Doctors-in-training are facing difficulties with adapting to the training programmes in hospitals and are struggling to cope with the pressure, causing many young doctors – especially those who have studied abroad where healthcare systems were different – to leave the field without completing their training.

“Last year, 1.2% of housemen were either terminated or had quit because they could not take the heat,” said Deputy Health Minister Datuk Seri Dr Hilmi Yahaya.

“Many went to other countries to complete their internship, while those who did not show up for many months were sacked.”

Many housemen unable to cope under pressure

It was recently made public that housemen account for the highest number of civil servants to be dismissed from employment, with many failing to turn up for work for long periods of time likely due to workplace stress.

“There are hospital interns... who go missing for up to 400 days at a time. They were let go because of this,” said Chief Secretary to the Government Tan Sri Dr Ali Hamsa.

The reveal prompted discussions about the stresses faced by hospital interns, with many voicing concerns over the growing number of practitioners who are unable to cope with the demands in the field.

A doctor, known by the assumed name of Ahmad, revealed that many of his colleagues have left the field after enrolling as house officers due to “malignant superiors and long working hours”.

“Those who quit tend to jump to different fields, or have their hearts set on becoming lecturers, for example, instead of working in a hospital environment,” he said. “A friend had quit and he now earns RM400 per month, but he seems happy and content.”

Ahmad himself completed a year-long internship in India, where he described the environment as placing less emphasis on seniority which resulted in better teamwork, but said that the training in Malaysia was different.

“We get 20-hour days, where we don’t see the sun rise or set, and we have to somehow squeeze in time for family and friends,” he said, explaining that the working hours of a doctor are never fixed.

In addition to the working hours, doctors must also manage all sorts of patients, such as those who retrieve information from “Dr Google” or those who turn to social media to defame healthcare professionals, said Ahmad.

Doctors more likely to burnout that other professionals

Dr Elaine Cox, the medical director of infection prevention at Riley Hospital for Children at Indiana University Health, estimates that one third of doctors’ report of burnout at any given point.

“As a matter of fact, doctors are 15 times more likely to burn out than professionals in any other line of work, and 45% of primary care physicians report that they would quit if they could afford to do so,” she said, adding that there are roughly 300 to 400 suicide deaths by doctors each year.

Cox attributed the high-stress environments to the limited control over schedules that result in poor sleeping patterns, interference with family bonding activities and neglect in self-care.
“The result can be physical and emotional exhaustion leading to cynicism and burnout,” she said.

Counsel and train graduates before internship

According to Health minister Datuk Seri Dr S. Subramaniam, roughly 20% to 30% of 5,000 housemen who are recruited into the service are unable to complete their housemanship within two years, positing that stress was the main factor for drop-out rates, absenteeism or extension of training.

“Once they drop out, it is the end of their medical career. The Malaysian Medical Council (MMC) will not recognise them as practising doctors,” Subramaniam said, adding that those who wanted to rejoin the service would not be allowed a second chance.

However, he said that the ministry has taken steps to address the issue by counselling and training housemen before they begin their internship in order to help them adjust to the environment.

“On our side, it is to make the working environment more conducive so that they can fit into it. So collectively, we hope this problem can be addressed,” he said. MIMS

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