I am a physician currently undergoing subspecialty training within the Ministry of Health (MOH). I write to highlight a matter that has generated increasing concern among many physicians regarding the implementation of the Garis Panduan Program Fellowship Kementerian Kesihatan Malaysia (Kemaskini 2025).
According to this guideline, doctors applying for fellowship or subspecialty training must observe a waiting period after completing previous courses of training. The policy clearly outlines the following requirements:
| Duration of Course | Required Waiting Period |
| More than 12 months | 2 years |
| More than 3 months but less than 12 months | 1 year |
| Less than 3 months | No waiting period |
As most subspecialty programmes exceed 12 months, physicians are therefore expected to complete at least two years of service as a gazetted specialist before becoming eligible to apply.
For many years, this requirement was enforced with strict adherence. Physicians who were even slightly short of the two-year waiting period were not permitted to apply.
There were cases where doctors missed the requirement by only a few weeks yet were still told to wait until the full duration had been completed.
Some have postponed their applications for months or even an entire intake simply because the two-year requirement had not been met precisely.
At the time, this was accepted as part of the system. The rule was clear, and it applied equally to everyone.
However, in the past two years, the situation appears to have changed in practice following the change in leadership of the Head of Service for Internal Medicine.
Since this change, there have been numerous confirmed instances in which physicians who have not completed the required two-year waiting period were nevertheless interviewed and accepted into internal medicine subspecialty training programmes.
These cases are not isolated rumours or misunderstandings. Many physicians within the internal medicine community are aware of multiple such appointments across recent intakes.
What makes this particularly difficult for many physicians to accept is the contrast between past and present enforcement of the same rule.
Under the previous leadership of the Internal Medicine service, the two-year waiting period was treated as an absolute requirement.
Physicians who were even slightly short of the required duration — sometimes by only a matter of weeks — were not permitted to apply.
In contrast, since the change in leadership, multiple physicians who have clearly not fulfilled the same waiting period have nevertheless been interviewed and accepted into subspecialty training programmes.
When the same rule is enforced rigidly for one group of doctors but relaxed for another, it inevitably raises questions about consistency, fairness, and the principles guiding these decisions.
The concern here extends beyond administrative technicalities.
First, there is the issue of fairness between different cohorts of physicians. Earlier batches complied with the rule as written and delayed their subspecialty training accordingly. It is understandably frustrating for those who followed the requirement strictly to now see others entering training without meeting the same criteria.
Second, there are serious workforce implications. Malaysia has long acknowledged the shortage of general physicians, particularly in district hospitals where internal medicine specialists are essential to maintaining inpatient services, supervising junior doctors, and managing complex medical cases.
The two-year waiting period likely existed to ensure that newly gazetted physicians contribute to the general medical workforce before transitioning into narrower subspecialty fields.
If this requirement is bypassed for a significant number of applicants, it risks accelerating the movement of physicians into subspecialty training while district hospitals continue to struggle with manpower shortages.
The unintended consequence may be an increasing imbalance between subspecialists and general physicians, with direct implications for patient care in hospitals that rely heavily on general internal medicine services.
Third, there are implications for professional morale and institutional trust. Doctors are generally willing to comply with demanding policies when they are applied consistently. However, when rules appear rigid for some cohorts but flexible for others, it inevitably creates the perception that career progression may depend less on policy and more on circumstance or timing.
Such perceptions can be deeply damaging to confidence in the fairness and transparency of the training system.
For these reasons, I respectfully urge the highest levels of the Ministry of Health, as well as the divisions responsible for subspecialty development and medical training, to review how this guideline is currently being implemented.
Specifically, clarification is needed on several important points:
- Whether the two-year waiting period requirement remains official MOH policy.
- If it does, how physicians who have not fulfilled the requirement have been accepted into subspecialty training programmes.
- Whether the selection process for internal medicine subspecialty training is being applied consistently across all applicants.
Given that the apparent change in practice coincides with the change in leadership of the Internal Medicine Head of Service, it would also be helpful for the current Head of Service for Internal Medicine to clarify the rationale behind these decisions and whether the policy itself has been modified.
Ultimately, this issue is larger than the career progression of a few physicians. It concerns how national training policies are interpreted, implemented, and enforced within the public health system.
If the two-year waiting period has been revised, then physicians across the country deserve to know that the policy has changed. If it has not been revised, then there must be a clear explanation for why it appears not to have been applied consistently in recent subspecialty intakes.
Guidelines exist to guide decisions. When they are applied inconsistently, they risk becoming rules that exist on paper while practice follows a different set of standards.
Physicians are willing to follow strict rules when they apply to everyone equally. What becomes difficult to accept is when the same rule that once delayed careers for months or years suddenly becomes flexible for others.
A guideline that is enforced strictly for some doctors but ignored for others stops being a policy, and becomes a question of accountability.
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.
