FEBRUARY 14 ― There is a heap of write ups lamenting at our predicament with national “Malaysian Brain Drain” issue in the popular newsprint media. The “Talent Corps” in 2011 was formed to engineer brain gain and stem brain drain. It is quoted from CEO Talent corps that almost half a billion ringgit had been spent (Letters, NST, January 11, 2023, Chew Kok Liong).
Although it had some initial success, but it was not sustainable enough to dissuade our precious talents from leaving our shores nor to bring back talents from abroad. Here in this write up, our focus is the medical brain drain from the subspecialists’ perspective.
A new mould is needed. The absence of the voice is the key element, the discontented human capital, from junior to the most senior doctors, sub-specialists, and clinical researchers, does not bode well of a long-lasting solution.
The suggestion implied by Prof. Datuk Dr. Asma binti Ismail, formerly the President of Academy of Science Malaysia (Bernama, Consider This) that piecemeal effort at realignment is not apt but instead a wholesome approach at inclusivity of all relevant players is what is needed. We should now steer from merely mulling the obvious problems but focus on the why or how to stem this brain drain.
Sustainability is achieved by providing training from a pool of talented junior doctors, with confirmation of permanent posts thereafter and thus allowing the creation of pathways for general specialist to branch to sub-specialties. Thus, more specialties are available in more regional hospital of each state, and this can then be propelled further to create sub-specialty services.
Patients are now aware of the rapid progress in medical care which need the newer subspecialties. High end cardio-thoracic & brain surgery, transplant medicine, clinical genetics, clinical immunology services are available only in selected public and university hospitals at this moment.
“Losing our fresh medical talents outwards, (Singapore is a favourite) would negate creating new sub specialists of the future” ― Professor Datuk Dr Adeeba Kamarulzaman, ex-Dean of UM Medical Faculty.
Some policymakers appear unruffled, giving narratives that brain drain occurs in many sectors as in developed countries; without offering a solution it is bound to get worse. We cannot trivialise of the loss of our prized talents at the nations expense. What is also amiss in the narratives, is that the new medical graduates are the future human capital to prop up our healthcare service to greater heights, and to enhance quality of patient care besides research capabilities.
They could be our next iconic physician scientists and potential Nobel laureates.
How grave is the loss of senior consultants to the nation
It is estimated that the nation spends RM1 million through five years of medical school to produce one new doctor; it costs much more as he moves up the career pathway. Specialist training with local Master of Medicine specialty is of four years duration (after three years compulsory service), and further moving up to sub-specialist training another three years. Clinicians with additional role in translational research will venture further with doctoral training usually a clinical PhD (3-4 years).
With such long years (at least 18 cumulative years) and such huge cost (at least RM4-5 million), it is behoved on policymakers not to trivialise these victims’ misgivings, but duty bound to review facilities to be afforded, remuneration as proportionate, promotion prospect expanded so as to be equitable to their sacrifices of surpassing stiff competitions, and enduring long duration of training.
When meaningful funding and provision of good research facilities are not forthcoming and then to be labelled as ineffectual, is indeed demoralising. Can we blame them when they start looking outward? Administrative leaders could do more with a permissive mode of prospering an ecosystem to yield an intended outcome and not to be inhibitory to new ideas and innovation.
Increase funding for research
A need to be realistic that better research output is doomed to be at average level even when the country has the best brains available when research funding is inhibitory; research funding from present 1 per cent of GDP for Malaysia is untenable. The amount allocated for research would translate as RM20.21 billion (for a GDP RM1,871 billion in 2022).
Malaysia’s Budget 2021 allotment for Covid-19 control alone was RM45 billion (equivalent of US$10.43 billion (Parliament December 16, 2020) which translates to more than twice the amount of research allocation. The nation had little home Covid-19 research data to modify CDC recommendation to suit to local needs unlike a few research-intensive countries.
Elsewhere, research funding to GDP revealed the following figures ― South Korea 4.55 per cent, Israel 4.54 per cent, Japan 3.21 per cent, USA 2.79 per cent, Singapore 1.95 per cent, Thailand 1.0 per cent. Should we not increase our research allocation at 2 per cent GDP, like Singapore, at least?
Funding for medical/clinical research usually requires larger quantum and longer duration to have their impact realised. In addition to funding, the research ecosystem must also be improved to encourage scientists from the medical/clinical areas to be motivated to do advanced research in their respective fields. Many of our medical scientists are working outside Malaysia and efforts to bring them back should also be made.
It behoves the nation then to shed all previous misconceptions and biases and to form a national task force to stave off further brain drain, ‘bottom up and not top down’ and come as a wholesome recommendation and not segmented piecemeal effort.
1. To include the representatives of intended groups; (a) medical graduates, house officers, medical officers, specialists, sub specialists, and (b) policy makers of MoH, MoHE, Mosti, JPA, PM’s Department
2. To refer to existing white papers from Ministry of Health
3. To a refer to Academy of Science Malaysia
4. Viewpoint from medical associations ― Academy of Medicine, MMA, MSAI
5. Deans of Medical schools & hospital Directors
The “Push and Pull” factors to prevent brain drain exhaustively provided by leading professionals and academics alike. TIGERS may provide the perspective of sub-specialty input.
Let us implement the “hows” after grasping the “whys”.
This article is jointly written by:
Prof. Dr. Lokman Mohd Noh
Dr. Amir Hamzah Abdul Latiff
Prof. Dr. Rahim Md Noah
Assoc. Prof. Dr. Adli Ali
Dr Intan Juliana Abd Hamid
Assoc. Prof. Dr. Intan Hakimah Ismail
Prof. Dr. Norazmi Mohd Nor
* This is the personal opinion of the writer or organisation and does not necessarily represent the views of Malay Mail.
