Our Medical Education System Is Falling Apart

May 11, 2016
JAKARTA, KOMPAS — The government must do what it can to reform our medical education system and to bring about a more equitable distribution of healthcare providers throughout the country. These goals will be more easily attainable if the government considers medical doctors as a strategic asset.

Young doctors listen to skin and sexual organ medical specialist Rani Manoe before treating a patient at the Dok II Jayapura General Hospital, Papua, Tuesday (3/5/2016).
Young doctors listen to skin and sexual organ medical specialist Rani Manoe before treating a patient at the Dok II Jayapura General Hospital, Papua, Tuesday (3/5/2016).

As a consequence, the government will have to foster and oversee the quality of medical education institutions, provide sufficient funding for medical education, and incentivize doctors to go where they are needed-even if that means out in the boondocks. Without long-term state presence in a system of 83 medical schools that churn out 10,000 young doctors each year, the quality of our medical education will continue to deteriorate.

M. Adib Khumaidi, Indonesian Doctors’ Association (IDI) secretary general, said on Tuesday (10/5/2016) in Jakarta that the government could not just tell young doctors where to practice once they graduated. Instead, the government should be involved in medical education from the beginning.

Should it decide to treat doctors as strategic assets, the government will subsidize -if not cover the entirety of- the costs of medical education. This will allow the government a say in deciding where young doctors are most needed in the country.

This way, when medical students start their first semester, they will be ready to be placed anywhere in the country upon graduation. After all, the government is shouldering most of their education costs.

Medical schools should likewise be transparent regarding the costs it takes to educate a doctor. The government then decides how much money to set aside.

With a large subsidy, medical students will no longer be weighed down by the cost of their education. “These days, students must pay for most of their education costs, which can reach hundreds of million of rupiah,” Adib said. “So we shouldn’t blame them if doctors are less altruistic and socially minded these days, and the law of economics prevails.”

Another important part of reforming our medical education system is to ensure selective recruitment. Medical schools must similarly be of high quality. There should no longer be medical faculties with A, B, or C accreditations. Medical schools should either be accredited or not.

“Don’t let it be like now when we let the number of medical schools mushroom on the basis of doctor shortage,” said Adib. “In fact, the problem is inequitable distribution of doctors.”

When doctors get assigned to practice all over the country, the government must provide sufficiently high remuneration and make sure their work facilities are in an acceptable condition.

Redistributing doctors

When asked about the lack of official mechanism for doctors to practice all over the country in a fair way, Usman Sumantri, medical personnel development and empowerment unit chief at the Health Ministry, said the ministry would push for the redistribution of medical doctors within provinces. “The governors can coordinate with the regional chiefs to redistribute the number of doctors needed in each district or town. This is ongoing in East Java,” said Usman.

What the Health Ministry has done so far to address the shortage of qualified medical professionals all over the country includes launching the Healthy Archipelago team, assigning doctors on temporary contracts, and drafting a regulation to compel young specialists to work in locations as the government directs.

The Healthy Archipelago team comprises a doctor, a nurse, a midwife, a community health expert, a pharmacist, an environmental health expert, a nutritionist and a laboratory expert. They pick up the slack in isolated areas, border areas and archipelagos.

Four types of specialists who will be affected are pediatrics, internists, gynecologists and anesthetists. The program will be extended to other types of recently graduated specialists, reaching general practitioners eventually.

Osman said no appropriate regulatory instrument had been found to address the distribution problem apart from the compulsory assignment after graduation. Even the compulsory assignment that doctors must complete to receive their license comes with a large budgetary liability for the government.

“The incentives for doctors to live at an acceptable level with their families can reach Rp20 million a month,” he said.

Apart from the incentives, payments from the National Health Insurance (JKN) system could also assuage the distribution problem in the regions. Current payments, however, are considered too low for doctors to consider working in remote areas.

Education quality

Research and Technology and Higher Education Minister Muhammad Nasir said his ministry was continuing to work with established medical schools to maintain standards and with newly founded and troubled medical schools to raise standards.

Nasir said he would not hesitate to revoke the license of a troubled medical school because the government has a responsibility to the people to provide educational facilities.

Such disciplinary action will occur if a school has been proven to commit crimes such as fraud, forging diplomas and selling academic degrees. Most medical schools that face trouble are, however, weak in their administration, not in their education. “So, they could receive the guidance of the government, large medical schools or Private Higher Education Institutions Cooperatives,” said Nasir.

Hartono, chair of the Indonesian Educational Institutions Association, said the higher education ministry, the Council of Indonesian Doctors and other stakeholders needed to sit down to map out the actual demand for doctors in the country. With 83 medical schools, this evaluation must take place to see if there is an oversupply of doctors.

If there is, the government must issue a moratorium on new medical schools and ensure that troubled medical schools are up to standard. Guidance is especially acutely.