There has been a heap of write-ups lamenting the national brain drain issue in the media. Here, we would like to focus on the medical brain drain from the perspective of sub-specialists.
While TalentCorp was formed in 2011, it was intended to stem the brain drain, with almost half a billion ringgit spent towards this end. Although it had some initial success, it wasn’t enough to dissuade our talents from leaving Malaysia, nor was it successful in bringing back talents from abroad.
A new way of doing things is needed. The absence of the voices of the discontented human capital, from junior doctors to senior doctors, from sub-specialists to clinical researchers, does not bode well for a long-lasting solution.
The suggestion by Prof Dr Asma Ismail, the former President of the Academy of Science Malaysia that an inclusive approach involving all relevant players is exactly what is needed. We should now steer away from merely mulling over the obvious problems to focusing on the hows and whys of the brain drain.
Sustainability is achieved by providing training for a pool of talented junior doctors, with confirmation of permanent posts thereafter, allowing the creation of pathways for general specialists to branch out to sub-specialties.
Thus, more specialties should be made available in more regional hospitals, and this can then be propelled further to create sub-specialty services. Patients are now aware of the rapid progress in medical care which need the newer sub-specialties.
High-end cardiothoracic and brain surgery, transplant medicine, clinical genetics, and clinical immunology services are available only at selected public and university hospitals at this moment.
“Losing our fresh medical talents outwards (Singapore is a favourite) would negate creating new sub-specialists of the future,” said Prof Dr Adeeba Kamarulzaman, the former dean of the medical faculty at the University of Malaya. However, some policymakers appear unruffled, saying that brain drains occur in many sectors in more developed countries, without offering any solutions.
We cannot trivialise the loss of our prized talents at the nation’s expense. What is also missing in the narrative is that new medical graduates comprise future human capital that can propel the public health care service to greater heights, and can enhance the quality of patient care and research capability. They could be our next iconic physician scientists and potential Nobel laureates.
How Grave Is The Loss Of Senior Consultants To The Nation?
It is estimated that the nation spends RM1 million over five years of medical school to produce one new doctor, and it costs more as he or she moves up the career ladder. Specialist training with a Master of Medicine specialty takes four years of study (after three years of compulsory service), and sub-specialist training takes another three years.
Clinicians with additional roles in translational research will progress further with doctoral training, usually opting for a clinical PhD, which takes three to four years. With such a long period of time (at least 18 cumulative years) and with such huge costs involved (at least RM4 to 5 million), policymakers must not trivialise the current problems, but should improve facilities, award proportionate remunerations, and expand promotion prospects.
When meaningful funding and provision of good research facilities are not forthcoming and doctors are then labelled as ineffectual, it will be demoralising for them. Can we blame them when they start looking outward?
Increase Funding For Research
Better research output will be doomed to remain at an average level even when the country has the best brains available when research funding is inhibitory. The current research funding derived from 1 per cent of the GDP is untenable.
The allotment from Budget 2021 for Covid-19 control alone was RM 45 billion, which is more than twice the amount of research allocation.
Malaysia has a dearth of local Covid-19 research data to modify any recommendations made by the United States’ Centers for Disease Control and Prevention to suit local needs, unlike other research-intensive countries. In other countries, research funding from GDP constituted 4.55 per cent (South Korea), 4.54 per cent (Israel), 3.21 per cent (Japan), 2.79 per cent (the United States), 1.95 per cent (Singapore), and 1.0 per cent (Thailand). Should we not increase our research allocation to at least 2 per cent of GDP, like what Singapore has done?
Funding for medical and clinical research usually requires a larger quantum and a longer duration to have their impact realised. In addition to funding, the research ecosystem must also be improved to encourage scientists from medical and clinical settings to be motivated to do advanced research in their respective fields. Many of our medical scientists are working outside Malaysia and efforts to bring them back should also be made.
It then behoves the government to shed all prior misconceptions and biases and to form a national task force to stem any further brain drain. Efforts should include:
- Representatives of medical graduates, house officers, medical officers, specialists, sub-specialists, and also policymakers within the government.
- References to existing white papers from the Ministry of Health.
- Viewpoints of the Academy of Science Malaysia.
- Viewpoints of medical associations.
- Deans of medical schools and hospital directors.
The government should consider viewpoints and suggestions to stem the brain drain, as provided by leading professionals and academics. TIGERS can provide the perspectives of sub-specialists.
Let us implement the hows after understanding the whys.
The Translational Immunology Group for Education, Research and Society (TIGERS) comprises:
- Prof Dr Lokman Mohd Noh
- Dr Amir Hamzah Abdul Latiff
- Prof Dr Rahim Md Noah
- Assoc Prof Dr. Adli Ali
- Dr Intan Juliana Abd Hamid
- Assoc Prof Dr Intan Hakimah Ismail
- Prof Dr Norazmi Mohd Nor
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
