Cause for concern: The maldistribution of healthcare workers puts a strain on doctors doing the on-call shifts. — AZMAN GHANI/The Star
‘Working hours should be humane so patient care is not affected’
PETALING JAYA: Do away with 30-hour on-calls, say doctors.
Malaysian Medical Association president Datuk Dr Kalwinder Singh Khaira said while on-call shift hours and the on-call frequency depend on the number of doctors available in a department, the hours should be “humane”.
“However, the hours and frequency should be humane and not lead to a worsening of patient care. Ideally, a 24-hour on-call shift with the doctor on-call going home the next morning is something we should look at. An active 30-hour call is tiring and may affect patient care,” he said.
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“We are happy that the long-delayed review of the on-call allowance rate, which is expected to be part of Budget 2025, is taking place.
“However, we hope that the quantum commensurates with the service and workload that the doctors provide to give 24/7 care for all their patients.
“While we welcome the positive steps, it is critical that the government also addresses the maldistribution of healthcare workers. In many understaffed hospitals, doctors and specialists are forced to work extended hours, often taking on additional on-call shifts.”
This maldistribution puts a strain on doctors doing the on-call shifts. This situation not only leads to burnout but also risks contributing to further brain drain from the healthcare sector.
He added that MMA has long requested the sharing of manpower data to enable better planning and, consequently, ensure the best use of resources.
Senator Dr RA Lingeshwaran said there had been reports and concerns raised about young doctors falling ill or even dying due to overwork and stress.
He said although it will require further investigation to ascertain the alleged links between the death of a 31-year-old doctor in a government hospital in Penang and overworking, he said it is nevertheless the pressure many doctors face.
“The issue of young doctors’ mental health needs immediate attention – cases of burnout and even depression are on the rise, and it’s not fair to judge these cases without thoroughly understanding the root causes,” he said.
He said on-call hours should be reviewed and reduced.
“The ideal number of hours for on-call shifts should be 12 to 16 hours rather than the current 30 hours. This would ensure doctors are well-rested, alert, and capable of delivering the best care to their patients without risking their own health.
“Rotating shifts based on the number of doctors available, hospital location, and department workload could also be considered,” said the former director of Hospital Sungai Bakap.
Hartal Dr Kontrak Dr Muhammad Yassin said a shift system would be a better alternative than on call. However, he said that this would necessitate a larger workforce.
He said if the on-call system continues, it should not be more than 24 hours.
“A few changes were made, especially in regard to the duration of working hours per week for house officers, which had been set at 60 hours per week. The hospitals mostly strictly adhered to this timing, allowing for a more humane working schedule for the junior house officers,” he said.
In 2018, Health Minister Datuk Seri Dr Dzulkefly Ahmad reportedly said in an interview with a news portal that while he has not personally come across doctors working the 30-plus-hour shifts, he would still look into the matter.
“For the medical officers, some departments do have more favourable working hours, particularly the anaesthesiology department, which permits their on-call medical officers and specialists to return home after the morning passover, typically completed by 9am or 10am at the latest.
“Certain departments, such as surgery or internal medicine, do not follow this practice, and their medical officers continue to work after on-call hours, returning only at 5pm. This adds a lot of stress and may also put patients at risk due to poor judgment by the doctors who are extremely tired,” he said.
Independent healthcare advocate and former contract doctor Dr Sean Thum said the on-call shift should not be more than 12 hours. Agreeing with Dr Yassin, he said this is not possible due to the manpower crunch.
“Housemanship was changed from on-call to shift. This could be done because they had enough doctors,” he said.
“Doctors are overworked due to long shifts, including 30-hour on-call duties, leading to physical and mental exhaustion. This excessive workload increases burnout and health risks, affecting their well-being and patient safety,” he added.
