Recognise medical specialists abroad who want to return

In the March Dewan Negara sitting, I brought up the issue of the parallel pathway programme (PPP) for aspiring medical specialist trainees in Malaysia to get trained and recognised by the world-class Royal Colleges of Physicians.

I raised the subsequent benefit that Malaysians will derive from these PPP trainees being acknowledged, including being able to serve the rakyat and fill in the gaps for our population’s demands for quality and qualified specialist healthcare.

This PPP will go hand in hand with the local Master’s programme and together, these two pathways will develop a healthy ecosystem whereby Malaysians will get the best healthcare from doctors who have undergone training with the best local and foreign medical postgraduate institutions.

As the dust settles from the debate on PPP recognition which has culminated with both the Higher Education Ministry and Health Ministry bringing this issue for deliberation at the cabinet level and the subsequent proposed amendments to the Medical Act 1971, another long-standing issue has come to my attention for immediate action.

My emails and phone have been flooded with calls and messages from patriotic Malaysian doctors living and working abroad in countries ranging from Hong Kong, Taiwan, Singapore, England, Australia and Brazil to name a few.

These doctors have passed specialist examinations from around the world and some are performing state-of-the-art procedures not available in Malaysia.

The issue that all of them face is recognition or lack of an equivalency pathway for their postgraduate qualifications from around the world that will enable them to work in Malaysia as specialists in their respective fields.

Imagine this - a Malaysian born and bred in Kota Bharu, upon completion of his undergraduate in Singapore, furthers his interest in neurosurgery in Hong Kong and passes the necessary board examinations.

The Malaysian then secures a job as a super surgeon in Taiwan performing state-of-the-art brain surgery and wants to return home to Malaysia after more than 15 years abroad.

He wants to return to his beloved homeland to be closer to his ageing parents, and eat budu and nasi dagang whenever he wants.

This neurosurgeon has requested the Malaysian Medical Council (MMC) allow him to practise in Malaysia and earn a living since he is a recognised practising neurosurgeon in Taiwan.

To his utter dismay, his request was turned down due to the lack of provision in the country, or more specifically the MMC, to recognise his postgraduate training.

I strongly believe that this phenomenon is holding back many highly skilled and trained Malaysian specialists from returning to serve our rakyat.

Is there a way?

A check on the MMC website, National Specialist Register Registration Procedures and Guidelines, the Medical Act 1971 (amendment) 2012 and Medical Regulations 2017 which came into force on July 1, 2017, revealed that there seems to be a pathway to recognise those who graduated with postgraduate qualifications outside the list of recognised postgraduate qualifications of MMC.

For example, if Dr Ahmad, a recognised neurosurgeon practising in Taiwan applies to work in Malaysia, the specialist subcommittees (SSC) for neurosurgery within the ambit of MMC will decide on the merits of applications based on his postgraduate qualifications and training, taking into account factors such as the length of his service.

The SSC for neurosurgery then will need to forward their recommendations to the Evaluation Committee for Specialist Medical Qualifications (ECSMQ) for further deliberation under Section 14C of the Medical Act.

It’s worth noting the various levels of scrutiny that take place before one can be registered to practise as a specialist under the Medical Act 1971 in Malaysia.

The role of the SSC and ECSMQ is truly important to facilitate and not frustrate these Malaysian doctors serving as specialists abroad.

However, to what extent this pathway works is a big question mark.

I have received at least two heart-aching and gut-wrenching stories of patriotic Malaysian doctors who yearn to return home and serve our rakyat who MMC have been given a very cold shoulder by stating that they don't qualify to serve here despite being recognised to serve out of Malaysia.

I am sure you have heard of the neurosurgeon with FRCS Ireland who filed a judicial review application after MMC rejected his application to be registered as a specialist on NSR due to the non-recognition of his qualification.

Dr Lu Yeow Yuen, practising in Hong Kong, wants to return to Malaysia. He has practised in Singapore before and was trained in Hong Kong.

I made an observation when going through the documents that two Malaysian specialists had submitted to MMC as well as the reply from MMC regarding their application to be recognised as a specialist.

I observed that prior to 2023, there seemed to be an interest from MMC to genuinely try to look through the credentials of these two Malaysian specialists and asked them to submit further information as in the structure of their training as well as the duration of their service as a specialist outside Malaysia.

They were asked to submit their qualifications through the Primary Source Verification (PSV). It is clearly stated on the MMC website that PSV is for doctors with foreign postgraduate qualifications/credentials applying for specialist registration.

However, to their disappointment, the recent replies that they received from MMC dated last year were outright rejections based on the grounds of Section 14B (c) of the Medical Act, not holding a qualification in the recognised list of postgraduate qualifications.

What do we do now to bring these brains back? We talk about brain drain and Talent Corp with their fantastic initiative to bring back Malaysian talents from abroad.

This so-called “equivalency pathway” is much needed now for there are hundreds if not thousands of ready-made, fit and serving specialists who will be able to return immediately to serve our country and to reduce the specialist-to-population gap.

For the record, in the UK, they have what they call the portfolio pathway.

It is a process by which doctors who have not trained in an approved programme can demonstrate they hold the knowledge, skills and experience required to practise as an eligible specialist in the UK and join the specialist register. These doctors are awarded a Certificate of Eligibility for Specialist Registration (CESR).

They also have other portfolio pathways such as:

Portfolio pathway in non-CCT specialty

Applications via portfolio pathway are made in a specialty that we haven't approved a CCT curriculum in.

Doctors must demonstrate that their knowledge and skills are equivalent to the standards required of a consultant in the UK health services.

They must have a specialist medical qualification or six months of training in a non-CCT specialty from outside the UK.

These doctors are awarded a CESR if successful in their application.

Portfolio pathway through academic or research medicine

For doctors who have not followed a fully approved GMC training programme, but have knowledge, skills and experience in a very specific area.

Applicants must demonstrate that they have academic or research and clinical skills equivalent to those of a consultant in the UK health services.

These doctors are awarded a CESR if successful in their application.

Bring them home

How much more frustration do we need to ditch out to our own Malaysians before we can come to a rational consensus to recognise their qualifications and bring them home?

The cabinet in amending the Medical Act 1971 has to look into the equivalency proviso to facilitate returning Malaysian brains.

We should have done this long ago. But it's never too late to bring them all back in fair, transparent and legal manner.

The ball is firmly in the court of the MMC and Health Ministry to work on this as soon as possible! - Mkini

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DR RA LINGESHWARAN is a senator.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.