A HEAP of write-ups lament our predicament with the national ‘Malaysian Brain Drain’ issue in popular newsprint media.
The ‘Talent Corps’ 2011 was formed to engineer brain gain and stem brain drain.
Its CEO was quoted as saying that almost half a billion ringgit had been spent.
Although it had some initial success, 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 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 for a long-lasting solution.
The suggestion implied by Prof Datuk Dr Asma Ismail, the former president of the Academy of Sciences Malaysia, that a piecemeal effort at realignment is not apt but instead a wholesome approach to inclusivity of all relevant players is needed.
We should now steer from merely mulling the obvious problems and 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, thus, allowing the creation of pathways for general specialists to branch to sub-specialities.
As such, more specialities are available in more regional hospitals of each state and this can then be propelled further to create sub-speciality services.
Patients are now aware of the rapid progress in medical care which needs newer subspecialties.
High-end cardio-thoracic and 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, (Singapore is a favourite) would negate creating new sub-specialists of the future,” said Prof 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 and without offering a solution it is bound to get worse.
We cannot trivialise the loss of our prized talents at the nation’s expense.
What is also amiss in the narratives, is that 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 five years of medical school to produce one new doctor. It costs much more as he moves up the career pathway.
Specialist training with a local Master of Medicine speciality is of four years duration (after three years of compulsory service) and further moving up to sub-specialist training for another three years.
Clinicians with additional roles in translational research will venture further with doctoral training usually a clinical PhD (three to four years).
With such long years (at least 18 cumulative years) and huge cost (at least RM4 million to RM5 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 a long duration of training.
When meaningful funding and provision of good research facilities are not forthcoming and then are 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
There is a need to be realistic, that better research output is doomed to be at an average level even when the country has the best brains available and when research funding is inhibitory, research funding from the present 1% of GDP for Malaysia is untenable.
The amount allocated for research would translate as RM 20.21 billion.
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 of research allocation.
The nation had little home Covid-19 research data to modify CDC recommendations to suit local needs, unlike a few research-intensive countries.
Elsewhere, research funding to GDP revealed the following figures - South Korea 4.55%, Israel 4.54%, Japan 3.21%, the US 2.79%, Singapore 1.95% and Thailand 1%. Should we not increase our research allocation to 2% of GDP, such as in 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, “bottom-up and not top-down” and come as a wholesome recommendation and not segmented piecemeal effort stated below:
1. To include the representatives of intended groups; (a) medical graduates, house officers, medical officers, specialists, sub-specialists, and (b) policymakers of the Health Ministry, Higher Education Ministry, Science Technology and Innovation Ministry, Public Service Department and the Prime Minister’s Department;
2. To refer to existing white papers from MOH;
3. To refer to the Academy of Sciences Malaysia;
4. Viewpoint from medical associations - Academy of Medicine, Medical Association, Society of Allergy and Immunology; and
5. Deans of medical schools and hospital Directors
Leading professionals and academics exhaustively provide the “push and pull” factors to prevent brain drain.
The Translational Immunology Group for Education, Research and Society (TIGERS) may provide the perspective of sub-speciality 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 and Prof Dr Norazmi Mohd Nor, TIGERS. Comments: letters@thesundaily.com
