I return to work each day with exuberance, conviction, and a deep sense of duty to serve within our public health care system. But that commitment is being tested relentlessly by policies and structures that are increasingly inimical not only to doctors, but to the very patients we are trying to protect.
As a subspecialist in a government hospital, my responsibility goes far beyond routine clinical care. I manage some of the most complex, high-risk cases often with limited resources, outdated equipment, and insufficient systemic support.
These are not minor inconveniences; they are systemic deficiencies that directly heighten medico-legal risk while demanding outcomes that rival far better-equipped centres. We are expected to perform at the highest level, in circumstances structurally stacked against us.
Yet the burden does not stop there.
In a system strained by a shortage of subspecialists, I am frequently called upon, late at night, during off-days, across institutions, covering another hospital, be it in the same state or even other states, to provide urgent consultations or even physically attend to critically ill patients.
These efforts are not exceptional; they are routine. And yet, they remain largely unrecognised, uncompensated, and administratively draining. To normalise this level of sacrifice without structured support is not only unsustainable, it borders on being impertinent.
Beyond clinical care, subspecialists are deeply embedded in the machinery of the health care system. We lead portfolios, sit on committees, and contribute at hospital, state, and national levels to improve service delivery.
These roles demand time, energy, and personal financial cost. They take us away from our families, erode our personal time, and over time, can irrevocably affect our well-being. What is perhaps most disheartening is that this is not an isolated experience, many centres run by a single subspecialist endure this same reality every single day.
And still, despite all this, we are told we are not yet “consultants”.
Within the Ministry of Health, the title of “consultant” remains bound by rigid and outdated criteria, often requiring 10 years of service as a specialist, and further tethered to administrative hierarchies, such as Jusa, before he or she is recognised as a “Senior Consultant”.
This framework fails to reflect modern clinical realities. It disregards the structured, rigorous subspecialty training we have completed under recognised national bodies, and ignores the level at which we are already functioning daily.
When it comes to clinical responsibility, subspecialists are pushed to the forefront. We are expected to make the hardest decisions, to lead, and to be accountable. Yet when it comes to recognition, we are pushed to the margins, asked to defer to circulars and technicalities that deny what we already practise every day: consultation at the highest level.
The contradiction is glaring.
But when a general specialist steps into private practice, they are immediately addressed as “Consultants”, without hesitation or bureaucratic restraint. The same individual, often with less specialised expertise and narrower scope of responsibility, is suddenly conferred recognition.
At the same time, large private institutions actively court subspecialists with lucrative offers, respect, and clear acknowledgment of their value.
This inconsistency is not merely ironic, it is indefensible.
Worse still, within our own institutions, initiative is too often mistaken for insubordination. When younger and proactive subspecialists bring forward constructive ideas or push for change, they are labelled as rambunctious or disrespectful.
At times, those with stronger clinical capability are perceived not as assets, but as threats. Innovation is recast as aggression; dynamism is reduced to self-interest. In such an environment, progress is not just slowed, it is actively discouraged.
What message does this send?
- That expertise is valued only outside public service?
- That sacrifice within government institutions is expected, but not worthy of recognition?
- That initiative is punished rather than nurtured?
- That titles and by extension, respect are dictated not by competence, but by bureaucracy?
This is not merely a matter of semantics. It is a matter of dignity, morale, and retention.
A system that persistently under-recognises and, at times, suppresses its most highly trained professionals should not be surprised when they leave. Make no mistake, many are already contemplating that path.
If this trajectory continues, the consequences will be irrevocable. The public health care system will lose the very individuals it depends on to manage its most complex and vulnerable patients.
And when that happens, the greatest loss will not be ours.
It will belong to the patients: those who rely entirely on public health care, who have no alternative, and who will bear the cost of a system hollowed out from within.
This must change.
Subspecialists who have completed accredited training should be recognised as Consultants formally, fairly, and without unnecessary delay. The pathway to recognition must reflect clinical reality, not outdated hierarchy.
Contributions beyond clinical care must be acknowledged, structured, and supported, not silently absorbed as expected sacrifice. Just as importantly, a culture that encourages initiative, respects capability, and embraces progress must be fostered, not feared.
Public health care cannot continue to run on goodwill alone. To rely on goodwill as the backbone of service delivery is, in truth, a form of moral coercion. One that quietly exploits professionalism while offering little in return.
But when individuals inevitably choose a different path, they are reminded that “no one is indispensable,” as if that justifies a system unwilling to retain or recognise its own.
A strong message to the authority: if the issue of recognition and welfare for subspecialists continues to be ignored or handled surreptitiously, the consequences will be detrimental, potentially undermining the very future of our public health care system.
We are still here. We are still serving. But for how much longer?
The author is a subspecialist serving in the Ministry of Health, a tired and exhausted subspecialist who still believes recognition will come one day, but is no longer certain how long he can continue to wait. 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.
