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Government Service: Past, Present and ………………… Future?

          Over the past 2 years I have been writing numerous articles in Berita MMA mainly concentrating on SCHOMOS issues. I am sure many of us would have realized by now, the struggle that SCHOMOS had to go through to achieve something meaningful in our government service. With great regret I would like to say that this would be my last and longest article concerning SCHOMOS issues as I would cease to be a SCHOMOS member soon (still a MMA member though). This article would be divided into 3 segments about the past, present and future of government service.

 Past

          As I have been in service for only about 10 years now, I can’t actually comment much on the achievement of SCHOMOS prior to 1990’s. Early 1990’s saw one of the major changes that took place in the government service. The introduction of SSB (Sistem Saraan Baru) in 1992 replacing the “cabinet” salary scheme saw the reduction of salary of doctors. If I am not mistaken, the salary increment for doctors and the prospect of getting promotion were badly affected by this scheme. In the “cabinet” salary scheme, I was told that after 5 years of service, a doctor would be promoted to “Tingkatan Kanan” which would carry a salary of about RM 2500. We lost this privilege when SSB was introduced. I am not sure the role of SCHOMOS on this issue.

          In 1994, after almost 7-8 years of battle, SCHOMOS finally manage to push through the “On Call Allowance”. Up to today, this is probably the most outstanding achievement of SCHOMOS and it is still being promoted as one. The introduction of “On Call Allowance” brought much joy to the doctors as now atleast they are not treated like “slaves” for the Ministry of Health. Even tough the amount was small (you can earn more in McDonald!), it was better than nothing.

          Then came the promotion issues for doctors. Many specialists were remainig in U3 scale for years after gazettement as specialist. Some waited for almost 5-8 years in the U3 salary scale. So in the late 1990’s, the major bulk of SCHOMOS struggle was to get faster promotional scale for doctors especially the specialists. During the tenure of Tan Sri Abu Bakar as the Director General of Health (DG), many promises were made. We were promised then, as well, that every specialist would be getting their U2 upon gazettement. This promise still remains as a promise even though almost 10 years has past. However, in the year 2000 and 2001, we saw the major exercise of promoting almost all specialist gazetted in 1998 till 2000 to U2. I was made to understand that this was the best push that Tan Sri Abu Bakar could do for us (remember the JPA bureaucracy!!). But yet again, this brought much dissatisfaction among the doctors. Many senior and junior specialists were given U2 from the same date. Seniority was lost, frustration grew and many left to the private sector despite getting promoted. The private centres were mushrooming all over the place especially in the Klang valley in the 1990’s absorbing all of them.

                   While everyone thought that the promotional issue was coming to an end, as specialists were getting promoted to U2 within 1-2 years after gazettement, another major disaster struck the government service yet again. This came in the form of SSM (Sistem Saraan Malaysia) which I would elaborate in my next segment.

                     We also saw a 10% pay rise for all government servants in the year 2000. In 2001, we finally saw for the first time an attempt was made to reward doctors by introducing a special rate of “Critical Allowance” of RM 500 flat for all doctors. Prior to that, it was only 5% of the basic salary, which would come to a miserable RM 80-90. I must say that the increase of the critical allowance was a struggle of our past SCHOMOS teams as well. In 2002, another 10% pay rise was given to all government servants. A 25-50% increase in “On Call Allowance” was given in 2003, a miserable amount but still an increase after 10 years of the previous rate. All these resulted in some amount of increase in the take home salary of doctors. The table below shows the salary of doctors (Housemans) before and after the year 2000:

EKA : Elaun Khidmat Awam

COLA : Elaun Sara Hidup

 Table 1: Salary of Houseofficers at appointment.

 Present 

                   All these temporary happiness that came to the members of SCHOMOS in 2001 and 2002 came to an abrupt end with the introduction of the “Great Disaster”, the Sistem Saraan Malaysia (SSM). End of 2002 saw the introduction of this new salary scheme by our previous prime minister, which many of us signed in, thinking that there is a salary increment (salary adjustment actually!) and better promotional prospects, as the self development programmes are taken into consideration. Unfortunately things did not turn out as what it was thought to be. Many of us thought that our postgraduate degrees and the medical courses that we attend would be considered as part of the “Penilaian Tahap Kecekapan” but our JPA friends thought otherwise. For them, it is their very own “Penilaian Tahap Kecekapan (PTK)” exam which is going to decide whether you are a good doctor, physician or surgeon. So, these guys who do not know the difference between “urology and nephrology” are deciding our faith on who is qualified to be promoted! 

                   So the saga continued…… SCHOMOS began to address this issues right from the beginning in 2003. As usual we were given promises that, the speed of the promotions will remain the same except the fact that there will be an extra hurdle of passing the PTK. Nothing was revealed about the PTK till December 2003 when the first PTK 1 exams were held and the result was disastrous, not taking into account the 8 months it took for the results to appear. No promotions took place under SSM for 3 years (2003-2005), 3 years of silence but 3 years of agony, pain and money for the poor doctors and specialists. Our proposal to remove the PTK and replace it with postgraduate degrees was rejected initially but later a proposal was made to introduce CPD (Continuous Professional Development) as part of PTK. The first meeting for CPD was in January 2005 but unfortunately up to today, another silence has occurred on this issue. Many times we were told it will take off in July 2005 then January 2006 then July 2006 etc. etc. but till today it still remains a mystery. This is similar to the Budget 2004 promise of setting up of private wing in government hospitals which was later changed to full paying patient system which has undergone a silent dead as well.

          Our new minister’s promise to increase the “On Call Allowance” took almost more than a year to be revealed in June 2005. We were given a 100-400% increase in the allowances. This would probably be the only increase for another 10-15 years to come, I guess. Tax exemption for “On Call Allowance” and “Specialist Allowance” were also announced in July 2005 following SCHOMOS submission of these proposals to MBK ( Majlis Bersama Kerajaan). All government servants received an increase in “Housing allowance” from RM 165 to RM 210 in 2005 and an increase of “Elaun Khidmat Awam” from RM 170 to RM 300 in 2006 (Table 1). Cost of Living Allowance (COLA) was also introduced in 2006. All these perks in the government sector has definitely made the doctors salary better than 1990’s. Remember that all this happened within the last 5 years, with constant pressure from CUEPACS, SCHOMOS etc.

          The appointment of our new DG, Tan Sri Dato Dr. Ismail Merican in 2005 brought a lot of happiness to the doctors as a DG who cares. Many promises were made again that brought cheers to our members. The multiple doses of promises that were made include promotion to U48 upon gazettment, U54 within 3 years and JUSA Khas C within 3-5 years. We were told that we do not need PTK to be promoted and CPD will replace PTK. To date, this has not happened. Our good old JPA friends shook their tails and made sure that these promises would not be fulfilled easily. The JUSA Khas C promotion in 2005 and 2006 were skewed to certain people and certain hospitals. Poor, hardworking consultants in busy and isolated hospitals were left out. This again resulted in severe disappointments among the doctors.

         The much awaited promotion of U41 specialists to U48 finally came in June 2006 but not without conditions. We were given “Memangku Bukan Tujuan Naik Pangkat (BTNP)” rather than a direct U48 and we were forced to attend and pass a short 4 days PTK course (a waste of tax payers money, I would say). All these were not what we were promised but we had to swallow it. The most distressful and disappointing event was the fact that the promotion would not be backdated. Some of us lost almost RM 60 000 worth of money and lost almost 2½ years of seniority due to this. To my knowledge, as I have mentioned earlier, this situation has happened before in the 1998 to 2000 batch. So I am not surprised at all. History always repeats itself. 

          Legalising locum was probably the best news in 2006 for government doctors. This was a struggle that SCHOMOS was fighting since the 1980’s. Unfortunately this is not going to change anything except the fact that the doctors could do the locum without any fear.

 Future?

          In my article for July Berita MMA entitled “Future of Government Doctors: Die Another Day?” I think I have elaborated in detail regarding the future in government service for doctors. The number of new doctors in the next few years would fill up almost all the post by 2009 and there would be surplus of doctors by 2010. There will come a time where doctors would have to queue up for appointment in government service.

Unfortunately I don’t think this would eliminate the mal-distribution of doctors in service right now. There would still be many neglected areas and hospitals where the doctors and consultants would be struggling to cope, where as there will be some hospitals which would be overloaded with doctors doing “nothing” compared to the neglected hospitals. “Cables” and “strings” would be used by many so called VIP doctors to remain in major towns, especially Klang valley. At the same time, many low quality doctors would be produced and may deteriorate the public health service. Quantity do not equate to quality. The best brains would still continue to migrate out to the private sector and other countries with better perks and appreciation.

Whatever said and done, we cannot run away from the fact that we work for our family and children. As a professional we would definitely want our children to be a professional as well and this needs money. We may want our children to go overseas for education or to private institutions in the country. All these need us to start accumulating money from now onwards as not all our children going to get scholarship despite doing well in studies, as Dr.Kuljit Singh once wrote in Berita that government service in only for the rich.

          Well, there is not going to be much change in the government service for doctors in the future. SCHOMOS would still be fighting the same course for years to come and probably would never achieve all that the members want. The Private Health Care Facilities act, National Specialist Registry and the National Health Financing scheme will make the life of a doctor more difficult in the future. Doctors are not going to enjoy their life without any strict legislation like before. We will be strictly monitored by enforcement officers who are lower educated than us but sometimes, the doctors themselves are to be blamed for this. Few black sheep have destroyed the trust given to doctors. Public will be getting smarter and would not hesitate to question the doctors and take legal actions.

          Finally, I think it is utmost important that we decide on our very own future without depending on the government service. There are many options available globally waiting to be explored. Gone are the days where a doctor is considered rich by the community. In the future, we may actually see poor, urban doctors struggling to survive. So are you sure you want your child to be a doctor in the future? I leave the readers to ponder upon …………….