Dear Malaysians, when you visit a hospital and see a subspecialist doctor — a neurologist, cardiologist, gastroenterologist, endocrinologist, or rheumatologist — you might assume that this doctor simply studied medicine a few extra years after graduating.
That assumption would be perfectly reasonable. In many countries, the journey from medical school graduate to subspecialist takes around nine to ten years.
But in Malaysia, it often takes around 15 years. Yes, 15. And before anyone assumes that Malaysian doctors require longer training because our standards are somehow higher than the rest of the world, allow me to explain what actually happens behind the scenes.
Because the extra years do not come from additional medical knowledge. They come largely from bureaucracy.
Let’s walk through the pathway. After completing five years of medical school, newly graduated doctors in Malaysia often do not begin work immediately.
Many must wait six months to one year just to obtain a housemanship placement, because the health care system cannot absorb graduates quickly enough. Once housemanship begins, it lasts two years.
Housemanship is essentially internship training where junior doctors rotate through several departments to gain basic clinical exposure. Two years might sound reasonable, until you realise that in many other countries, internship lasts only one year.
But Malaysia’s system is just getting started. After housemanship, doctors must serve as medical officers (MOs) for another two years of compulsory service before they are even eligible to apply for specialty training.
Not start training. Apply for it.
Assuming the doctor is fortunate enough to secure a place in a Master’s specialist training programme, the training itself takes four years.
This assumes everything goes perfectly — no exam failures, no extensions, no interruptions. At the end of this process, the doctor finally becomes a specialist.
Most people would assume the training journey ends here. But Malaysia, being Malaysia, has one more administrative requirement waiting.
Under current policies, newly qualified specialists must accumulate three consecutive years of Annual Performance Assessment Report (LNPT) performance evaluations before they are allowed to apply for subspecialty training. For those unfamiliar with government terminology, LNPT refers to the annual performance evaluation for civil servants.
In practical terms, this means that after completing four years of specialist training, doctors must still work another three years before they are even eligible to begin subspecialty training.
Only then can subspecialty training start, which itself usually takes three to four years. Add everything together and the timeline becomes something like this:
- After five to six years of medical school, up to a year waiting for housemanship.
- Two years of housemanship.
- Two years of compulsory MO service.
- Four years of specialist training.
- Two to three years of specialist experience, then only one is allowed to apply for subspecialty training.
- Three to four years of subspecialty training.
Total: around 13 to 15 years. And this is assuming everything goes smoothly.
Now let us compare this with other countries. International studies comparing postgraduate medical training systems show that in countries such as the United States, the United Kingdom, and Australia, specialist training programmes generally last between three and seven years, with doctors entering structured residency programmes relatively early after graduation.
In other words, the system focuses on training doctors efficiently.
Interestingly, even countries with fewer resources, such as India and Indonesia, often produce subspecialists faster than Malaysia, because their doctors proceed directly into structured residency programmes after internship.
Meanwhile, Malaysia has managed to design a system where doctors spend years moving between waiting periods, administrative requirements, and service obligations before they can even begin certain stages of training.
One might reasonably ask why. Which brings us to a slightly uncomfortable question.
Does the Malaysian system intentionally slow down specialty and subspecialty training in order to keep doctors in government service longer? One certainly hopes not.
But when every stage of training seems to acquire an additional administrative requirement, it becomes difficult not to wonder.
After all, if doctors spend more years waiting between training stages, they inevitably spend more years serving within the government health care system.
Perhaps this is simply an unintended side effect of policy design. Or perhaps it is a remarkably creative workforce retention strategy.
But here is the reality. If Malaysia truly wants to produce more specialists and subspecialists, there is no mystery about what needs to happen. The country must invest more in health care.
Training specialists requires funding for training positions, supervisors, teaching hospitals, and structured programmes. It requires budget.
The Ministry of Health (MOH) can promise many things — more specialists, improved services, better health care access. But promises alone do not train doctors.
Without sufficient funding, those promises often contradict the reality on the ground. Policies say one thing while budgets say another.
Today, Malaysia faces growing shortages of specialists across multiple disciplines. At the same time, increasing numbers of doctors explore opportunities overseas where training pathways are clearer and career progression is faster.
This phenomenon is often described as brain drain. But perhaps the explanation is simpler. Doctors tend to go where systems make sense.
No doctor is asking for an easy path. Medicine demands years of training, discipline, and dedication.
But there is an important difference between rigorous training and prolonged bureaucracy. Malaysia currently appears to have plenty of the latter.
And when becoming a subspecialist takes 15 years instead of ten, the question Malaysians should ask is not whether doctors are willing to train.
The real question is whether the system guiding that training is designed to produce specialists efficiently, or simply to keep them waiting.
The author is a physician in Selangor. 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.
