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THERE is a heap of write-ups lamenting our predicament with the national “Malaysian brain drain” issue in the popular newsprint media.
TalentCorp was formed in 2011 to engineer brain gain and stem brain drain. It is quoted by the TalentCorp chief executive that almost half a billion ringgit had been spent.
Although it had some initial success, the programme 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 sub-specialists' perspective.
A new mould is needed. The absence of the voice is the key element and discontented human capital – from junior to the most senior doctors, sub-specialists, and clinical researchers – do not bode well for a long-lasting solution.
Former Academy of Science Malaysia president Prof Datuk Dr Asma binti Ismail had reportedly implied that piecemeal effort at realignment is not apt as compared to a wholesome approach that is inclusive of all relevant players.
We should now steer from merely mulling the obvious problems and focus instead on why this brain drain occurs and how to stem it.
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 specialists to branch to sub-specialties. Thus, more specialties are available in each state's regional hospitals, and this can then be propelled further to create sub-specialty services.
Patients are now aware of the rapid progress in medical care which needs newer sub-specialties. High-end cardio-thoracic & brain surgery, transplant medicine, clinical genetics, and clinical immunology services are available only in selected public and university hospitals at this moment.
“Losing our fresh medical talents outwards (mostly to Singapore) would negate creating new sub-specialists of the future,” said former Universiti Malaya medical faculty dean Prof Datuk Dr Adeeba Kamarulzaman.
Some policymakers appear unruffled, giving narratives that brain drain occurs in many sectors as in developed countries, which would worsen if no solution is offered. We cannot trivialise the loss of our prized talents at the nation's expense.
What is also missing 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 the 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 5 years of medical school to produce one new doctor, which costs much more as he moves up the career pathway.
Specialist training with a local Master of Medicine specialty takes four years (after three years of compulsory service), and another three years as he moves up to sub-specialist training. Clinicians with an additional role in translational research will venture further with doctoral training, usually a clinical Ph.D. (three to four years).
With such long years (at least 18 cumulative years) and such huge cost (at least RM4-5 million), it falls on policymakers not to trivialise these victims' misgivings as they are duty-bound to ensure facilities that can be afforded, proportionate remuneration, expansion of promotion prospects to reward those who overcome stiff competition and endured long training duration.
When meaningful funding and provision of good research facilities are not forthcoming, and then labelled as ineffectual, it 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
When research funding is inhibited, we can expect a realistic outcome of sub-par research output despite the availability of competent personnel in the country. The current research funding of 1% of Malaysia's GDP, which is equivalent to RM20.21 billion, is untenable.
Malaysia's Budget 2021 allotment for Covid-19 control alone was RM45 billion, equivalent to US$10.43 billion, which translates to more than twice the amount for research allocation. The nation had little home Covid-19 research data to modify the Centre for Disease Control's recommendations to suit local needs, which several research-intensive countries have done.
Elsewhere, research funding to GDP revealed the following figures – South Korea (4.55%), Israel (4.54%), Japan (3.21%), USA (2.79%), Singapore (1.95%), and Thailand (1.0%).
Should we not increase our research allocation to at least 2% of GDP, similar to Singapore?
Funding for medical/clinical research usually requires a 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 to shed all previous misconceptions and biases and to form a national task force to stave off further brain drain from a bottom-up approach to find a wholesome recommendation and not merely segmented piecemeal effort such as:
1. To include the representatives of intended groups; (a) medical graduates, house officers, medical officers, specialists, sub-specialists, and (b) policymakers from the Health Ministry, Higher Education Ministry, Science, Technology and Innovation Ministry, Public Service Department and Prime Minister's Department.
2. To refer to existing white papers from the Health Ministry
3. To refer to the Academy of Science Malaysia
4. To refer to viewpoints of medical associations namely the Academy of Medicine, Malaysia Medical Association, Malaysian Society of Allergy and Immunology
5. To refer to deans of medical schools and hospital directors
The “push and pull” factors to prevent brain drain have been 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”. – The Vibes, February 14, 2023
Letter from the Translational Immunology Group for Education, Research and Society (Tigers) is co-signed by Dr Amir Hamzah Abdul Latiff, Prof Dr Lokman Mohd Noh, Prof Dr Rahim Md Noah, Dr Adli Ali, Prof Dr Norazmi Mohd Nor, Assoc Prof Dr Intan Hakimah Ismail and Prof Dr Zamberi Sekawi