The scope of my letter touches on the jurisdiction of both the Health Ministry as well as the Higher Education Ministry. Thus, I hope to bring it to the attention of Health Minister Liow Tiong Lai and Higher Education Minister Khaled Nordin.

First of all, we can truly be proud of the Malaysian health system which has managed to provide healthcare to all at affordable cost. At the same time, the quality of our healthcare is also considered to be almost on par with the developed countries. All in all, this achievement can be credited to the Alliance and the subsequent Barisan Nasional governments which has placed healthcare as a priority in their national development agenda.

However, the Malaysian health system is still plagued by some problems. These problems are proving to be impediments to further improving the Malaysian healthcare service to achieve world-class standards. It is my belief that with the right policy, this problem can be overcome by the Barisan Nasional government and the Malaysian healthcare service can achieve world-class standards by the year 2020.

A major problem in the Malaysian health system is the lack of doctors in the government health service. Our ratio of doctors to population stands at 1:1200 whereas the ratio in developed countries is 1:600. This problem is further compounded by the fact that many doctors choose to leave the government service as soon as their compulsory service period is over.

To compensate for the lack of doctors in the public healthcare service, many of the junior doctors have to work 24, 36 and even 48 hours non-stop. Working that many hours surely means the junior doctors may not be in their optimum condition to give the best healthcare advice and treatment all the time to the Malaysian public.

To look at the problem in an objective way, let’s start from the medical universities. In Malaysia, there is the public university and the private medical universities. With limited places in the public universities, many aspiring doctors go to private universities to fulfill their ambition. There is also no shortage of private medical universities with the opening of numerous new private medical colleges in Malaysia in recent years.

However, to go to a private medical university is not cheap. The minimum fees are at least RM150,000 to RM220,000 and this does not include living expenses. Thankfully, there is the PTPTN education fund set up by Barisan Nasional government. PTPTN loans help the students to achieve their ambition to become doctors by helping the student to pay for medical education by covering half the cost.

However, due to the fact that medical education is very expensive, the newly graduated doctor has to clear debts amounting to at least RM80,000 to RM100,000 and that’s even before he or she has even started to work. At the same time, the cost of private medical education also keeps increasing. For example the cost of medical education in a local private medical university used to be RM190,000 but has now increased to RM220,000.

The increasing costs means the potential medical student has to find more sources of financing including borrowing from a few loan agencies all at the same time and later adding to his or her financial burden. It is feared that the increasing cost of medical education will soon be beyond the reach of even middle-class Malaysians and will defeat the government’s intention of creating a pool of qualified doctors to meet the healthcare needs of Malaysians.

It shouldn’t be a surprise that the massive debt will make the newly-graduated doctor to be more ‘money-minded’ rather than being more concerned about the patient’s welfare. In the end, after the compulsory government service period and having to work 24, 36 and even 48 hours non-stop, the doctors choose to leave for the lucrative and less demanding private healthcare sector where they can settle their PTPTN and other loans faster and lead a more comfortable life.

When the doctors leave, the in-coming junior doctors will have to through the same experience of the seniors and the vicious cycle continues. A solution must be found to break this vicious cycle. So I call upon the honorable Health Minister Liow Tiong Lai and Higher Education Minister Khaled Nordin to consider the following suggestions:

1. Reduce the burden of debt for doctors by providing PTPTN scholarships for private medical students with a clause requiring the medical graduate to work with the government for a minimum of 12 or 15 years. This scholarship is strictly for medical students of local private medical universities and not for overseas students. While it may seem a lot to give a minimum of RM100,000 of scholarship for just for one medical student, below is the financial calculation of why it is justified:

Let’s say a junior doctor works 300 days in a year treating 25 patients per day for ten years:

300 x 25 x10 = 75,000

Now let’s say the minimum the patients have to pay is RM1:

75,000 x RM1 = RM75,000

That is a whopping RM75,000 and logically speaking, most government doctors especially the housemen and medical officers treat more than 25 patients per day. In the end the government easily more than recoups what it has spent on the doctors’ training.

For RM1 million the government will be able to train 10 doctors while with RM10 million the government will able to train 100 doctors and keep them in the government health service longer. I am aware that a similar scholarship scheme does exist for sending students overseas and its consequent problems.

Thus, my suggestion is to have a scholarship scheme strictly for medical students of local private medical universities. Not only will it help medical students but it will also boost the local education industry in line with the government’s vision of turning Malaysia into a regional education hub. Apart from that, the government can save a lot in foreign exchange.

Or,

If it is not possible to provide RM100,000, perhaps the government can provide RM50,000 in medical scholarship with a clause requiring the medical graduate to work at least eight years in the government health service.

Under this calculation, for RM1 million, the government will be able to train 20 doctors while with RM10 million the government will able to train 200 doctors and keep them in the government health service longer.

Or,

If providing PTPTN medical scholarship is not possible, consider abolishing the 3% administrative charges for PTPTN loans given to medical students. At present, PTPTN charges 3% in administrative charges which will increase the amount of loan the junior doctor has to pay back. In other words, provide interest-free loans for medical undergraduates.

Or,

If it is not possible to abolish the 3% administrative charges for PTPTN loans, at least consider reducing it to 1.5 % percent. Also direct other education loan-giving agencies to reduce their education loan interest rates given to medical undergraduates. Presently these education loan agencies charge interest rates of up to 6% per annum which will add to the financial burden of junior doctors.

The rational is to reduce the financial burden of the junior doctor which in turn will help the doctor to be more ‘patient-minded’ rather than ‘money-minded’.

2. With more doctors working in the government health service, it might be possible to reduce the working hours of doctors especially those working 24, 36 and even 48 hours non-stop. With more rest and less demanding work, the junior doctors will be able to be at their best to provide quality of healthcare to the patient. They will also be encouraged to remain in the government service.

3. Provide other incentives for doctors to remain in the government health service.

I truly hope the honorable Health Minister Liow Tiong Lai and Higher Education Minister, Khaled Nordin will consider the suggestions outlined above. Be kindly reminded that all the suggestions outlined above merely covers half of the actual cost of medical education and the medical undergraduate still have to come with the other half of the cost.

Any government decision to help will show that the government cares for the welfare of the junior doctors. In return, hopefully, the junior doctors will reciprocate by being more ‘patient- minded’ and give their very best healthcare advice and treatment to the rakyat . In the end the rakyat will appreciate and continue to give their support and mandate to the Barisan Nasional government.