In my previous letter, I explained how the journey to become a subspecialist doctor in Malaysia can take around fifteen years. That timeline assumes something remarkable: that everything goes perfectly. No exam failures, no training extensions, and no bureaucratic surprises.
Today, I would like to discuss another important question. After spending 15 years training within the system, what does the system actually offer these doctors in return?
Let us consider a common example. A doctor trains as an Internal Medicine specialist, then completes further subspecialty training in cardiology.
This doctor has now spent approximately 15 years in medical training. They have worked overnight calls for years. Managed critically ill patients. Passed multiple postgraduate examinations. Performed complex procedures. And dedicated the majority of their adult life to mastering their profession.
At the end of this journey, the doctor returns to the public health care system as a consultant cardiologist.
Now let us ask the obvious question. What is the salary? Most government specialist doctors in Malaysia fall under the UD54 civil service pay scale, depending on years of service.
The basic salary usually ranges around RM9,000 to RM11,000 per month, before allowances. Including allowances and on-call payments, the total monthly income for many specialists may reach RM12,000 to RM16,000, depending on workload and call frequency. This is the compensation after 15 years of training.
Now let us compare this with the private health care sector. A subspecialist consultant in private hospitals can often earn four to five times more than what the same doctor earns in the government sector. In some cases, the difference can be even greater, depending on procedural workload and hospital arrangements.
This creates a rather predictable situation. Doctors who have completed more than a decade of demanding training suddenly realise that the private sector values their expertise significantly more than the system that trained them.
But yet, when doctors choose to leave for private practice, the narrative often becomes strangely moralistic. Doctors are labelled as “money-minded.” Some are even described as betraying the public health care system. This raises an interesting question.
If two systems offer vastly different compensation for the same expertise, who exactly should be blamed when professionals choose the better option? The doctors? Or the system that refuses to remain competitive?
The irony becomes even more apparent when one examines the responsibilities of newly appointed subspecialist consultants. A consultant who has just completed subspecialty training often carries significantly greater responsibility than a general specialist.
They are expected to introduce new clinical services, develop subspecialty units, perform complex procedures, train junior doctors, supervise trainees, and often establish entirely new subspecialty services within hospitals.
In other words, their workload increases dramatically. Their clinical responsibility increases dramatically. Their legal and professional risk increases dramatically. But their salary? Exactly the same as other specialist who did not pursue subspecialty training.
Yes, remarkably, there is currently no additional allowance specifically for doctors who complete subspecialty training and return as consultants in many government hospitals.
So, the system effectively says: “Congratulations on completing four additional years of subspecialty training. You now carry greater responsibility, perform more complex procedures, and help develop new services. Your reward? Exactly the same salary.”
If this sounds slightly absurd, that is because it is. Meanwhile, policymakers continue to express concern about the migration of specialists to the private sector. But the underlying question remains painfully simple.
If a system expects doctors to invest 15 years in training and then offers them compensation far below market value — while simultaneously increasing their responsibilities — who exactly would choose to stay?
If Malaysia genuinely wishes to retain subspecialists within the public health care system, the solution is not mysterious. It requires competitive policy design.
This could include:
- More competitive consultant salary structures.
- Additional allowances for subspecialty consultants.
- Tax relief for government specialists.
- Subsidised housing or loan schemes.
- Protected research and academic opportunities.
Many countries implement such measures because they recognise that highly trained specialists are not easily replaceable. Training them takes years. Losing them takes minutes.
There is another uncomfortable reality to consider. Malaysian doctors often take longer to complete specialist and subspecialty training compared with many other countries. In some systems, subspecialists are produced within nine to 10 years after medical school. In Malaysia, the journey may stretch to 13 years or more.
Yet despite the longer training period and higher responsibility, the financial recognition often remains modest.
In simple terms, doctors train longer, shoulder heavier workloads, but receive compensation that struggles to compete with alternative opportunities. That is not merely inefficient workforce planning. It is fundamentally unfair.
No doctor expects to become wealthy from public service. But fairness matters. Professional recognition matters. And sustainable workforce planning certainly matters.
If Malaysia wants to maintain a strong public health care system staffed by highly trained specialists, then the system must evolve. Competitive compensation with meaningful incentives and recognition of subspecialty expertise.
Otherwise, the government may continue asking the same question every few years: “Why are doctors leaving?” When the real question should be: Why would they stay?
The author is a physician in Selangor. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
