There are still many misconceptions about the role of Family Medicine Specialists (FMS) in Klinik Kesihatan (KK) throughout Malaysia. Too often, FMS are perceived as either detached administrators or all-powerful decision-makers, when in reality their role is more complex and nuanced.
Understanding what FMS actually do, and why they matter, is essential if we are to strengthen primary care as the backbone of our health system.
FMS are first and foremost clinicians. They are trained to deliver specialist-level care within the primary care setting, managing not just routine conditions but also complex and chronic illnesses.
On top of their own patient lists, FMS also receive referrals from medical officers (MOs). In many clinics, these referrals can number up to over 100 a day.
Each referred case usually involves complex decision-making: patients who need medication optimisation, those with multi-morbidity requiring careful balancing of treatments, or those whose social circumstances complicate their care.
Far from “seeing fewer patients,” FMS carry a workload that is often less visible but no less intense. Consider, for example, an expectant mother with diabetes and HIV. Beyond monitoring her blood sugar and viral load, the FMS must ensure safe antenatal care, coordinate with hospital specialists, and provide counselling to reduce stigma.
At the same time, this patient may face domestic stress, limited family support, and financial struggles that make it difficult for her to adhere to treatment or prepare for child care. Her living environment may be challenging, and increasingly, even the effects of climate change, such as floods or heat waves that can affect her health and safety.
In such cases, the consultation is not just about prescriptions or lab results. It often involves acting as a psychologist, a social prescriber, a family counsellor, and a trusted confidant, all within the same consultation room.
This illustrates why a single consultation with an FMS can last an hour or more. Family medicine is not a conveyor belt of quick visits. It is about addressing health in its full context, recognising that a patient’s well-being is shaped not only by biology but also by relationships, work, income, community, and environment.
In the course of a single day, an FMS may review a patient with diabetes and depression, counsel a young mother experiencing domestic violence, manage an elderly man with multiple chronic illnesses, and support a teenager struggling with anxiety.
Each encounter demands not only medical expertise, but empathy, patience, and leadership. Just as important, it is about recognising that counselling and communication are also forms of medicine. Sometimes, what heals is not only the pill, but the words of reassurance, the act of listening, and the building of trust.
The philosophy of family medicine is often described through two sets of guiding principles: the 4Ps and the 4Cs.
The 4Ps emphasise that primary care is the primary contact for patients entering the health system, that care must be person-centred, that it must prioritise the preventive as well as the curative, and that it must be delivered in a professional manner rooted in ethics and accountability.
Complementing this are the 4Cs. In the KK example, they provide the first contact between Malaysians and the health system. They deliver continuity by following patients across years and illnesses, offering care literally “from womb to tomb.”
They embody comprehensiveness by addressing a wide spectrum of needs—physical, mental, social, environmental, and even spiritual—whether it is a child’s vaccination, a young adult’s mental health crisis, or palliative care for an elderly patient at the end of life. And they ensure coordination, linking patients seamlessly to hospitals, tertiary specialists, and community resources.
Together, the 4Ps and 4Cs form the compass of family medicine, guiding FMS in their daily work. These principles distinguish primary care from fragmented or episodic care, and it is the FMS who are tasked with upholding them.
Yet, clinical work is only part of their reality. FMS in Malaysia carry heavy administrative responsibilities as well: managing clinic resources, overseeing staff allocation, and coordinating an ever-growing list of health programmes.
Many of these initiatives originate from senior leadership directives that, while important, may sometimes overlap or compete for limited resources. Similarly, non-clinical specialists or officers from administrative backgrounds can occasionally exert influence over matters that affect clinic operations.
While their contributions in areas like communicable disease control are indispensable, extending into clinical decision-making risks blurring the lines of responsibility. A more collaborative framework, one that respects boundaries while promoting partnership, would allow both other specialties and family medicine to complement each other more effectively.
That is why family medicine is a specialty that demands formal postgraduate training like any other. In fact, it is known to be one of the hardest training programmes, with a high failure rate that reflects the breadth and depth of knowledge required.
The structured training usually takes at least four years, combining clinical practice with academic coursework and rigorous assessments. Trainees rotate through hospital specialties and community postings before returning to primary care, where they must demonstrate competence in everything from managing patients with chronic diseases to emergency care, mental health, maternal-child health, and geriatrics.
The exams test not only knowledge, but also clinical reasoning, communication skills, and the ability to integrate social and environmental factors into care. Over the years, the training has also evolved: what was once largely focused on clinical mastery now includes leadership, teamwork, and system-level skills, reflecting the reality that FMS are both healers and leaders in KK.
This training prepares doctors not only to manage patients with acute and chronic illnesses across all age groups, but also to lead teams, integrate public health initiatives, and ensure continuity of care within the community. Without it, KK risk being driven more by administrative convenience than by clinical outcomes.
That is why postgraduate family medicine programmes are critical, and why MOs interested in meaningful, holistic, and community-focused care should consider pursuing this pathway.
In countries such as the United Kingdom, Australia, and New Zealand, every general practitioner (GP) undergoes postgraduate training before taking on independent practice.
In these countries, GP are trusted to lead clinics precisely because patient care is clinical at its core. Administrative officers support them, but they do not override clinical pathways. Malaysia, too, should embrace this principle.
The FMS, with their training in both breadth and depth of care, are best placed to lead KK and ensure that decisions are made with patient outcomes at the centre. To achieve this standard, Malaysia still needs more than 8,000 FMS nationwide.
This would gradually replace the reliance on MOs without postgraduate training, some of whom may feel disillusioned or mismatched in primary care roles. Supporting more doctors to specialise in family medicine will help ensure that KK are staffed by those truly equipped and motivated to provide comprehensive care.
Yet, at the same time, we are seeing waves of FMS leaving the Ministry of Health, their expertise and dedication flowing to countries such as Australia, where primary care specialists are highly valued and well supported.
Each departure is not just the loss of one clinician; it is the loss of years of training, the loss of a trusted mentor for younger doctors, and the loss of continuity for countless patients. Malaysia cannot afford to keep losing these precious minds.
To all FMS still serving in KK throughout the country: thank you. Thank you for holding together a system that often asks for more than it gives back, for balancing clinical excellence with administrative duties, for carrying the ever-growing programmes and expectations placed upon your shoulders, and for never losing sight of the patient in front of you.
Your efforts sustain the very foundation of our healthcare system. And as much as the system must support you, FMS must also support each other. No one understands the unique demands of family medicine better than those who practice it.
By lifting one another up, sharing burdens, and mentoring the next generation, FMS can help ensure the specialty remains resilient, respected, and sustainable.
More importantly, KK should never be perceived as postings of last resort. They are not places where doctors simply serve because they must. They are the frontline of healthcare in Malaysia, where trust is built, lives are changed, and communities are strengthened.
Doctors who do not find meaning in primary care may find their calling elsewhere, but those who embrace family medicine will discover a specialty that is intellectually demanding, emotionally fulfilling, and socially impactful.
At its heart, family medicine is a discipline that blends science and humanity. It is about listening as much as diagnosing, counselling as much as prescribing. It is about journeying with patients not just through their illnesses, but through the very fabric of their lives.
If Malaysia is to sustain a strong, equitable, and people-centred health system, then we must empower FMS to lead KK, support postgraduate training in family medicine, and cultivate a culture that recognises primary care for what it truly is: the foundation of health.
Dr Jazlan Jamaluddin is a senior lecturer and family medicine specialist at the Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
