THERE have been many reports lamenting the “Malaysian Brain Drain”. The Talent Corps was formed in 2011 to engineer brain gain and stem brain drain. Almost half a billion ringgit has been spent on the effort (Letters, New Straits Times, January 11, 2023, Chew Kok Liong). Although it had some initial success, it was not sustainable enough to dissuade our precious talents from leaving our shores or bring them back from abroad.  Our focus today is on the medical brain drain from the sub-specialists’ perspective.

A new approach is needed. The absence of the voices of discontented human capital, from junior to senior doctors, sub-specialists, and clinical researchers does not bode well for a long-lasting solution. Prof Dr Asma Ismail, formerly the Academy of Science Malaysia president,  has suggested that piecemeal effort at realignment is not apt. Inclusivity of all players is what is needed. We should steer from merely mulling the obvious problems to focusing on how to stem brain drain. 

Sustainability is achieved by providing training for talented junior doctors, with confirmation of permanent posts thereafter. This creates pathways for general specialists to branch into sub-specialties. Thus, more specialties are available in more regional hospital of each state, and this can further create sub-specialty services. High-end cardio-thoracic and brain surgery, transplant medicine, clinical genetics, clinical immunology services are now available only in selected public and university hospitals.

Some policymakers appear unruffled, saying that a brain drain occurs in many sectors even in developed countries. We cannot trivialise of the loss of our prized talents. New medical graduates are the future human capital to take our healthcare services and research capabilities to greater heights.  

It is estimated that the nation spends RM1 million to produce one doctor; it costs much more as he moves up the career pathway. Specialist training is of four years’ duration (after three years of compulsory service). Sub-specialist training takes three more years. Clinicians with an additional role in translational research will venture further into doctoral training. This takes three to four years. After investing so much time and money in the healthcare workers, the country cannot afford to lose them to better prospects abroad. When meaningful funding and research facilities are lacking, can we blame them for looking outward? 

More research funding

Better research output is unlikely from even the best brains without funding is inhibitory. The present rate of research funding of 1% of the GDP, which translated into RM20.2 billion last year, is untenable. The Budget 2021 allotment for Covid-19 control alone was RM45 billion. The nation has little home research data on the virus to modify US recommendations to suit local needs. South Korea sets aside 4.55% of its GDP for medical research, Israel 4.54%, Japan 3.21%, US 2.79%, Singapore 1.95%, and Thailand 1%. Should we not at least increase our research allocation to 2% GDP?

Funding for medical/clinical research usually requires a larger quantum and longer duration. 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.

Policies should be drafted with the input of representatives of the target groups, i.e. medical graduates, house officers, medical officers, specialists, sub-specialists, and the Health, Higher Education, Science, Technology and Innovation Ministries, Public Services Department, and Prime Minister’s Department.

Policymakers should refer to existing white papers by the Health Ministry and take in the viewpoints of the medical associations, medical schools and hospital directors. The Translational Immunology Group for Education, Research and Society may provide the perspective of sub-specialty input.

Let us implement the hows after grasping the whys. – February 14, 2023.

* 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 are members of the Translational Immunology Group for Education, Research and Society.
 

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.