The claim that Malaysia’s health care system is run solely by the administrative and diplomatic officer (PTD) is simply not true. Since the establishment of the Ministry of Health (MOH), doctors have always been at the helm, leading the organisation.
However, the perception that health care leadership is detached from the realities on the ground is not new. This criticism has been directed not only at PTD officers, but also at doctors in administrative roles.
Over the years, many policies have been questioned for being impractical, with some even appearing completely disconnected from real clinical work. A recent example is the Waktu Bekerja Berlainan (WBB) shift system for doctors, which seemed unrealistic and unfeasible. Such policies would likely not have been proposed if decision-makers had a basic understanding of how doctors actually work in Malaysia.
Since this issue erupted, admin doctors have often been accused of lacking empathy and losing touch with the hospital environment after being in office for too long. This accusation is not new.
I recall an influencer specialist once referring to admin doctors as mere “postmen” — implying that their role is limited to relaying information without truly making a meaningful impact. To be fair, there are indeed some who fit this description, focusing more on “reten” (report) and spreadsheet figures than actual patient care.
However, in my research for my master’s dissertation, I found compelling evidence that clinician leaders tend to deliver significantly better clinical outcomes compared to non-clinician leaders, although some studies suggest no major difference. One notable study by Veronesi et al. (2013) examined 169 NHS hospital trusts in the UK and found that hospitals led by clinical doctors had better Mortality Ratios (HSMR)1.
Similarly, Krishnan et al. (2015) analysed hospitals in California and found that doctor-led hospitals had better outcomes in heart failure, pneumonia, and surgical site infections2. These findings reinforce the argument that having clinicians in leadership roles can positively influence hospital clinical outcomes.
On the other hand, when assessing financial outcomes, clinician leaders perform on par with non-clinician leaders, with no significant differences in efficiency or cost-effectiveness. Several studies have confirmed this, including Moores et al. (2021)3, Zuchowski et al. (2023)4, Tasi et al. (2019)5, and Kuntz et al. (2016)6, all of which analysed financial performance and found no meaningful differences between hospitals led by clinicians and those led by non-clinicians.
This suggests that while the debate over who makes a better leader in health care — clinicians or non-clinicians — cannot be answered with a simple “yes” or “no”, the benefits of having clinicians in leadership roles should not be undermined.
However, leadership effectiveness depends on multiple factors, including the specific performance metrics being evaluated. Clinical expertise alone does not automatically translate to strong leadership, just as administrative skills alone do not guarantee effective health care management.
Therefore, rather than pitting one group against the other, the focus should be on fostering collaboration. Health care thrives not under unilateral control, but through synergy between clinical vision and administrative pragmatism.
Dismissing PTD officers as “outsiders” ignores their institutional expertise, just as sidelining clinicians risks dehumanising care. The future belongs to leaders who value both stethoscopes and spreadsheets – because healing requires heart and efficiency.
Dr Mohd Khairul Ikhwan Mohd Nizam is a dedicated medical officer with 14 years of service in the Ministry of Health Malaysia, a Chevening Scholar (2023/2024), and holds an MSc in Healthcare Leadership and Commissioning from the University of Brighton, UK.
References:
- Veronesi G, Kirkpatrick I, Vallascas F. Clinicians on the board: What difference does it make? Social Science & Medicine. 2013;77:147-55).
- Bai G, Krishnan R. Do hospitals without physicians on the board deliver lower quality of care? Am J Med Qual. 2015;30(1):58-65).
- Moores LE, Landry A, Robert HS, Szychowski JM, Borkowski N. Reported Clinical and Financial Performance of Hospitals With Physician CEOs Compared to Those With Nonphysician CEOs. Journal of Healthcare Management. 2021;66(6):433-48.
- Zuchowski M, Göller A, Henzler D. Is medical leadership associated with better hospital management? Evidence from a structural analysis of hospitals in Germany. British journal of healthcare management. 2023;29(2).
- Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Management Review. 2019;44(3).
- Kuntz L, Pulm J, Wittland M. Hospital ownership, decisions on supervisory board characteristics, and financial performance. Health Care Management Review. 2016;41(2):165-76.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
