Job insecurity and psychological wellbeing among junior doctors in Malaysia: A national cross-sectional study

In Malaysia, the rising number of medical graduates has led to a shift from permanent to contract employment in the healthcare system since 2016. This study investigates the impact of employment status on mental health outcomes, job satisfaction, and career perceptions among junior doctors in Malaysia.

This nationwide study compared 1,966 contract and 698 permanent junior doctors in Malaysia using validated instruments (Maslach Burnout Inventory, DASS-21, WHOQOL-BREF) and career perception measures.

Contract doctors showed higher depression (adjusted mean 8.72 [95% CI: 8.18-9.26] vs 6.88 [95% CI: 6.25- 7.51], p<0.001), anxiety (adjusted mean 6.41 [95% CI: 5.96- 6.86] vs. 4.89 [95% CI: 4.36-5.41], p<0.001), stress (adjusted mean 8.74 [95% CI: 8.24-9.23] vs 7.86 [95% CI, 7.28-8.44], p<0.001), emotional exhaustion (adjusted mean 32.14 [95% CI: 30.86-33.42] vs 27.18 [95% CI: 25.68-28.68], p<0.001), and depersonalization (14.10 [95% CI: 13.41-14.80] vs 11.94 [95% CI: 11.13-12.76], p<0.001). Their quality of life was lower in physical (adjusted mean 10.48 [95% CI: 10.30-10.67] vs 11.09 [95% CI: 10.87-11.31], p<0.001), psychological (adjusted mean 11.50 [95% CI: 11.29-11.70] vs 11.86 [95% CI: 11.63- 12.10], p<0.001), and environmental domains (adjusted mean 12.42 [95% CI: 12.18-12.65] vs 13.11 [95% CI 12.83-13.38], p<0.001). Contract doctors reported significantly lower satisfaction across multiple domains. Despite similar aspirations to succeed in medicine (OR 0.8 [95% CI: 0.6-1.1], p=0.117), contract doctors reported lower career security (OR 0.04 [95% CI: 0.03-0.05], p<0.001), reduced confidence in specialty training access (OR 0.3 [95% CI: 0.2-0.3], p<0.001), and higher intentions to change careers (OR 5.9 [95% CI: 4.7- 7.5], p<0.001) or emigrate (OR 1.9 [95% CI: 1.5-2.3], p<0.001).

Contract employment is associated with poorer mental health, reduced job satisfaction, and diminished career confidence despite similar professional aspirations. These findings suggest current employment practices may threaten healthcare workforce sustainability and highlight the need for policy reforms.