By The Translational Immunology Group for Education, Research and Society (TIGERS)

There is a heap of write-ups lamenting at our predicament with the national ‘Malaysian Brain Drain’ issue in the popular newsprint media. Talent Corporation Malaysia Berhad (TalentCorp) was formed in 2011 to engineer brain gain and stem brain drain. It is quoted, from CEO TalentCorp, that almost half a billion ringgit had been spent (Letters NST Jan 11, 2023, Chew Kok Liong). Although it had some initial success, it was neither 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; the discontented human capital, from the junior to the most senior doctors, sub-specialists, and clinical researchers, does not bode well of a long-lasting solution. The suggestion implied by Prof Datuk Dr Asma Ismail, formerly President of the Academy of Sciences Malaysia (Bernama, Consider This) of piecemeal effort at realignment is not apt but instead a wholesome approach at inclusivity of all relevant players is what is needed. We should now steer from merely mulling the obvious problems to focusing 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 and thus allowing the creation of pathways for general specialists to branch to sub-specialties. Thus, more specialties are available in more regional hospitals of each state, 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 the 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, (Singapore is a favourite) would negate creating new sub-specialists of the future” - Professor Dato' Dr Adeeba Kamarulzaman, ex-Dean of UM Medical Faculty. Some policymakers appear unruffled, giving narratives that brain drain occurs in many sectors as in the developed countries; without offering a solution as 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 the new medical graduates are the future human capital to propel 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/she moves up the career pathway. Specialist training with local Master of Medicine specialty is of four years’ duration (after three years of compulsory service), and further moving up to sub-specialist training another three years. Clinicians with additional role 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 such huge cost (at least RM4-5 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 prospects expanded so as to be equitable to their sacrifices of surpassing stiff competitions, and enduring long duration of training. When meaningful funding and provision of good research facilities are not forthcoming, and then to be labelled as ineffectual, 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

A need to be realistic that better research output is doomed to be at average level even when the country has the best brains available when research funding is inhibitory; research funding from the present one per cent of GDP for Malaysia is untenable. The amount allocated for research would translate as RM20.21 billion (for a GDP RM1,871 billion in 2022). Malaysia’s Budget 2021 allotment for COVID-19 control alone was RM45 billion (equivalent of US$10.43 billion (Parliament, December 16, 2020) which translates to more than twice the amount of research allocation. The nation had little home COVID-19 research data to modify CDC recommendation to suit to local needs unlike a few research-intensive countries. Elsewhere, research funding to GDP revealed the following figures - South Korea 4.55 per cent, Israel 4.54 per cent, Japan 3.21 per cent, USA 2.79 per cent, Singapore 1.95 per cent, and Thailand 1.0 per cent. Should we not increase our research allocation to two per cent of GDP, like Singapore, at least?

Funding for medical/clinical research usually requires a larger quantum and longer duration to have the 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 then 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.

1. To include the representatives of intended groups; (a) medical graduates, house officers, medical officers, specialists, sub-specialists, and (b) policy makers of MOH, MOHE, MOSTI, JPA, PM’s Department.

2. To refer to existing white papers from Ministry of Health.

3. To refer to Academy of Sciences Malaysia.

4. Viewpoint from medical associations – Academy of Medicine, MMA, MSAI.

5. Deans of medical schools & hospital directors.

The ‘Push and Pull’ factors to prevent brain drain 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’.

-- BERNAMA

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 of the Translational Immunology Group for Education, Research and Society (TIGERS).