Contract employment among junior doctors in Malaysia is associated with poorer mental health, reduced job satisfaction, and diminished career confidence despite similar professional aspirations, suggesting current employment practices may threaten healthcare workforce sustainability.
Contract doctors showed significantly higher depression scores than permanent doctors.
Contract doctors showed significantly higher anxiety scores than permanent doctors.
Contract doctors showed significantly higher stress scores than permanent doctors.
Contract doctors experienced significantly higher emotional exhaustion and depersonalization, two components of burnout.
Contract doctors had lower quality of life in the physical, psychological, and environmental domains compared to permanent doctors.
Contract doctors reported significantly lower career security and reduced confidence in accessing specialty training.
Contract doctors had significantly higher intentions to change careers or emigrate compared to permanent doctors.
Contract doctors reported significantly lower job satisfaction across multiple domains.
This research suggests that junior doctors in Malaysia who are employed on temporary contracts experience substantially worse mental health outcomes than those with permanent positions. Specifically, contract doctors reported higher levels of depression, anxiety, stress, emotional exhaustion, and depersonalization (feeling detached from patients). Their overall quality of life was also lower across physical, psychological, and environmental dimensions. The study surveyed nearly 2,700 junior doctors nationwide and used widely recognized measurement tools to capture these differences. This research also suggests that contract employment shapes how doctors think about their futures in medicine. While contract and permanent doctors had similar ambitions to succeed in their careers, contract doctors were far less confident about job security and access to specialist training. They were nearly six times more likely to consider leaving medicine entirely and almost twice as likely to consider emigrating to work abroad. These findings point to a potential long-term drain on Malaysia's healthcare workforce. The broader context is important: Malaysia shifted toward contract employment for junior doctors starting in 2016 due to a growing surplus of medical graduates. This research suggests that while contract employment may have been introduced as a practical workforce management solution, it may be creating conditions that harm doctors' wellbeing and undermine the stability of the healthcare system. The authors indicate these findings highlight the need for policy reforms to address the sustainability of the medical workforce.
Siow S, Chuah J, Subramaniam S, Mahendran H, Bujang M, Kok J. (2026). Job insecurity and psychological wellbeing among junior doctors in Malaysia: A national cross-sectional study.. The Medical journal of Malaysia. https://pubmed.ncbi.nlm.nih.gov/41617507/