#Rural practice : Don’t make the mistake of just throwing money as a carrot

Editorial

Talks about wooing more doctors into rural practice is nothing new. There is still a vacuum of doctors serving in rural areas. The previous modus operandi was to “force” doctors into these areas. However, the process is has never been transparent and those who are well connected would be able to escape this fate.

The question they have to ask is why is there an aversion to rural practice, which is not unique to our country.

Money, how much can they give? Can they compensate these doctors to the extent of dissuading them from private practice? The answer is quite clearly no. Even JUSA grade officers earn substantially less than their private counterparts. Unless there is a revolutionary change in the salary scale, this tactic is doomed from the very start.

So why do doctors refuse to go into rural communities?

Well, there are some who are eager to serve and gain the invaluable experience of serving in rural communities. This insight into a different practice often augurs well in their future careers and help them shape a realistic approach to their care. Often times, doctors in hospitals remain in their cocoon oblivious to the different hardships in the communities.

Therefore, it is important first to identify individuals who are eager to serve. However, placing them in communities does not equate to job done. If they fail to see the light in their careers, then it would be futile in the long run and we are back to where we started.

Doctors needs to know that they are needed and taken care of professionally. This includes regular continuing medical education opportunities, both locally and abroad, and the ability to network with their peers. Keeping them relevant through teaching opportunities with local varsities can be a strategy to maintain professional sanity. There should be opportunities to advance their education to a subspecialty level and in turn return to these communities for which they have bonded with. Maintaining a 2-way communication between the Ministry and the individual is vital so that grievances can be addressed expeditiously.

There is much more than just money in luring doctors to rural communities. Understanding the real issues is essential, not just what the administrators assume the problem is.

In The Star today,

Published: Monday April 20, 2015 MYT 12:00:00 AM
Updated: Monday April 20, 2015 MYT 7:42:10 AM
More perks to woo rural docs

BY YUEN MEIKENG

PETALING JAYA: The Health Ministry wants to dangle a bigger carrot of higher allowances and fast track promotions to attract more doctors to rural areas.

Health director-general Datuk Dr Noor Hisham Abdullah said the ministry was looking at increasing the various allowances given to government doctors stationed in rural areas, including cost of living and on-call payments.

He said the aim of this was to encourage more doctors and specialists to be sent to rural areas, especially in Sabah and Sarawak.

“We are in discussions with JPA (the Public Service Department) on its implementation,” Dr Noor Hisham said.

Asked what would be the quantum of increase of the allowances, he said: “It has yet to be decided with the JPA.”

Also, he quashed rumours that the on-call allowance for doctors was going to be cut.

Government doctors receive allowances for cost of living, housing, providing critical services, and others.

Doctors who are more senior get an entertainment allowance while the on-call allowance is on a per claim basis.

A houseman in Malaysia takes home an average monthly salary of about RM4,000, which includes basic pay and the various allowances.

Asked if there will be budget cuts for the ministry, Dr Noor Hisham said: “We are managing at the moment and in any case of shortage, we have the mid-year review.

“There is no issue in government hospitals now but we could still cut wastage and be more cost-efficient and effective, which is what we are doing.”

He was responding to several people who have said that there would be budget cuts for the ministry.

Commenting on the proposed increase in allowances to woo more doctors to rural areas, Malaysian Medical Association president Dr Krishna Kumar said the ministry should address more pressing issues first.

“As it is, promotions are already limited and government doctors are told that there are no higher posts to be filled,” he said, further questioning how the ministry planned to give fast track promotions.

Dr Krishna said another issue that needed to be addressed was the number of specialists leaving the government service.

“Many who have left were those in the surgical discipline, which includes orthopaedics, obstetrics and gynaecology,” he said.

He proposed the setting up of a commission on health so that government doctors did not have to rely on PSD to handle matters like promotions and wages.

Health Minister Datuk Seri Dr S. Subramaniam was reported on March 11 as saying that the ministry wanted to increase the number of medical assistants, which was especially crucial in rural areas where there were not enough doctors.

In 2013, it was reported that Deputy Health Minister Datuk Seri Dr Hilmi Yahya said Malaysia hoped to reach a 1:434 ratio of medical officers to the population by 2020.

In that year, the ratio was 1:758.