Physicians are trained to be autonomous problem solvers. But that ability to function independently can be a downfall when it comes to dealing with workplace stress.
– Erica Sprey, author
THE directive by Health director-general Dr Mahathar Abd Wahab to cap housemen’s weekly working hours at between 60 and 62 hours is a welcome move that is long overdue and badly needed. For far too long, housemen in Malaysia have been subjected to punishing schedules that seem to treat exhaustion as part of medical training and fatigue as some sort of badge of honour.
There has been this outdated belief within parts of the healthcare system that young doctors must first suffer before they can become competent medical professionals. That mentality is not only cruel but also dangerous because it ignores the reality that overworked and mentally drained doctors are more likely to make mistakes, less likely to absorb knowledge properly and more vulnerable to emotional burnout.
Hey, housemen are not machines or disposable labour! They are graduate medical officers who have spent years studying medicine and are now entering one of the most critical phases of their professional development. They are in hospitals not merely to fill manpower shortages but to learn, observe, practise and develop into safe and competent doctors under proper supervision.
When they are pushed beyond humane limits, the entire purpose of housemanship is defeated. A doctor who is physically exhausted and mentally numb cannot provide the level of care and focus expected in a profession where lives are literally at stake.
Many housemen I spoke to, especially in Malaya, appeared visibly relieved by Dr Mahathar’s latest directive. Some sounded as though a huge burden had finally been lifted from their shoulders. There is now a feeling among many young doctors that perhaps the authorities are finally beginning to acknowledge that the current system is unsustainable.
However, while they welcome the move, many also believe conditions can and should improve even further. They remain cautious because directives from Putrajaya often look impressive on paper but fail to translate into meaningful changes at hospital level. The real test now lies in whether hospital directors will enforce the directive.
The Malaysian Medical Association (MMA) is absolutely right to argue that even a 60-hour work week remains a heavy burden in the long run. Its proposal for a more humane working schedule of between 45 and 48 hours a week deserves serious attention because it is more aligned with international standards and modern workplace expectations.
I fully agree with the MMA’s proposal because Malaysia cannot continue operating a healthcare system that normalises excessive working hours as part of professional culture. The association correctly pointed out that the issue goes beyond rosters and schedules. It reflects deeper systemic weaknesses, including chronic doctor shortages and inadequate staffing ratios.
The MMA also highlighted alarming reports of housemen working up to 85 hours a week. That is not training anymore. That borders on institutional abuse, more like the ‘kunta kinte’ working culture of 18th century United States. No profession should expect young workers to function effectively under such punishing conditions, much less a profession that deals directly with human lives.
Exhausted housemen are unable to think clearly, unable to learn efficiently and unable to perform at their best. This is not merely a welfare issue concerning junior doctors; it is a serious patient safety issue. When doctors are physically and mentally fatigued, the risks of mistakes increase.
That is why enforcement is now crucial. Hospital directors must not treat this directive as another administrative circular to be quietly filed away and forgotten after the initial publicity fades. They must be held accountable to ensure compliance. The directive clearly states that working hours must be organised into three fixed flexible shifts, namely morning, afternoon and night, and that hospitals are not allowed to revert to a two-shift system or quietly reintroduce the old on-call culture through the back door.
The authorities must also recognise that workload distribution matters just as much as total working hours. Some housemen may technically work the same number of hours as others but end up carrying far heavier responsibilities because senior staff rely excessively on competent juniors. A 60-hour week in one hospital department may feel completely different from a 60-hour week elsewhere.
Some are constantly running from one task to another without proper meal breaks or even time to use the restroom because of relentless clinical demands. Their shifts may officially fall within structured hours, but physically and mentally they remain completely drained by the end of the day.
The situation is not confined to Malaya alone. Housemen in Sarawak and Sabah also continue to face heavy workloads despite structured shift arrangements. Many complain that most of their time is consumed by endless administrative duties and paperwork instead of actual learning opportunities.
They arrive early, leave on time and technically comply with roster requirements, yet spend almost every waking minute under intense pressure trying to complete tasks. That is not the kind of environment that produces confident, capable and motivated doctors.
We must also acknowledge that medical officers and senior doctors themselves are often overburdened. Housemen may be able to leave once their shift officially ends, but many medical officers continue working far beyond official hours without additional pay. They carry significant clinical responsibilities while simultaneously supervising junior staff and handling administrative demands.
This is why the government cannot merely focus on housemen alone. It must address the entire healthcare workforce structure because otherwise the burden will simply shift from one exhausted group to another.
One former houseman I spoke to welcomed the latest directive enthusiastically because he believed it would finally allow current housemen more time to learn properly. He recalled feeling completely drained during his own housemanship years, describing himself as “brain dead” most of the time as he moved endlessly from one task to another without proper guidance or teaching.
He spoke about taking blood, arranging scans and rushing through endless duties while feeling as though he was “on a train to nowhere”. The stress, exhaustion and emotional fatigue eventually became part of daily life.
He believes the new directive could finally allow housemen to breathe, observe, focus and learn with greater clarity while minimising mistakes and human errors. That observation is extremely important because rest is not a sign of weakness or laziness. Rest is essential for safe medical practice.
However, reducing working hours alone will not solve everything if the toxic working culture within hospitals remains untouched. Bullying, harassment, intimidation and demeaning treatment of junior doctors continue to be serious issues within many hospitals nationwide. Some senior staff still behave as though humiliating housemen is part of professional training. Such behaviour is unacceptable and has no place in a modern healthcare system.
The government should seriously consider introducing people-management and leadership training programmes for specialists, consultants and senior medical officers who supervise housemen. Clinical excellence alone is not enough. A brilliant doctor who lacks basic leadership and communication skills can still create a toxic working environment that destroys morale and confidence among young doctors. Malaysia’s healthcare system desperately needs mentors rather than tormentors.
At the same time, policymakers must address other longstanding issues including the contract system, salaries, career progression and opportunities for specialisation. Many young doctors feel the compensation they receive does not reflect the workload, pressure and sacrifices expected of them.
If the government truly wants to stop the ongoing brain drain involving qualified doctors and specialists leaving public healthcare or migrating overseas, then it must create a system that values and supports its medical workforce properly.
Dr Mahathar’s directive is therefore a positive and necessary first step, but it must not end as another temporary reform that fades away quietly after public attention shifts elsewhere. Hospital directors must be monitored closely, leave entitlements must be respected and abusive practices must end completely.
A country that continues exhausting its young doctors is ultimately weakening its own healthcare system from within. Housemen deserve humane working hours, proper guidance, respectful treatment and genuine opportunities to learn and grow.
The views expressed here are those of the columnist and do not necessarily represent the views of Sarawak Tribune. The writer can be reached at rajlira@gmail.com
