Shortage of Specialist Doctors Needs Urgent Attention

The recent draft of the Healthcare Omnibus bill has raised hope among certain groups that Indonesia can improve medical services across the country and suspicion among others that it does not address some long-standing fundamental issues. One of the key areas of contention appears to be related to the legal framework around increasing the quality and distribution of doctors, particularly specialist doctors in Indonesia.

In a recent article, Antara News reported that the distribution of specialist doctors is primarily focused on Java, which then creates shortages in other parts of the country, but it’s also related to inadequate educational resources and institutions.

According to the Indonesian Medical Council’s (KKI’s) data, as of December 6, 2022, the number of specialist doctors in Java reached 34,763-people. This translates to approximately 22-medical specialists for every 100,000-residents in Java.

Meanwhile, there are only 615-specialist doctors in Maluku and Papua or around seven specialist doctors for every 100,000-residents in Eastern Indonesia.

The Health Ministry reports that Indonesia is woefully short of obstetricians, gynaecologists, internists and paediatricians. Unfortunately, around 300-pregnant women die every 100,000-live births in the country. In addition, the mortality rates of neonatal infants aged between 0-28 days, is far above other countries, including Singapore, Malaysia, Thailand, and Vietnam. The current system of Medical Specialist Education Program (PPDS) in Indonesia will need around 36-years to address this, report Antara News.

With the current number of lecturers and student quotas per lecturer, medical schools in Indonesia are estimated to need 1.36-years to meet the needs of obstetricians, 2.26-years for paediatricians, and 3.23-years for internists.

The PPDS entrance fees as well as expensive college tuition fees and “illegal levies” (locally called “biaya siluman”) that prospective students need to pay may also be contributing to the limited number of specialist doctors in Indonesia, say Antara News.

Medical students also face other challenges, such as paying to attend workshops and training events, daily living expenses for themselves and their families, as well as “unofficial costs” when meeting with seniors who want them to buy food, office needs, and medicines.

Antara News report that apart from the limited PPDS quota and the “bullying system”, the “biaya siluman” may be the reason why Indonesia is still lacking specialist doctors. There has been a lack of transparency at universities regarding the costs because they are suspected to be illegal.

On the other hand, doctors who pursue specialist disciplines or residencies do not receive a salary reward, even though they work for 48-hours per week without taking a rest.

The salary system for resident doctors, however, is mandated in Law Number 20/ 2013 concerning Medical Education. Article 31, Paragraph B, stipulates that every student has the right to receive incentives at Teaching Hospitals and Medical Education Facilities, report Antara News.

This provision applies to students of primary care doctor programmes, specialist and sub-specialist doctors, as well as specialists and sub-specialist dentists.

What is regulated in these provisions is also applied in other countries. The average salary for resident doctors in the United States, for example, can be up to IDR 900-million per year or around USD 58,000. In Australia, the salary could reach IDR 1.2-billion or USD 78,000.

Health Minister Budi Gunadi Sadikin stated that the concept of hospital-based specialist education is a new system to increase the number and distribution of specialist doctors in all districts and cities in Indonesia.

The addition of the capacity of the medical faculty according to the government’s plan is estimated to cut the time needed to meet the need for specialist doctors. The concept is carried out through the assistance of senior doctors at the hospital and a salary system for general practitioners who participate in the specialist programme.

However, Dean of the University of Indonesia’s Faculty of Medicine Professor Ari Fahrial, said the programme has the potential to reduce the quality of specialist medical graduates due to the absence of a curriculum and the role of professors in fulfilling competencies, say Antara News.

According to him, medical education and medical practice cannot be combined through the provisions of the Healthcare Omnibus Bill owing to the fact that both of them are still dealing with problems that have not been completely resolved yet.

The rapid development of medical science in Indonesia has not been equipped with an equal amount of infrastructure and educational resources. For example, many medical schools do not have biomedical science lecturers. Therefore, scholarships are needed for prospective teaching staff. 

Meanwhile, some of the problems in medical practice are included in the challenges of using telemedicine and artificial intelligence (AI) innovations in the health sector, bringing foreign doctors to Indonesia, and accelerating doctors’ graduation.

Based on Fahrial’s experience in formulating the Health Law 10-years ago, the issue of the current bill being deliberated is not much different. The current crisis of specialist doctors is actually the result of stakeholders’ collective failure to comply with the mandate of Law Number 20/ 2013, say Antara News.

Meanwhile, Chairperson of the Executive Board of the Indonesian Medical Association (PB-IDI) Adib Khumaidi has pushed for data alignment on the number of medical professions in Indonesia.

According to the IDI version, the number of doctors and specialists is recorded at around 204,492-people, while the KKI version shows a higher figure of 214,878-people. This number also differs from the figure from the Health Ministry’s report, which is 145,913-people.

He said he is worried about a possibility that the acceleration of the production of doctors in Indonesia will trigger an increase in the number of unemployed professionals in Indonesia.

Referring to the IDI and KKI data, in which the number of specialist doctors is recorded at around 44,753-people, there will be a need for additional specialists doctors of around 67,000- people to meet the WHO ratio of 1:1,000 in Indonesia, say Antara News.

Apart from the pros and cons related to the Healthcare Omnibus Bill  currently being deliberated by the lawmakers and government, the availability of specialist doctors is something the state needs to provide to meet its citizens’ rights and to allow access to equitable health services.

In this regard, those getting involved in deliberating the Healthcare Omnibus Bill need to prioritize the principles of collaboration of all stakeholders to enable all members of communities throughout Indonesia to receive improved quality of healthcare services.

Source: Antara News

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