Malaysia needs more specialists

Malaysia needs more specialists

Almost all fields of speciality in the country are in need of doctors.

Urging the Health Ministry to invest in human capital, Malaysian Medical Association president Prof Datuk Dr Subramaniam Muniandy noted that our specialist to population ratio is almost three times lower compared to developed countries.

On Aug 1, StarEdu reported that Malaysia is currently facing a shortage of specialists with only four specialists to 10,000 citizens as of June 30, 2020.

According to Universiti Kebangsaan Malaysia medical faculty deputy dean of undergraduate studies Prof Dr Roslina Abdul Manap, this was much lower than the recommended average of 14 specialists to 10,000 citizens by the Organisation for Economic Co-operation and Development in 2018.

While medical experts acknowledge that there is a shortage, a more pressing problem is the lack of sound policies to address issues relating to the profession.

Dr Subramaniam said the brain drain of specialists to the private sector is a problem.

Expand the intake for the Health Ministry’s Master’s programme, he suggested, and give those enrolled in the parallel pathway the same perks as their colleagues in the Master’s programme.

“Private sector specialists earn at least three times more than their contemporaries in the civil service.

“The Health Ministry should increase the salaries of specialists and offer them better promotion opportunities,” he said, while calling for a nationwide rollout of the full paying patient scheme to all government specialist hospitals.

“Currently, the scheme is only available in certain places. The scheme would make specialists more keen on working overtime in government hospitals as it would increase their earnings.”A moratorium on the opening of new private hospitals could also be imposed until all government facilities are staffed, he offered.

Medical Practitioners Coalition Association of Malaysia president Dr Raj Kumar Maharajah said lured by attractive perks and salaries, some 3% of specialists resign from government hospitals to enter private practice yearly.

While he noted that more oncologists and neurologists are needed, he said a more pressing issue is to keep specialists from leaving government hospitals.“The private sector has some 60% to 70% of specialists who treat about 30% of patients, while government hospitals only have about 30% of specialists who treat a large number of patients.

“The government must look into the heavy workload these specialists are shouldering (because they are caring for the majority of Malaysians),” he said.

Agreeing, University Malaya Medical Centre clinical (medical) deputy director Dr Mohmmad Salleh Yahya said more people throng government hospitals due to its affordability – further compounding the problem of maldistribution.

A few years ago, it was reported that the country was facing a shortage of specialists as there were only some 7,000 specialists nationwide, he said.

“But the issue is actually the poor distribution of specialists in the country. In places like the Klang Valley, for example, where there is a big number of cardiologists due to the demand, they aren’t necessarily accessible to the poor.

“It comes down to the localities, affordability and the distribution of these specialists,” he added.

The Academy of Medicine of Malaysia (AMM) said there are several ways to determine the number of specialists a country needs. Many developed countries use the specialist-to-population ratio, it noted.

“When you use this measure, there is a large shortage of specialists in all the surgical specialties, but this measure may not be appropriate for a developing country like Malaysia, particularly for surgical specialties.

“This is because the limiting factor in providing a specialist surgical service in developing countries is often not just the availability of a specialist, but also the infrastructure, resources, and supporting specialties and services,” the AMM said.

AMM College of Surgeons consultant cardiothoracic surgeon and council member Dr John Chan Kok Meng said a cardiothoracic surgeon, for example, would need an operating theatre, perfusion and other equipment, an intensive care unit equipped for advanced cardiac care, supporting specialists such as cardiac anaesthetists, and other supporting staff such as perfusionists, nurses and technicians, to do any heart or aorta surgery.

A more appropriate measure for Malaysia would be to look at whether there are enough specialists in specialist centres providing such services; the workload in each of the specialist centres for elective and emergency surgeries; and the waiting list for surgery in the respective centres.

A heavy workload, long working hours and long waiting lists for elective surgeries contribute to the perception that there is a shortage of specialists, the AMM said.

“There is only one colorectal surgeon in Johor Baru, Penang and Kota Kinabalu performing a very high volume of surgeries; these centres would benefit from an additional colorectal surgeon.

“Similarly, the waiting lists for heart surgery in both Kuching and Kota Kinabalu are very long and they too would benefit from additional cardiothoracic surgeons.

“In Kuantan, Kota Kinabalu and Kota Baru, there are cardiothoracic centres with only a single cardiothoracic surgeon,” the academy added. — The Star