Are there too many GPS and is the healthcare system overwhelmed?
THE Covid-19 pandemic that shook the world back in 2020 certainly shone a very bright spotlight on the healthcare system in every nation across the globe.
As doctors and healthcare practitioners struggled to cope under the enormous weight of the pandemic, some mourned the loss of their fellow comrades while others suffered from serious burnouts.
Fast forward to four years later, and not much has changed.
Medical practitioners in Malaysia today are overworked and fatigued from the long hours, while patients suffer from the lack of public health facilities and the dependence of profit-oriented private healthcare providers have further muddied the waters.
To top that, there have been reports of too many general practitioners (GPS) in the country, which have resulted in multiple private clinics mushrooming.
Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) president Dr Shanmuganathan Ganeson says the general observation is that there are too many clinics in the same localities despite no
nd solid data for the number of GPS per segment of a population.
Why has this become an issue? Are more government doctors leaving the civil service for good reasons?
Ganeson says most GPS’ decision to open their own clinics are a result of the contract system in place, set by the government.
In 2016, the Health Ministry (KKM) began implementing a contract appointment policy for newly graduated medical officers to overcome the lack of permanent posts.
This, in turn, caused many disadvantages to those that now fall under this policy due to salaries, leave provision and career prospects.
“According to industry sources, roughly 3,000 clinics opened up last year. These doctors do not have much choice but to join the private sector,” he tells Starbizweek.
He says that one root cause for the oversupply is the overproduction of medical graduates, attributable to the lack of foresight in human capital planning by the ministry itself, and is further compounded by unfettered issuance of licences allowing clinics to operate.
“These clinics are now exploited by privately-managed care companies in which they have a contractual agreement. Patients pay fees that are lower than Schedule 7 fees under the Private Health Care Facilities and Services Act,” he says.
He adds that while the GP is busy attending to patients, businesses in the corporate sector are busy plotting ways to carve out existing GP businesses such as dispensing of long term medications.
“It is indeed challenging, it’s a perfect storm for the annihilation of the new GPS,” he says.
Ganeson adds the quality of healthcare is adversely affected because of these factors.
Furthermore, he says when GPS go into specialisation, there is significant impact on the sector overall.
“The pathway to specialisation is unique in medical training. But service and training cannot have gaps; however this is happening. Such gaps often spell the death knell for proper training,” he notes.
Meanwhile, the Hartal Doktor Kontrak movement has been vocal on what needs to be done.
Spokesperson Dr Muhammad Yassin says the urgency to reform the Health Ministry is lacking, most likely because the leverage of dealing with the pandemic is no longer present today.
He says there are still numerous cases of overworked medical practitioners, long waiting times for patients and poor management issues.
“When KKM doctors mass resigned from their jobs, many turned to become private general practitioners or pursued other medical-related jobs. This may be true, and we need to examine the number of new GPS and existing ones. However, this may not reflect the true number as some of them may work at multiple GPS as part-time locum doctors,” he says.
On whether there has been an oversupply of GPS in certain areas, Muhammad Yassin says a larger number of doctors usually equate to better healthcare, provided, of course, they have the right kind of training and equipment to be able to perform to the best of their abilities.
“There is a concern regarding whether junior doctors receive sufficient training when being trained during a pandemic, as their superiors were overwhelmed with dealing with a large number of patients. We try not to comment and generalise this statement, as their capabilities are individual and dependent on their own self-learning,” he says.
Additionally, on the number of GPS in certain areas, Muhammad Yassin says there is no current data to support this, however if there were more turning up in rural areas, it only meant good news.
“Having more doctors in rural areas will help patients there get better access to care and treatments, eliminating the need to travel and face congestion in KKM facilities,” he explains.
More could be done for the sector as it needs much improvement looking at the situation today.
“The lack of funds is causing a shortage of working equipment and meagre pay for staff.
“Morale is low due to working in sub-optimal conditions.
“Workloads are increasing with the seemingly never-ending influx of patients.
“There is no direct answer to this as we have discussed multiple times. But it all boils down to more funding and budgeting.”
On the other hand, Ganeson, says that a Royal Health Commission is needed to identify shortcomings, while rapidly providing solutions to mitigate them.
“We in FPMPAM have been calling for one for more than a decade.”