In Malaysia, the health care industry is facing a significant brain drain problem, with a large number of qualified and experienced professionals leaving the country for greener pastures. According to a report by the World Bank, Malaysia has been losing nearly 20 per cent of its trained medical professionals each year since the late 1990s.
This trend has been particularly worrisome, given the country’s rapidly ageing population and the increasing demand for quality health care services.
While the term “brain drain” is often associated with the loss of specialists in hospital-based fields like surgery or cardiology, many overlook the fact that it is also happening in Malaysia’s primary care system, which is a matter of great concern as primary care serves as the gatekeeper or the first line of defence for our health care.
Most major health clinics in Malaysia are led by Family Medicine Specialists (FMS), who are trained to provide comprehensive and continuous medical care for individuals and families. Despite the integral role they play within the health care system, few Malaysians are cognisant of this specialisation.
In Commonwealth nations such as Australia, the United Kingdom, and New Zealand, FMS is recognised as a General Practice (GP) specialist. Meanwhile, in the United States and Canada, they are referred to as Family Physicians.
As with other medical specialisations, the training required to become an FMS involves an arduous and daunting post-graduate specialist education, and registration with the National Specialist Registry (NSR) is a mandatory requirement.
At present, there are three distinct pathways available to aspiring FMSs in Malaysia: local Master’s programmes offered by public universities, the Advanced Training in Family Medicine Program (ATFM) provided by the Academy of Family Physicians of Malaysia (AFPM) in collaboration with the Royal Australian College of General Practitioners (RACGP), and the newly minted MINTFM/MICGP program delivered by RCSI and UCD Malaysia Campus (RUMC).
The number of FMSs who have decided to seek better opportunities abroad has been increasing in recent years. A source familiar with the matter has indicated that approximately 30 to 40 FMSs in public health care facilities are in the midst of planning their relocation abroad.
This is especially true for those who have obtained internationally recognised qualifications in family medicine, such as the Fellowship of the Royal Australian of General Practitioners (FRACGP), which is recognised in Australia, the UK, Ireland, Canada, and New Zealand.
Individuals who possess the FRACGP qualification are presented with a clear and straightforward choice to migrate to Australia, as they are not mandated to undertake the AMC (Australian Medical Council) examination in order to commence working as a medical specialist.
However, the RACGP, which serves as the governing body for general practice in Australia, has developed a pathway for Malaysian who have completed a local Master’s programme in family medicine to participate in the Practice Experience Program for Specialists (PEP-S) which can lead to them attaining the Fellowship of the Royal Australian College of General Practitioners (FRACGP) qualification.
According to a report by the Australian Medical Association in 2018, Malaysia was one of the top 10 countries that supplied international medical graduates to the Australian health care system. The report also stated that there were approximately 2,545 Malaysian-born doctors practising in Australia.
FMSs who hold the FRACGP qualification in Malaysia consider Australia as their preferred work destination for various compelling reasons. A high demand for GPs in Australia is due to its ageing population and the increasing burden of chronic diseases.
As a result, there is a shortage of GPs in many areas, particularly in rural and remote regions, which creates employment opportunities for GPs who are willing to relocate.
Furthermore, General Practitioners (GPs) in Australia are provided with competitive remuneration and perks such as relocation packages and a guaranteed minimum income. There are several GP job opportunities that offer flexible work arrangements and the potential for career advancement.
Australia is widely recognised for its exceptional quality of life, high standard of living, prestigious educational institutions, and favourable weather conditions. Additionally, the country’s diverse landscapes and outdoor activities attract many GPs, who often report a better work-life balance compared to their home countries.
Australia also has a robust continuing medical education system that offers GPs the opportunity to refine their abilities and knowledge through ongoing training and development.
To compound matters, FMSs in Malaysia are frequently encumbered with non-clinical tasks, excessive paperwork, and superfluous meetings. In contrast to their Australian GP counterparts, who devote less time to non-clinical duties, FMS in Malaysia spends a considerable amount of their time on non-clinical obligations.
This can prove challenging for FMSs, especially when handling chronic conditions like cardiovascular risks.
Moreover, FMSs frequently face demands to oversee numerous public health initiatives, despite their clinical expertise. These tasks, including community-based interventions, conducting verbal autopsies, and gathering data on health behavior and environmental factors, ought to be the responsibility of Public Health Specialists instead.
Considering the already demanding patient care duties of FMSs, the additional burden of public health programs renders it even more difficult for them to deliver high-quality health care.
Many FMSs are also frequently called upon to attend non-clinical meetings, which distracts them from their patients and makes it difficult for medical officers to refer cases to them. This issue is especially troublesome for consultant FMSs (JUSA C), who are frequently inundated with irrelevant meetings, such as asset and administrative meetings, causing them to unnecessarily reduce patient appointments.
As consultants, their proficiency and knowledge in family medicine should be utilised for the benefit of patients rather than for attending non-clinical meetings.
As a consequence, it is essential for public health specialists to concentrate on their primary duties rather than undertaking administrative tasks and developing policies that ought to be implemented by FMSs.
The Ministry of Health’s (MOH) frequent fragmentation and duplication of roles not only wastes resources but also places unnecessary strain on the already ineffective primary health care system.
Additionally, the presence of surplus medical officers (MOs) in PKD (district health office)/ PKB (division health office), as previously discussed in an article in CodeBlue, exacerbates the issue. Some of these MOs even hold the power to overrule FMSs, despite their lack of specialist qualifications.
Therefore, primary care and public health should not be structured in a way that considers one specialty inferior to the other. Primary care should not be regarded as a means of executing public health initiatives. A precise allocation of duties and responsibilities between FMSs and public health specialists would alleviate the unwarranted workload of the former.
This is crucial to enable FMSs and their multidisciplinary health care team to dedicate their efforts towards providing top-notch primary care services to patients. These efforts are indispensable in reducing the incidence of complications that necessitate hospitalisation, disability, and mortality.
As specialists in primary care, FMSs possess a profound comprehension of patients’ needs, their families, and the wider community, as well as the difficulties they encounter when delivering patient care on a daily basis.
This is consistent with primary care organisation and governance reforms in Europe, the UK, and Canada, which have highlighted the significance of primary care being guided by those who specialise in it.
Thus, it is critical to have a robust and independent primary care governance led by family medicine experts at the national, state, and regional levels to influence policies and planning related to primary care.
This will ultimately ensure that all Malaysians, regardless of their background, have access to high-quality, equitable, continuous, and coordinated primary care services from both the public and private sectors within a transformed primary health care system.
Despite a previous proposal to separate primary care from the current public health division and have it led by the Deputy Director-General of Primary Care who reports directly to the Director-General of Health in Malaysia, MOH top officials have disregarded this idea.
Collaborative efforts between primary care and public health provide a distinctive benefit in addressing intricate health concerns at both national and local levels.
These specialties have parallel objectives, and their restoration can be founded on this shared collaborative framework. To achieve optimal results, both specialties must collaborate in a mutually respectful manner while operating in tandem within a transformed primary health care system that aims to improve the well-being of the population.
As of December 2021, there were only 924 FMSs in the country, with 625 currently serving in 397 health clinics under the MOH. Malaysia requires an additional 8,000 FMSs to meet its target ratio of one FMS per 4,000 population.
If the MOH intends to accomplish this objective, they must improve the working conditions and revise the roles of FMSs to prevent any further brain drain of these specialists to developed countries as mentioned earlier.
In conclusion, the government needs to prioritise addressing the brain drain in Malaysia’s health care industry to ensure that its citizens have access to high-quality health care services.
This can be achieved through targeted investments, streamlined administrative processes, career advancement opportunities, and addressing political and economic instability, ultimately creating a more attractive environment for health care professionals to stay in the country and contribute to the growth and development of the health care sector.
Without the realisation of this objective, the aspiration for delivering exceptional, fair, and continuous health care will remain an unattainable dream.
The author is a family medicine specialist employed by Malaysia’s Ministry of Health, who is currently on an unpaid leave of absence working as a GP specialist on a locum basis in Western Australia and intends to resign from the Malaysian service by the end of this year. CodeBlue is providing the author anonymity as civil servants are prohibited from speaking publicly.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
