A 'critical' and 'serious' shortage of healthcare workers in Johor
Johor Bahru's main hospital, Hospital Sultanah Aminah, is Malaysia's second busiest government hospital, serving more than 2,000 patients a day.
– Cardiologist Ng Kim Fong worked long hours as a specialist at Johor Bahru's main hospital, tending to around 100 patients a day for years.
His daily shifts, for five days a week, consisted of morning rounds serving up to 40 patients in the wards of Hospital Sultanah Aminah, and then tending up to 30 outpatients in the hospital's clinic from noon. This would be followed by tending to another 30 or so patients in the wards before he could call it a day.
He switched to private practice in September 2024, after nearly two decades with the hospital.
'That was what we as government doctors had to do. It's part of our job. But in recent years, the patient numbers have been increasing,' Dr Ng told The Straits Times.
He is now a consultant cardiologist at the KPJ Kluang Specialist Hospital in the Kluang district, some 100km from Johor Bahru, and his pay has more than tripled.
'There is definitely a severe shortage of healthcare workers in Johor – especially staff nurses, medical officers and specialists,' he said, noting that public healthcare staff are overworked and overwhelmed.
The issue was spotlighted by Johor Menteri Besar Onn Hafiz Ghazi on July 14, when he said the state is facing a 'critical and serious' shortage of healthcare officers in major government hospitals.
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Doctors from the Johor Doctors Association told ST that more healthcare professionals are needed, as Malaysians from across the country move to the Johor capital city and its surrounding areas, which many use as a base for working in Singapore.
The migration to southern Johor districts is also due to the booming economy, leading to a wide availability of jobs for those not keen to work in Singapore.
Added to this is the longstanding issue of Malaysian nurses and doctors seeking jobs abroad, including in Singapore, for better salaries, said Johor's top health official, Mr Ling Tian Soon, on July 10.
Datuk Onn, during a visit to a government hospital ward on July 14, said that a nurse in Johor Bahru has to serve between 10 and 14 patients on every shift. Each nurse should ideally serve between six and eight patients, he added.
'The situation is not just unfair to our workers, but it is also not safe for our patients if we let this continue,' he said.
Mr Ling told ST that Johor needs at least 4,600 healthcare workers – including doctors, nurses, and specialists – to meet local demand.
He added that a task force was formed with Malaysia's Ministry of Health, after a meeting with its minister, Dr Dzulkefly Ahmad, on July 15 in Putrajaya.
But, he said, the current 4,600 number might be just a short-term fix, as many more may be required.
'You hear about patients saying they have to sleep in waiting areas, and doctors needing to put extra beds in between the wards. This is happening because there are too many people and too few staff,' he told ST over the phone.
Mr Ling said the two main hospitals in Johor Bahru, the 1,206-bed Hospital Sultanah Aminah and Hospital Sultan Ismail, which has 704 beds, are operating at 100 per cent to 110 per cent capacity each day.
'The actual number of healthcare workers needed in Johor may be more, taking into account the current population, so when we met the Ministry of Health, we told them to get the more than 4,000 (healthcare) positions ready first,' he explained.
Health Ministry data shows that Johor has 12 public hospitals across its 10 main districts, providing more than 5,200 beds.
Hospital Pasir Gudang, a new RM500 million (S$150 million) project in Bandar Baru Seri Alam – about 14km east of Johor Bahru – was initially expected to begin operations in August, but this has been delayed to 2026.
Mr Ling said the 304-bed hospital needs 500 new staff members for its first phase of operations, but only 315 vacancies have been filled.
Johor has about 6,800 doctors and 10,800 nurses for its more than four million residents, or roughly one doctor per 600 people, according to publicly available data from the ministry in 2022.
The Malaysia-wide ratio is better, with one doctor per 412 people.
Singapore, a developed nation offering high salaries, has an even lower doctor-to-population ratio, of about one doctor per 353 people as at 2023.
'The morale among healthcare workers is at an all-time low,' said Johor Doctors Association president Mohamed Amin Kader .
'Johor has suffered far too long. Besides Johor Bahru, we have Batu Pahat, Muar, Kluang, Segamat, Pontian, Mersing, each with a big population that lacks healthcare workers, with some sub-specialists even covering the entire state or two to three districts,' added the internal medicine specialist from Pantai Hospital Batu Pahat, located about 120km from Johor Bahru.
Johor's population was 3.6 million just 10 years ago , according to Malaysia's department of statistics. This has jumped 11.1 per cent to 4.01 million today.
The Johor Bahru district, where the state capital sits, recorded some 1.8 million people in 2024, making it one of Malaysia's biggest cities by population. In contrast, Kuala Lumpur has 2.06 million people and the Klang district in Selangor state has 1.17 million.
The Johor population surge compares with the slower rise of 9 per cent in Malaysia's overall population to 34.2 million today from around 31.2 million 10 years ago.
The Regent of Johor, Tunku Ismail Idris Sultan Ibrahim, said on July 8 that he has called on the federal government to 'expedite the approval and hiring process to fill vacancies' that are causing 'significant congestion' in Johor's hospitals.
During a recent visit by ST to Hospital Sultanah Aminah, patients complained to this paper about the long waiting times despite them having appointments, the lack of staff, the ageing equipment and even the shortage of chairs for those waiting.
At the hallway leading to the patients' wards, caregivers were seen seated on the floor and on concrete kerbs holding their queue slips.
'I came to the clinic at 9am for an orthopaedic appointment for my broken finger, and we got out only at 3.30pm,' said Kulai resident Mohammad Amirul Johari, 30, who met with an accident while riding his motorcycle two weeks ago on the way back home from work in Singapore.
The Singapore factor in attracting healthcare professionals is another issue that Johor, and the rest of Malaysia, has to contend with over the years. Countries in the Middle East also offer good pay for medical staff.
Senator R.A. Lingeshwaran on July 8 was quoted in Malaysian media as saying that a recruitment agency had offered local doctors an annual package of $110,000 plus housing and other perks, to work in Singapore.
Dr Lingeshwaran, a former director at a Penang hospital, said a Malaysian medical officer with three years' experience earns a gross salary of only about RM72,000 (S$22,000) a year.
Former public dentist Choudhry Sundaram Padiachee told ST: 'Low salaries, overworked staff, bad work culture, and lack of clear career prospects are among the reasons why I left, and why, I believe, many have left and are leaving.'
Dr Choudhry, who worked in Hospital Sultan Ismail for nine years, now runs Habib Dental in Bandar Dato Onn, a suburb 12km north of Johor Bahru.
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Sign up now: Get ST's newsletters delivered to your inbox Medical professionals have noticed that most of the patients were now young people between the ages of 15 and 40, with no prior history of drug addiction. SINGAPORE - In just a few months, experts say the profile of a typical Kpod user has shifted from adults with a history of drug use, to young people abusing substances for the first time. Senior consultant psychiatrist Munidasa Winslow, who was previously chief of the addiction medicine department at the Institute of Mental Health (IMH), said many of the Kpod-related patients he saw at the end of 2024 were already using other drugs such as methamphetamine and heroin. 'They (Kpod addicts) developed problems because they found it difficult to stop, and usually got high multiple times,' said Dr Winslow, who now works in private practice and runs Promises Healthcare. 'Because they've had a previous addiction, they tend to chase highs, which means they use higher doses. These are the people who develop hallucinations and dissociations.' Kpods are e-vaporisers laced with drugs, such as the anaesthetic etomidate. In the first half of 2025, Dr Winslow noticed that most of the patients were young people between the ages of 15 and 40, with no prior history of drug addiction. He has seen 24 cases of Kpod addiction to date who were referred to his clinic. 'About 90 per cent of the youth who are taking Kpods are actually mild abusers,' said Dr Winslow. 'They are abusing (Kpods) just to get high or to experience something different, and are not really physically addicted.' While there may be an absence of a physical addiction, Kpod use can lead to serious mental and physical issues. Professor Tan Huay Cheem, chairman of the Singapore Heart Foundation, said on the organisation's website: 'Mentally, they (Kpods) can cause anxiety, paranoia, hallucinations, memory problems and psychosis. In the long term, they have been linked to depression, suicidal thoughts and increased risk of schizophrenia.' Singapore had its first indication that young people here were using Kpods in April, after a 13-year-old girl was found behaving erratically outside the State Courts while puffing on an e-cigarette. In the first half of 2025, the Health Sciences Authority detected 28 cases involving Kpods, up from 10 cases recorded in 2024. Mr Narasimman Tivasiha Mani, co-founder of youth mental health charity Impart, said it handled only one Kpod user in 2024, who was also a methamphetamine addict. Since the start of 2025, the charity said it has seen about 10 Kpod-related cases, with young people aged between 14 and 24. None of them had a history of drug use. According to Mr Narasimman, Impart, which conducts counselling for at-risk youth, said the calls it received for help were from parents and referrals from schools. There is no clear explanation for the shift, but experts noted that sellers have been flooding the market by tapping social media platforms. Dr Winslow said: 'The sellers of vapes want to drum up as much business as possible. The more they sell, the more people they get.' Ms Nasirah Nasir, head of the Singapore Anti-Narcotics Association's (Sana) Step-Up Centres, said it has received about two Kpod-related calls a week since the start of 2025. 'The calls are mostly from next of kin who are seeking help for the (Kpod) users. 'Another trend we've noticed is parents calling to ask how they can help their children kick the habit,' said Ms Nasirah, who added that the youngest user Sana has seen is about 13 years old. She said there has been a slight uptick since Health Minister Ong Ye Kung announced on July 20 that the Ministry of Health is working with the Ministry of Home Affairs to list etomidate as an illegal drug under the Misuse of Drugs Act , which carries a heavier penalty for abusers and traffickers. It follows the discovery that a third of more than 100 vapes seized during enforcement operations and tested at random were found to contain etomidate. Since January, Ms Nasirah said Sana's caseworkers have followed up on six calls, which involve providing counselling to Kpod users, or helping them seek professional care at IMH's National Addictions Management Service (Nams). End craving Dr Melvyn Zhang, senior consultant at Nams, said conventional treatment methods for addiction can be used for Kpod addiction. He added: 'Counselling is useful to help the individual develop coping mechanisms, deal with the triggers and cravings to use Kpods and address any underlying factors that predispose them to such. 'Psychiatric medication may be required if the individual also develops or suffers from co-morbid psychiatric disorders like depression and anxiety.' Dr Winslow said Kpod users may not develop physical dependency. 'You don't have withdrawals like with heroin, with the shaking and stomach pains. There's no physical dependency, but there might be a psychological dependency for vulnerable people,' he said, adding that the majority of his Kpod-related patients can be well within a week of treatment. The more complicated cases involve those who also use drugs such as methamphetamine and heroin, as they require him to help them detox from different substances. Impart's Mr Narasimman said that with Kpod users, counsellors learn the underlying reason for their usage and try to introduce lifestyle changes and coping mechanisms. 'If they are influenced by peers, we teach them how to be assertive and say no to their friends,' he said, adding that Impart has different counselling programmes catered to young people according to the severity of their Kpod use. 'For those who are merely experimenting, it's usually because of curiosity. So we'll lay out the pros and cons for them, and come up with a safety plan for them to prevent further usage,' he added. Mr Narasimman said young people who are addicted to Kpods are usually referred to Nams to get professional help. Nams also offers a family support group and counsellor service for caregivers to provide them with support, from stress management to strategies to cope with the effects of addiction and beyond. Mr Narasimman said Impart is looking into creating a support group for parents whose children are abusing Kpods. Nams' Dr Zhang said it is important for parents to create a safe space for children to share openly about their struggles. 'Take time to understand the underlying factors driving their behaviour – whether it's academic pressure, social influences or emotional difficulties,' he said. Some ways parents can support their children with vaping addictions are by validating their feelings while being clear about the risks of vaping, and guiding them towards professional help and counselling services when needed. Dr Winslow, the psychiatrist, said the worst thing for parents to do is to handle the matter themselves or ignore their child's Kpod use. 'You will need to spend a lot more time with your kids, even if it means you take time off from work,' said Dr Winslow. 'Tell them that there are consequences if you do this (abuse Kpods).' What works better is to enrol their children for treatment or rehabilitation sessions. For starters, parents can put in constraints such as cutting free time to go out with friends on weekends, or even disallowing them to join family holidays. 'Once there's a constraint or something where people check on you or help you learn more about self-awareness, emotions and all that, the whole use issue will go down,' he said. Mr Narasimman said parents should avoid shaming their children, or resorting to drastic measures like kicking them out of the house or cutting their pocket money. He said: 'This will push the young person to the edge, and they will be forced to react. I had a youth who resorted to selling vapes to fund his own addiction because his parents cut off his pocket money.' Members of the public can report vaping offences to the Tobacco Regulation Branch by calling 6684-2036 or 6684-2037 from 9am to 9pm daily, or online at Under current laws, possessing, using or buying vapes carries a maximum fine of $2,000. Anyone who distributes, imports or sells vapes and their components can be jailed for up to six months and fined up to $10,000. Those found in possession of or using pods containing etomidate can be jailed for up to two years and fined up to $10,000. If you need help to quit vaping, you can join the Health Promotion Board's I Quit programme by calling the QuitLine on 1800-438-2000.
