I refer to the letter by Beng with regards to the recent move by the Health Ministry to fast-track the promotion of specialists trained abroad who decide to return home. This is certainly a move in the right direction but it has seemed to cause some discontentment amongst locally-trained doctors.

The concerns of Beng and other local doctors are legitimate. However, there are a few issues that must be clarified. Firstly, the term 'specialist' should be clearly defined. In the UK, passing the basic postgraduate certificate (eg. MRCP, MRCS, MRCOG) does not qualify one to be a specialist. Upon gaining this postgraduate certificate, doctors will need to compete for a place on the specialist training programme which is takes five years to complete before gaining the Certificate of Completion of Training (CCT).

Only with the CCT can one be entered in a specialist register and be eligible to apply for consultant posts. The move by the Malaysian Medical Association to start a specialist register is commended to have some consistency in the use of the term 'specialist'. Just passing the MRCP and then, for example, going for a dermatology conference does not make one a consultant specialist dermatologist. A locally-trained doctor with the relevant postgraduate training should be given priority over these so-called specialists. There should be fair play in dispensing this new fast-track programme and promotion should be purely based on merit.

Secondly, the time taken to achieve specialist status abroad is not half or two-thirds the time of that taken by locally trained doctors. In the UK, upon graduation, it takes an average of eight years (longer in some specialties) to achieve the CCT. If an academic route is taken, then a further three years is added to this to do a PhD. So, length of training to achieve true specialist status should not be an issue for resentment in discussing this new fast-track promotion programme.

Thirdly, with this move, government-sponsored doctors (GSDs) abroad who have overstayed should have no further excuse not to return home. These doctors have unethically not honoured their agreement to return home after completing their training at the expense of Malaysian taxpayers. The taxpayers did not pay for them fill their pockets with more sterling pounds. The Health Minister on his visit to Ireland last year noted many GSDs doing locum jobs which are not recognised training posts.

For privately-sponsored doctors, this new move by the government is welcome as the added incentives will help pay off loans taken to finance their exorbitant medical school fees (RM 500,000 per student) although it may take a while to do this.

Thus, the delay in non-GSD doctors returning home is not about lacking patriotism or being mercenary, but all about getting value for money from the postgraduate training available abroad having already invested a lifetime of savings into this venture .

Specialists (true ones, of course) both locally and abroad just want to be appreciated and given due recognition for the time, work and effort they have put in for their training to give their best to their patients.