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Last December, the Public Service Department (PSD) announced the shock abolition of the Critical Service Incentive Payment (BIPK) involving 33 service schemes. BIPK is an additional monetary allowance introduced in 1992 to attract recruitment to join the public service. PSD believes that said policy is no longer relevant in the view of ‘sufficient’ professionals in the country and its huge surplus of applicants compared to the available number of positions. The cut was initially set to commence its effect on 1 January 2020, affecting fresh graduates nationwide. What is the reason for an uproar from Malaysian youths, especially the doctors in the country, as they argued for the authorities to not proceed with the allowance cut? Are our number of existing positions in public healthcare actually ‘sufficient’ to fulfill the nation’s needs? What current situation and other persisting issues in the medical field may have contributed to the abolition of BIPK?

Where do we stand now?

First and foremost, the number of medical graduates is on an exponential rise each year. The commercialisation of medical school throughout the past decades has resulted in our country having the highest number of  medical schools in the world, on a per capita basis. Today, Malaysia has a total of 32 local medical schools, including both public and private-run institutes. Medical programmes from another 346 foreign schools are also recognised in the Medical Act’s Second Schedule. Furthermore, many private companies and government-linked companies have offered undergraduate scholarships for medical studies overseas without coordinating actual needs in the nation with the Ministry of Health. These factors contributed to a surplus of medics in the market to compete for limited placements of training facilities. Malaysia has about 6000 medical graduates annually, but only 5000 out of 10,000 spots for housemanship are open for new intakes. It is obvious that approximately 1000 of them cannot start working as housemen each year, and this number only snowballs.

In July 2018, Free Malaysia Today reported that the waiting period fresh medical graduates has to undergo for housemanship placements at government hospitals has extended up to between 8 and 11 months. This is a worsened situation from that of mid-2016, when the wait for housemanship placement ranged from 2 to 6 months only. 

Health Minister, Dr. Dzulkefly Ahmad, told The Star in September 2018 that only 45 out of 145 government hospitals nationwide had sufficient facilities and specialists that can accommodate training programmes for fresh medical graduates. This ratio has not seen any significant improvement in the following year.

Students interviewed by The Star have also expressed the uncertainty of the wait, and compared the starting pay-workload contrast in the medical field to that of a fast food restaurant worker, complimenting on the latter for its low need of time commitment. The wait can be devastating, especially for those families who are weaker financially because the returns for heavy investment in tertiary education are not received instantly after graduation.

Malaysian Medical Association (MMA) revealed that the acceptance rate of medical graduates into housemanship has increased by almost five folds, from 1,049 in 2005 to 4,924 last year. However, quantity does not always promise quality. In September 2019, independent policy researcher, Lim Chee Han, reported that only 15% of Malaysia’s Housemen finished training within two years, backed by a piece of data obtained in 2016. Those who failed to complete their training in two years were halted by either incompetence or the need of extension due to personal reasons. Additionally, an approximate 50-60% of training dropouts graduated from foreign institutes, especially from Russia, Indonesia, India, and Egypt.

Youths and The Abolition of BIPK

A high number of housemen with extended training periods block the entries of fresh graduates into the field, while medical officers and specialised doctors in the nation remain insufficient. 

With the flooding of ‘doctors’ in the country, it seems clear that the abolishing of BIPK would save a grandiose amount of funds, to be utilised elsewhere. However, this discourages the current youths to serve in the public service and instead look to the private sector or foreign countries where better payoffs are received. This indicates that existing medical officers and specialists will be overworked. This is especially serious, as the climbing price of medicines had prompted the general public to switch from private to government hospitals, upscaling the demand for public health services. In 2018 itself, more than 77 million patient visits were recorded by the Ministry of Health, a 445% increase from data collected back in 2008.

UKEC’s long-time effort in tackling brain drain has led me to worry about the situation. While not all Millennials are motivated by monetary rewards, allowances and salaries are still returns to their years of hard work poured into equipping themselves with specialty knowledge for healthcare. As we wish to retain the future’s interest in serving for public healthcare, it is essential to prevent BIPK from being abolished.

I support the uproar on this issue, on behalf of all youths including myself, who will surely be affected as I graduate university. Youth and Sports Minister, Syed Saddiq, did not disappoint as he publicly stood up for the youths to oppose the motion, leading to an agreed postponement of the move with further discussions to be carried out. The situation is still grey without a certain status of the policy, yet, there is more the government can do for the medical field. 

The Forward Motion

Dr. Dzulkefly Ahmad, said in his aforementioned interview with The Star that the ministry will propose to increase training hospitals and consider shortening training time of excellent performing housemen. A priority for medical officer placements would be given to such medical graduates as an incentive to work harder. While this approach can avoid displacing medical graduates, other persisting issues will require different measures, considering the swamping of medical students should receive major attention.  

The government should reassess all the foreign medical institutes it recognises for a better control of graduate quality. For example, introduce a higher qualification entry requirement, or a standardised entrance examination to limit opportunities to those with actual and suitable potential. Additionally, intake of students from private schools should be screened, or reduced, from those without their own hospitals or facilities for practical training. As a comparison, Singapore recently reduced at least 57  of recognised foreign medical schools on their list, to a remaining total of 103.

MMA and Islamic Medical Association of Malaysia have also suggested a slight increase in the outpatient consultation fees at government hospitals/clinics, from RM1 to RM5. The increase is believed to be still affordable even among the B40 community, but is able to generate a potential revenue of RM300 Millions, to assist with funding in public healthcare. This brings us back to the discussion on the abolishing of BIPK, in my personal opinion, these solutions should be able to keep the policy running. Doctors are being overworked. Their critical allowance of RM750 per month is an essential reward for their professional specialty as well as effort invested in the curriculum.

Conclusion

The youths of Malaysia have voiced out their opinions on the allowance cut, as this does not only affect the futures of those with a heart for healthcare, this is a cut-throat issue across 33 professions under the public sector and will affect millions of Malaysian students. The bad news is, the approaches suggested in this article will take time to realise and show its positive effects on the nation’s allocation of talents. I cannot help but ponder, with the BIPK originally set to take effect on 1 January 2020, did we have enough time to reassess the situation and our existing policies before the allowance cut affects anyone even for the short term?

If brain drain is something we care to  prevent, the abolition of BIPK is what we have to stop.