CURRENTLY, Malaysia has a doctor to population ratio of 1:633. The target is for the country to achieve a 1:400 ratio by 2020. As is obvious, the gap to be closed in some four years is still quite substantial. Consequently, the announcement by the Health Ministry on the extended freeze on new medical courses is puzzling. It is explained away as inadequacy of infrastructure to absorb graduating trainees for internship and housemanship. The minister said the freeze will last “until our supply and demand balances out”, which has nothing to do with the care-giving aspect of the health service. If it did, then the targeted ratio of doctors to population would have been surpassed. Such a perspective — where the system cannot have more than a certain number graduating annually — defeats the objective of healthcare. To match the number of graduating medical students to whatever hospital capacity is available is to be inflexible. And, this also means that there are not enough hospitals in the country. Is this the case?
Even then, ways can be found to surmount the problem. For example, a working relationship can be established with hospitals abroad that need doctors and are willing to take in trainees. This should also be the responsibility of the course provider. It is for the medical college to guarantee that the students will receive the standard practical training, which is an essential part of the course. The Education Ministry cannot license an institution until it has proof of its ability to provide the relevant training.
And, given that healthcare in this country reaches into the rural areas in the form of rural clinics and district hospitals (there should be more of them, by the way) one wonders why with the “so-called glut of doctors” the solution cannot be found in upgrading these clinics. To have at least one qualified doctor must surely improve the services extended considerably. Why the need to curtail the number of medical graduates when there are enough willing and able candidates? If the problem is the unwillingness of doctors to serve in rural areas, then KPIs (key performance indicators) should include a period of rural service for promotion and, for those wanting to specialise, scholarship purposes. A similar condition can be imposed on those entering private practice. On balance, is not willingness for hardship posting evidence of their calling?
The upshot is, healthcare is a citizen’s right, and Malaysia’s population is growing. Do the number of doctors graduating annually match the rate of population growth? It would be a tragedy if the freeze on new medical courses results in a perpetual catch-up game with medical breakthroughs and discovery of new diseases. It will also result in a situation where there are never enough doctors. As the target ratio suggests — assuming that it is the appropriate balance — Malaysia’s policy is to provide the kind of healthcare matching that of the developed world, for, we cannot claim to have arrived if the country’s healthcare is only a little better than it is now. If the authorities expect Malaysians to pursue their medical studies abroad, then the likelihood is that they will not come home. Doctors are always needed somewhere, everywhere.