WHILE the country is losing medical graduates to better opportunities abroad, it is also retaining talents who choose to stay on due to various reasons.
Among them, said Universiti Malaya (UM) medical faculty deputy dean of undergraduate studies Prof Dr Muhammad Yazid Jalaludin, include serving the nation after having benefited from heavily subsidised fees provided by the government throughout their medical studies.
Prof Yazid: Most of the medical graduates claim that they would get better training or better career opportunities if they went overseas. This is not always true.
“All medical students in public universities are heavily funded by the government.
“The cost of training a medical student is almost RM400,000 to RM500,000 for the five-year programme,” he told StarEdu.
He added that working in Malaysia also provides graduates with vast experience in managing patients from all walks of life, with limited resources in some areas.
“This is challenging but definitely fulfilling when one could provide a helping hand for the patients in need.
“Other factors include family, friends and colleagues,” he asserted.
Universiti Kebangsaaan Malaysia (UKM) deputy dean of undergraduate studies Assoc Prof Dr Jemaima Che Hamzah said medical graduates trained locally, especially in a teaching hospital, are fully equipped to work as qualified doctors as they are trained in the local setup.“They are more resilient and experienced in handling patients in the wards and clinics.
“They understand the system, therefore it is easier for them to deal with the red tape better than overseas graduates,” she said.
Agreeing, Prof Yazid said the exposure medical students receive makes them better doctors.
“This includes clinical exposure or ward rounds, community postings, research and other cocurricular activities such as UM’s Baktisiswa community outreach programme, blood donation drives and activities at people’s housing projects (PPR).
“The variety of diseases that they are exposed to during their medical school journey, be it communicable or non-communicable diseases, will make an impact during their working days,” he added.
Dr Jemaima: Medical graduates trained locally, especially in a teaching hospital, are fully equipped to work as qualified doctors as they are trained in the local setup.
Managing expectations
With around 18,000 contract doctors and over 3,000 medical graduates entering the healthcare system each year, Malaysian Medical Association (MMA) president Dr Muruga Raj Rajathurai said there cannot be an assimilation of all new graduates into permanent positions, especially in a pension scheme, as the current healthcare spending will not be able to sustain it.
“If without pension, it may be doable but only on a gradual increase in numbers and not a sudden intake of all the new doctors as it will mean that there will be a shift of spending on manpower from other critical needs within the same budget,” he said, adding that a significant increase in the health budget is important.
Dr Indra: The system of having only permanent government positions for a limited number of specialists while all other positions are contracts of varying lengths is not uncommon in developed countries.
According to United Nations University principal visiting fellow Dr Indra Pathmanathan, the system of having only permanent government positions for a limited number of specialists while all other positions are contracts of varying lengths is not uncommon in developed countries.
“The duration of a contract is determined by the time required for the individual to reach the next step in career progression, for example, for a house officer to become a medical officer and a medical officer to complete speciality training.
“Perhaps a change in mindset is needed; after all, if you graduated as a lawyer or engineer, you would not expect the government to provide you with a permanent job,” she said.
Although retirement benefits are essential, Dr Indra is concerned about the viability of the current system of government pension for an ever-increasing public sector workforce.
“It has been suggested that the public sector health workforce should be separated from the general civil service and have its own terms and conditions of service, including a separate pension scheme as is done in other countries.“Such a separation of service would make the medical services more flexible and better able to adapt in response to rapidly changing technology and new health needs,” she said.
On the higher starting pay of doctors working in developed countries after currency conversion, Dr Muruga is of the opinion that the situation depends on which countries medical graduates are comparing with.
“We can’t compete with Singapore because of its higher currency exchange rate.
“For the amount of work in managing the high patient load at public healthcare facilities, I would say the junior doctors aren’t being paid enough,” he said.
Dr Muruga further explained that healthcare workers in other countries like Australia, Singapore and the United Kingdom also clock in long hours, but the working hours are well regulated with sufficient manpower ensured to cope with the patient load.
“Healthcare workers in these countries are paid for any extra hours spent at work, even if they are replacing a colleague.
“In these countries, there are policies and regulations that support a work-life balance,” he said, adding that proper planning and development of healthcare human resources is essential and should be seen as an investment, not an expenditure.
Dr Muruga: Proper planning and development of healthcare human resources is essential and should be seen as an investment, not an expenditure.
Not always greener on the other side
One of the great strengths of the Malaysian system, said Dr Indra, is that everyone, however poor, has access to reasonably good and affordable healthcare when they need it, with few countries able to claim as much.
Echoing her sentiments, Prof Yazid added that with just RM1, patients could afford to see a doctor for treatment.
“This is definitely a plus point, especially for those who are in dire need.
“With this very affordable healthcare system, medical graduates who work at the Health Ministry’s facilities do not need to think about whether the patients they are treating can afford to pay for the treatment or not,” he said.
Prof Yazid urged medical graduates to ponder on what the country has given them, such as a heavily subsidised medical programme in public universities, before deciding to work overseas.
“Most of the medical graduates claim that they would get better training or better career opportunities if they went overseas. This is not always true.
“From past experience and communications with colleagues, only a small percentage were able to climb the ladder and achieve their dreams,” he shared.
On the demand for local medical graduates overseas, Dr Jemaima said it is good to see Malaysian medical graduates being recognised internationally.“This provides evidence that the quality of local training and product is on par with overseas training.
“This also proves that Malaysia can be a hub for medical training and in the future, be an exporter of trained workers,” she said, adding that it is good experience for them to work and experience a different healthcare system overseas.
However, both Prof Yazid and Dr Jemaima urged medical graduates to return to serve the country after specialisation.
“Malaysia needs more specialists to cater for our nation,” said Dr Jemaima.
“For those who have successfully achieved their dreams, please come back and serve the nation with the expertise that you have gained, as the country needs you!” said Prof Yazid.
Zhi Yong, 23, a medical student at Universiti Malaya, is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. To join Star-NiE’s online youth community, go to facebook.com/niebrats.
Merits of staying
Getting firsthand experience in one of our local teaching hospitals has helped me to be accustomed to the system. Building rapport with my patients has never been an issue. I believe that knowing the cultural and spiritual backgrounds of patients is an imperative aspect of holistic patient care. It is always a privilege to serve our nation. 
As the profession can be arduous and comes with great responsibilities, I value moral and emotional support from my family and friends. Staying means being physically closer to those whom I cherish. As brain drain is happening across our country, I believe that with a clearer specialisation pathway, many, including myself, will choose to stay. Malaysia is in dire need of more specialists; many would gladly stay if there were vast career opportunities here. In the long run, I hope for better working hours for junior doctors with proper overtime pay. I have witnessed housemen staying past their working hours to complete their work without getting compensated. This will inevitably lead to burnout and exhaustion.
– Nazlin Adlina Mohd Mahyudin, 24, fifth year medical student, Universiti Malaya
As medical students, we are exposed from our first year to the healthcare system in Malaysia through hospital visits and later rotations in specific disciplines. 
Hence, progressing from medical school as graduates would be easier in the Malaysian setting as there is prior acclimatisation in terms of the prevalence, diagnosis and management of diseases in this country without the need to refamiliarise ourselves with the healthcare system abroad if we choose to work overseas. Among the issues I hope can be resolved include better job security, permanent job placements to proceed with postgraduate training, and better training environment and working hours.
– Hariharan Ganesmoorthy, 23, fourth year medical student, International Medical University
To me, Malaysia is not a place, but home. It is where I was born and raised, and where I want to live my life for the rest of my days. I am passionate about helping others who are less fortunate than me, and would like to contribute towards strengthening Malaysia’s economy by working here.
I want to make a difference in my country. I am aware that many people choose to work abroad due to the wide range of opportunities. However, if healthcare professionals choose to work abroad, who will be here to save those who stay at the end of the day?
– Ong Zeyi, 22, second year medical student, Universiti Sains Malaysia
