I refer to the Malaysiakini report Housemen not over-worked in hospitals' .

I am currently completing my surgical residency in the US. Being a Malaysian citizen and having friends who have remained in Malaysia to complete their housemanship training, I have the opportunity to compare the work environment, training atmosphere as well as the issue of work hours in both places.

Health Director-General Dr Ismail Merican is either completely oblivious to the fact that – yes, housemen in Malaysia are grossly overworked and underpaid or he is ignoring the obvious.

He needs to get his feet down to reality and start taking the physical, mental and social health of housemen seriously. After all, ultimately, all these affect patient care and as the health DG, he has an obligation to make sure it is taken care of.

In the US, there exists strict 80 hours per week work rules. It is also illegal to have residents work more than 24 hours without at least a 12-hour break before the next shift. These are strictly regulated by the Accreditation Council for Graduate Medical Education (ACGME) and was implemented in 2003.

The ACGME regularly conducts spot checks on residency programmes to review resident work hours. Any programme which violates these rules are subjected to hefty penalties, including firing of programme directors or having the entire residency programme placed on probation.

In Malaysia, such regulatory bodies do not exist and there is no council that overlooks the welfare, training and education of housemen.

There is research from Europe and the US on nonstandard work hours and sleep deprivation and they found that late-hour workers are subject to higher risks of gastrointestinal disorders, cardiovascular disease, breast cancer, miscarriage, pre-term births, and low birth weight of their newborns.

Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents.There are also social effects such as a significantly higher rate of marital difficulties and divorce among physicians who work long hours.

Almost every single friend of mine who did their housemanship in Malaysia tell me about their 100+ hours work week, poor pay, 36-hour straight on-call, the resulting fatigue, weight loss, social problems, health and safety issues (including a few near post-36 hour on-call car accidents). They aren’t the only ones affected - their patients suffer as well as their care is affected by physician fatigue.

Senior physician bullying is also a common problem in Malaysian hospitals and I feel for the housemen because they do not seem to have anyone to turn to for help. In the US, any act of bullying, coercion or harassment is reportable to the ACGME and appropriate investigative and disciplinary actions are undertaken with severe consequences.

I think there needs to be a regulatory body formed for the Malaysian healthcare system which specifically functions to regulate and monitor housemen/medical officers/registrars work hours and well-being as well as provide specific patient-oriented core competencies like the ones endorsed by the American ACGME.

This includes Patient Care, Medical Knowledge, Practice- based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice I do not know if the Malaysian Medical Association has provisions for this.

Then again, given the attitude and track record of our politicians and the higher-ups in the health ministry, I doubt this will ever materialise in the near future. However, I do encourage more housemen to continue voicing out their discontent and to fight not only for their right to provide the best healthcare, but to be adequately compensated and  their own physical, financial and mental well-being taken care off.

If things continue the way they are, many doctors are going to continue opting out of public service or seek greener pastures overseas. The public health system will continue to suffer a ‘brain drain’ and we will continue to hire poorly-trained foreign medical graduates.

Taxpayers money will not translate into  improvements in health care but on the contrary into worse treatment by tired, disgruntled, poorly trained and underpaid physicians.