The shortage of rural doctors questions the profession's commitment to care-giving
THE Sabah health department's move to also post housemen to district hospitals in Keningau and Lahad Datu from next year is a reflection of the shortage of doctors in rural and interior areas around the country. For, in spite of a glut of medical training programmes in the country (33), Malaysia is still some way away from filling all its hospitals with quality doctors. Obviously, the problem does not lie with the country not producing enough doctors. While in the past, the Malaysian Medical Council used to register housemen in just the hundreds, it now registers more than 4,000 house officers a year. In fact, the country is churning out between 3,500 and 5,000 medical graduates a year -- so much so that the Health Ministry is confident that Malaysia will achieve the World Health Organisation's recommended doctor-to-population ratio of 1:600 by 2015, and even surpass it to 1:400 in 2020. (Currently, the ratio is 1:800.)
However, a good national doctor-population ratio does not mean that there will be equity in the distribution of doctors to rural and interior hospitals, especially if many refuse to be sent to these areas. For instance, in 2010, the national doctor-to-population ratio was 1:927. However, in Sabah and Sarawak it was greater than 1:2,000, while at the same time it was 1:328 in Putrajaya, and 1:488 in Kuala Lumpur. The national ratio may improve in leaps and bounds, but the great disparity between urban and rural areas means that the quality of rural healthcare is being compromised because many doctors refuse to serve in these areas. The ministry does dangle carrots: a monthly RM1,500 hardship allowance, and a good push up the queue for when they seek postgraduate training in any discipline of their choice; but still, many refuse -- even choosing to resign, rather than move to the boondocks.
As with teachers, police, soldiers, judges and journalists, signing up to be a doctor also means signing up for at least a few tours of duty in far-flung, alien, uncomfortable and inconvenient places. It is to be expected, and is part-and-parcel of what are fundamentally supposed to be altruistic professions -- to go, willingly, wherever one is needed, and to serve unreservedly. Do graduating doctors understand this? Perhaps they should be made to sign the modern-day version of the Hippocratic Oath -- the Declaration of Geneva, which was adopted by the General Assembly of the World Medical Profession in 1948, whose first principle is, "I solemnly pledge to consecrate my life to the service of humanity."