheap in Malaysia either! Most of my friends have ended up in GP clinics while the very few of us who really want to serve the needy continued our day-to-day abuse of staying in service. Then of course don’t forget our fantastic local masters programme that aims to fail people more than pass the deserving candidates.Before you join the programme itself some genius professors have already told you that barely 10 candidates will be sitting for the final exam!Then they cry that not enough specialists are being produced!
hardworking doctors who take their own initiative and pain to sit for overseas membership exams are being treated as outcast! When we pass our part 1 or part 2 exams people seem to think that we will be promoted based on merit, but sadly NO! Your HOD will not listen to evidence based medicine but instead will ask what is the difference between Ky jelly and lignocaine!There is no meritocracy since you are just like any civil servant! if you think after all the hardwork of passing exams and upgrading yourself you will get promoted automatically, you are gravely mistaken! You haven’t gone under the blade of the stupid clerks sitting at the desk who doesn’t know what the hell is going on outside his/her cubicle.
If you are in masters, people will think that you dun have to pay a single cent since you are supposed to be a scholar under scholarship! But no! you pay for almost everything then beg them to pay you back later! Yearly expenses that is being paid out to universities is about 10k max for 4 years, but if you break bond you pay rm100k back! that’s really business we are talking about.
My specialist who is hardworking but somehow got her logbook lost in university was forced to stay at UD41 for 2 years with the houseman while doing all pakar duties! Is this abuse? who would stay after such an insult> she left after she got ud48 2 years later. can you blame her?
how to retain specialists/seniors in service? If the authorities really do their job and research, they will probably give up the idea. At this rate we are going, we are going nowhere.
welcome to Malaysian “birokrasi”
I support that HO’s go on shift duties. It’s about time we improve the Ho hours. We can work out a system where HOs can learn, and at the same time , give them more humane hours.
As I said, it all depends on the situation in each individual hospitals. The time will come when shift hours will be introduced in all hospitals when the glut reaches unimaginable level by 2020.
dr, when do u think this will be implemented?? because i finish this year and am planning to apply to jb hospitals.. i am hoping to learn during my houseman hopefully adequate enough for me to became a good medical officer…. i am dissapointed with the idea of shift work as this would defin affect the quality of the housemans …. also dr what is your opinion about the sultanah aminah hospital, muar hospital and batupahat hospital?? are there any hospitals you would recommend for a houseman??
The are starting a pilot project in few hospitals next month but not sure when it will be implemented throughout the country. Personally, I think it will take atleast another 2-3 years as we need certain number of HOs in each hospital for it to be implemented. Hospital Sultanah Aminah is the best!
I just wonder, Singapore is a small country. Wouldn’t it experience glut of doctors too, what with Malaysian doctors moving in?
Yes, eventually they would but their own production is very low due to their strict quality control in intake of medical students. Even in Australia, certain states do not have any more post for housemanship.
It did experience a glut in the past (late 1980’s) and they tried to regulate it. Only recognised 20 medical schools worldwide. And of the overseas medical schools they recognised, they imposed a rule to them that they are only allowed to take in 5 Singaporeans per year (with minimum 3 have to be Chinese) – otherwise they would take away the recognition. But it worked too well and they had a shortage so from 2002/03, they’ve gradually increased the number of recognised med schools.
Sounds exactly like their one-child policy in the 1980’s – worked so well that they still can’t get Singaporeans to have more than one kid despite paying them lots of subsidies now to have more than 2.
There’s actually one other factor:
Most if not all the Singaporean medical students in Australia would rather stay here than return to Singapore. According to one medical student who attended a job interview back in Singapore, the recruiters seem to want him more than he wants them – hence the reliance on Malaysian graduates.
This is a bit info regarding the shift work that i can describe:
working hours: 3 shift (6 AM to 1 PM), (1PM to 8PM), (8pm-6AM)
Per shift: 2-3 HO per ward (need to cover for about 40 pts per ward).
Entititled 1 day off after 3 night shift (depend on the department)
No more weekend off, all request leave is subjected to the requirement of duty.
No claim is allowed, and probably less teaching (CME) for the housemen.
Clinic duty mostly MO’s need to cover (really mistake here, cause you may not see different/interesting cases in the ward)
MO and specialist still working 8-5 as usual
working start at 6 AM?? How many of you want to get up that early? Nurses and paramedic even better than doctors in term of working hours.. huhuhhuhu.. You need to finish the round before 8 am as specialist may come and do round around 8am. So, 2 person covering 40 patients.. (pass over + review all the patients in 2 hours)
Excluding need to attend new cases..
So looks like ‘buruh kasar’ here..
So, those who want to get a nice sleep with shift duty, have a nice early morning bath at 5 AM..
1 more thing, why this is different from A&E shift duty, coz doctors in A&E only attend the new cases and no need to review and to maintain the continuation of management. For the doctors in the ward, they need to manage new and old cases, that means need to review progress of the patient.
If you compare to nurses/paramedic shift duty, they don’t have to review the patient. They usually sit down and write all the same thing every day and their job is only to take the vital signs and to give medications. No need to examine the patient and to see the pt’s progress..
There are pro & cons comparing working in the ward and A&E. Although A&E doesn’t need to maintain the continuation of the patient (formally) but some of the good MOs I know did go to the ward to follow up their patient. Unfortunately, this very good doctor has left Malaysia for better prospect because of the current inefficient system.
Do not forget, A&E doctors despite no need to follow up patient’s normally. They have higher chances of getting public complaint because of many patients from multidiscipline problem to attend within such a short time e.g. difficult patient, difficult MO from other department and others.
If they couldn’t save the patient, the respective department will blame them. If they manage to save the patient, credit will go to the respective department.
Working as HO so far has no medicolegal responsibility except for MO/Specialist. If HO mistreat the patient, the most is get scolded by the MO/Specialist.
I will suggest not to compare with MO or nurses. If want to compare, some HOD is not doing any work, come working late and go home early and claimed more than 10k/month. What do you say?
These are the process that you have to go through.
It was a suggestion. Doesn’t mean it has to take place there and then. My idealism only work in UK apparently.
Thanks Dr. Pagavalan. You’ve just reminded me not to come home.
“Are you sure that by having shift work, the houseman will pay more attention to the patients? I don’t think so”
Good say
I am sure those who think this new system is a good idea definitely are those who are fresh graduate and wish for easier life doctor,
If you think this system is applicable, wait until you are in the system..
to those who think the ward’s work is management with shift system, wait until you start working with some “rubbish” houseofficer…
and to those fresh graduate who keep making complaints regarding current HO life and wish for easier life..
please looks for other non-medical base field..
Hi Dr.Pagalavan,
I enjoy reading your blog very much. I notice many HOs these days are doing locum work in clinics. They seem to be inexperienced in giving good quality medicine. Sometimes you need to make two or three visits before you could get better. But if you visit an experienced GP, chances are you may be given good quality medication on the first visit itself. I think HOs should gain adequate experience in treating outpatient cases before doing locum…..
The problem is there is no real GP training in Malaysia. The Masters in Family Medicine is not compulsory. Recently, the Academy of Family Physicians of Malaysia has offered the Diploma of Family Medicine for aspiring GPs, with variable take-up because the govt does not see the need for compulsory training of GPs.
MOs who work in klinik kesihatan spend 3-5 minutes with each patient. This is due to a combination of heavy patient workload, lack of teaching, and apathy on the part of some of these MOs. They cannot learn family medicine like this.
I wrote an article in Berita MMA in 2007 suggesting compulsory postgraduate education for GPs in Malaysia (even a diploma will suffice!) but I still do not see it happening due to the powers-that-be (although the introduction of the diploma is a pleasant development).
The vast majority of locum GPs in Malaysia practice cookbook medicine. They do not have the skills to function as a family physician. They are just doing the job to earn extra cash on top of their work in hospital. Look closely on the wall in the consultation room – sometimes you may see a list of medications matching certain signs/symptoms, provided by the clinic. This is how they decide how treat the patient!
Despite all I’ve said above, sometimes you have to fault the patients because everyone expects to be given a medication when they see a GP, even if it’s not warranted. Otherwise the doctor “is a lousy GP”. Combine that mentality of Malaysian patients along with the financial incentives of GP prescribing practices – most people get prescribed something (that may or may not work).
First of all, HOs are NOT suppose to do locum!! Thus, if the public knows that an HO is doing locum in a clinic, they should make an official complaint. HOs are not fully registered by MMC and thus action can be taken to the owner of the clinic and the doctor for doing locum.
Well Dr.Pagal, it’s a sad thing as most patients wouldn’t know if the doctor is a HO or not when they visit a clinic…they just want to get better. Medicine has become a profession to make money for many but not all and the public are victimised these circumstances.
As I said, it will be much easier to implement shift duty in smaller hospitals where there are only 2 wards per department compared to bigger hospitals. Let’s see whdether it will work.
Yes, what the government pays is just nice for a single person to live a comfortable life. The problem only comes when you get married and have children.
Actually doctor, there are only 25 house officers currently in the medical dept in Hsajb, thus, making it impossible to implement the shift system in the near future
The numbers will grow soon as it is just midyear still. Most Unis graduate after May.
…or the numbers will not grow at all, as the new housemen are merely replacing those who are becoming MOs.
Nice entry though.
Nope, you are wrong. The number of new housemen is increasing exponentially. So, the input is getting bigger than output every year.
dear dr,
i’m confused with all these shift system. and i certainly don’t like it, for financial reasons.
1) i heard that it’s confirmed system to be implemented now. is that true? or it’s still just undergoing pilot tests in certain hospitals?
2) if it is not implemented nation wide, then i should choose hospitals which has yet to implement it? where can i get a list of hospitals which has implemented shift system?
i personally am having huge issues with the no on call allowance. RM2700 is unacceptable. plus, i’m completely ok with working properly and learn properly. what is your advice on this dr. pagalavan? this piece of news really shakes me.
1) yes, the pilot test was done in Pahang and now has been expanded to JOhor and kedah. I think by end of this year, it will be implemented in all hospitals.
The is no doubt that with the increasing glut, the salary will drop. The government is not going to be bothered as getting a job itself is going to be difficult. So, no point complaining about the salary. At least you got a salary! My salary in late nineties as HO was only RM 1648, can’t even afford to buy a car! On call was RM 20/call.
and if this piece of news is true, which is saying that all hospitals will be having the shift system starting august, i’m seriously considering taking exam to jump ship to other countries. with all the hardwork, and sacrifices, bottom line, RM2700 is not acceptable.
It is entirely up to you. Salary might be better in some countries but not necessary your opportunities will be better. You have to fight for it and obviously their citizens will be gven priority. ANd don’t forget that they can kick you out if you are not performing.
To Dino,
If you are so confident that the grass is greener in the other side of the countries (SIngapore, UK, AUS, US or NZ), just board a ship and plane as you wish to.
Comparatively HOs in Malaysia earn more compare to other countries after taking consideration amount of tax one needs to pay and cost of living standard of these countries.
Since our Bolehland has more than enough HOs, the bottom line is, seriously the MOH DOESNT NEED any MONEY-MINDED doctors as our ‘beloved’ government is in debt.
To HES,
i am not confident at all that any other places is better than Malaysia in terms of gaining experience and learning. plus i have no idea at all about their tax or financial situations. but what i am sure is that it will be more than RM2700.
i am sorry if i sounded money minded as you mentioned. i am just disturbed by the fact of having 1/3 of the salary taken away, and to be completely honest, RM2700 is pretty low. doctors are human too, and for me it’s completely reasonable for us to ask for what we deserved. i do not know about those “lepak” HO who just wanted to get on with life. i personally thinks an honest hardwork should earn an honest pay. and it is not hard to understand that if i do not want to work in malaysia in the first place, i wouldnt be shaken by this piece of news in the first place, would i?
if you still think this is money-minded, then i have nothing more to say. sorry that i sounded that way, but please judge according to all factors. thank you.
and please leave a comment if anyone else has news regarding this issue.
If you are talking about HO level, you can forget about jumping ship, no other country (except Singapore if your MBBS / MD is from certain universities) will even accept you. Most developed countries are already producing more HOs than their system can cope. No doubt their pay is higher, but their costs is also way higher. If you are already complaining about 1/3 of salary taken away, try to complain of at least 40% taken away. On top of that, there is a much higher chance of being sued compared to Malaysia, that somewhat limits what you can do. If you are thinking of Singapore, let me tell you, every year they only have 2 opthalmology training posts, and 500-1000 people applying for that 2 posts. Even in Sinapore, it is not guaranteed that you will get into the training program. I can understand your point that RM2700 per month is hard to survive, but at least, you can survive with that pay, the same cannot be said if you choose to jump ship, in fact, you might one day regret it.
Wellcome to reality. The reality is , you will never be paid for amount of work that you do. The hardworking and the lazy ones will get the same salary, that is Bolehland’s government service. This is why many leave the government service, due to frustration.
Why not come to Australia? Interns (equivalent to houseman in Malaysia) make around AUD 60K per annum here. There must obviously be a reason why the JPA scholars are rocking out here 🙂
To Dino,
You should be thankful that our government still hire HOs despite the Housemanship glut. The news now is the shift system has been implemented in some central hospitals and will affect all the 39 hospitals sooner or later, although it hasn’t affect the one I am working at and hopefully these pieces of news dies sooner than it begins.
Also, have you done any survey about job opportunities and income if you choose to work elsewhere. I bet you would be shaken more.
Anyway, FYI our government especially the MOH and KKM are only good in talk the talk but never walk the walk because politics and money are more important to them.
They are many who are jobless after they graduated, to name few – engineers, pilots and nurses so be grateful while opportunities are still there.
Judging from your comments and the imminent implementation of shift system nationwide, it is better for you to jump the ship.
Hi all,
thank you all for the comments. i guess so far nobody knows exactly what is going on either, and we’ll just have to wait and see. i just hope everything turns out fine, and the government can finally lay off anymore drastic changes to the medical field.
i know it is important to be grateful. but i also believe that when going gets tough, we should think of solutions, and not staying put with accepting bad conditions. for example, dr. pagalavan had mentioned many feasible solutions to handle overflow of HO and even medical students in malaysia, but of course, he is not the prime minister. i for one would gladly accept any interview and exam system in exchange for the good of the country, and the good of the people. hire the good HO and not by slashing the existing salary.
and yet again, that’s just what i think. thank you all again for the valuable comments, and please share any news when it is available.
Thanks for the info. I am sure these were told to you by a ministry official or JPA official. I have heard this kind of talk too many times that I do not believe what they say on ad hoc basis without any evidence to back up their claim. The same officer will not be in MOH within the next 1 year as the people keep changing.
I am sure after the oncall allowance is removed, the next will be critical allowance. I can assure you that they will not introduce any new allowance unless it is for all government servants, like COLA allowance before. Any increase in basic salary will also be for all gov servants.
The payscale increment will not happen, trust me. It took us almost 10 years to get MOs in U44 after finishing HO in U41. Every 10 years, the government changes it’s salary system, the last was in 2003 where they introduced SSM from SSB. The next change might occur within the next 5 years.
6000+ housemen? when more than 50% of the medical schools are yet to produce their graduates! Imagine what the figure will be in next 5 years! you think the gov will be bothered to revise your salary when there is going to be more body than post? I don’t think so!
Government servant pays very minimal income tax. Only the basic salary is taxable. at the most, you will pay RM 100-200 per month
Nice to read you guys punya thought about HO and MO. Be proud to have your professional medical knowlegde. Work to improve yourself then the big gain will follow. Kalau still tak get big gain, then leave the medical profession and do something else coz you may not fit to be a doctor.
Hello all~
I’m a new doctor, just graduated a few months ago and will be undergoing induction hopefully this Sept.
So I’m hearing a lot of buzz on facebook from my seniors about the pay cut. I’m just wondering, is the RM750 Elaun Kritikal still in our pay or not?
Thank you.
at the moment, it is still in but may be removed when all the HO post are filled, likely in 2-3 years time. Critical allowance is reviewed every 3 years and the next review will be 2012.
hi delirioustk,….. yup .. i guess thr will be no more critical allowance …. so, basically, u r goin to get ard rm 2500 – 2600 per month
Shift is not a good idea to me. First I am pretty sure teaching would be less. Because most of the teachings happens at day time. Trust me, I am working as a HO.
2nd, work load increase, meaning the lazy ones will for some stupid reasons pass on the undone work to the ones taking over next. Even without shift systems, it is happening where the hardworking ones will have to do more jobs as compared, because we are dealing with patients life, where most of the time the hardworking ones would rather just do it to decrease scolding rate or doing any harm to the patients.
Working for long hours and studying for at least 5 years to excel and get a pay of about RM3000, is it worth it? Let us be honest, we need money for life, and if money is of such not important, then why no go volunteer? We are working our ass saving lives except our own life. And don’t forget most days when we have to skip our mealS.
Never expect that u can leave sharp when your shift is over, because it will never be so. Procedures (less teaching cause most are tried to not be done at night unless really needed), undone work…etc etc. Responsible HOs will try their best to finish it. Thus there is never leaving on time.
And do not forget those who left for the east Malaysia. Forcing leaves, where is the balik kampung time then? Staying there forever? How then is this shift system helping in increasing the amount of HO in East Msia? And do not forget, no more holidays for each respective festive seasons. It is basically leave without leave. And do not forget too, that some b*stard will just have ELs (by their wish) and passing on their duties to those HO with increasing work load. Is this then beneficial?
And do you really think with this shift system will bring better quality of life? Yet to see…
Do you know that for those HO who get to work the 8hrs shift is consider lucky.
Do you people know that certain hospital is implemented a free labour shift system.
A brilliant High Rank officer suggested all HO to work 8-5pm as compulsary service. Then “the shift starts” from 5pm – 12 am, and another “shift continue” from 12am to the next day 8am. HO will take turns to do this “shift duty”. The brilliant thing about this shift system compared to the one DG suggested is that HO works the same hours if not more compared to the previous call system “hence more experience” and that the Government can save more money for projects like introducing RM20 bills, or putting up grand fireworks in putrajaya everynight, 2 weeks in a row.
Well, Who are we to make noise. We are HO, and our priority is to learn and get experience. We are not suppose for care about money. Not suppose to care about financially supporting our parents. Not suppose to care about earning enough to feed for family especially those who are already married. Not suppose to spend time for family. And also We are as HO suppose to be brave to drive home at 12am or later because we need to think for for our career future and think for this brilliant government.
Well. Come to think of it We HO are really doing a noble job. haha. god bless us.
Welcome to the real world. Soon , even getting a job as a housemen is going to be a privilege. Thus, MOH is not going to be bothered about all this on-call allowance, critical allowance and doctor’s salary anymore. You don’t like it , leave and find a another job, that will be their motto soon ………….
Most Pengarahs are apple polishers. You can try to bring this issue up with the state SCHOMOS representative. Let him bring it up with the MOH and DG.
I had said this before that you can’t apply this to all hospitals as different hospitals have different constraints. Unfortunately, government is running out of money and the DG has been instructed to cut the budget for MOH. Shift system is inevitable and so does doctors income reduction
Well, no use all of us complaining about this shift system here is we have no guts to do more to make our sound heard by other.
I urge all HO out there to speak out their frustration and practice our right.
Afterall we are giving services to our beloved one Malaysia
Pls bring this matter up to your state SCHOMOS rep.
well said dr pagalavan. .its not bout shift( time) and $$ after all..even all HO were not entitled to get MC..
Please send someone to Sarawak. We only have 34 houseman left. 6 HOs in medical department taking care of 70 patients. We don’t even have enough man power to cover all our cubicles. Someone our NS ordered not to help HOs to label form, blood tubes, taking blood. Are we the one who are giving orders to nurses or we are the one who is doing the nurses jobs now also?
Don’t worry, soon all new housemen will be sent to outside klang valley. However, many people still pull big cables to stay put in their hometown. BUT I am very sure with the coming glut , the situation will change and housemen will have to go where they are sent. Getting a job itself is going to be a previlage.
Please send someone over to Sarawak. We don’t even have enough HOs to start a shift system. With 34 HOs running a district general hospital, this is ridiculous. How to start a shift system when we only had 6 HOs to take care of 70 patients? Someone we had to label our forms and bottles ourself? Do we need to up drip and do TPR chart one day in future?
I sympathise with you. 2 things could have happened:
1. Other HOs have used their cables to avoid going to East Malaysia
2. MOH are incompetent that they can’t distribute HOs evenly throughout hospitals in the country (some departments in the peninsular really do have 100 HO’s!)
Who knows, the day will come!
Seeing all the comments I kinda feel justified by going against my parent’s wishes to be a doctor. Not suitable for me at all. Currently living a decent albeit dull life as a researcher. MOH is in debt(a lot of debt), that’s why they are cutting everything. Pity to the doctors. Hope you all be strong.
Now i know why is everyone obsessed with locum …HAHAHA!!
hai..im one of d ho who was initially was very excited n hepi coz of shift system..bt nw i fil depressed n so unhepi of it!!! u knw y guyz?? coz itz x a truly shift system!!! in my hosp,it is called as extended hr system!! eat d hell rite?? bt it had practised in certain postings ani..basically we hd 2extended hr..one is 4m 5pm to 12am and anthr one is 4m 11pm to next 2pm!!! and we gt ONE day off in week!! it is basically everbdy wl b wrkng as usual 4m 6am to 5pm and certain grp wl b doin the extended hr!! can u guyz imagine hw shity it is?? it is exactly like doin half day oncall without claim and without WEEKEND OFF !!! in dis system,no weekend off,no half day 4weeknd or public hlday!! itz mr tiring n so x worth of wrkng 4it!!!!! help us here!!! hp to gt sm solution!!!”
TO SAD (SEPTEMBER 21):
IT BECOME EXTENDED HOURS BECAUSE U HV TO WORK MORE THAN 12 HOURS
FROM 7 AM TO 12 MIDNIGHT WILL BE 17 HRS
11PM TO 2PM WILL BE 15 HRS
I HEARD ANYDAY THAT WORK MORE THAN 15 HRS WILL GET OFF FOR NEXT DAY… WHY ONLY 1 DAY OFF PER WEEK?
LEE MENG TAT
ADMINISTRATION DIVISION
HOSPITAL TEMERLOH
[…] the shift system was implemented I wrote this https://pagalavan.com/2011/05/15/for-future-doctors-shift-work-for-housemen/. The whole idea of the shift system is to reduce the number of housemen in each shift so that they […]
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Is it really ~rm2000 only now for houseman since the shift system began?any idea on its approx exact number now?what about hospitals which still do not implement the system?do they get on call salary, no?
That”s the old rate. Now Houseman take home about RM4K after the recent pay rise.
Hello Dr Pagalavan. I have just graduated and waiting for housemanship posting . I’ve chosen Hsa as my first choice . What’s the working hours like ..? And any tips before I start ..? Thank you doctor . Jessica .
Housemen work shift duty nowadays but it is a busy hospital
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