Specialist Doctor Education and Education Reform Urgency

The shortage of specialist doctors in Indonesia has attracted the attention of many parties. The urgency of the situation is felt after many doctors, including specialists, died while carrying out their duties.

Data shows that 303 doctors have died due to exposure to Covid-19, including specialist doctors, some of whom were professors. In this regard, evaluation and efforts to improve the education and financing system are very important to overcome the shortage of specialist doctors in the country.

Currently in Indonesia there are around 43,000 specialist doctors and around 150,000 general practitioners. With a population of 270 million people, the number of specialist doctors is still inadequate because the need for a number of specialist doctors for each branch of knowledge is different.

For pediatricians (SpA), for example, 15,000 people are needed to serve around 90 million children under 18 years of age, while currently there are only 4,800 SpA doctors, according to the chairman of the Collegium of Child Health, Aryono Hendarto.

For obstetric and gynecology (SpOG) specialists, according to Wachyu Hadisaputra, the chairman of the Collegium of the Indonesian Obstetricians and Gynecologists Association (POGI), currently 7,200 SpOG doctors are needed to serve 120 million women of childbearing age (aged 18-37 years), while there are only as many as 4,900 SpOG doctors.

Likewise, the number of other specialists, such as internal medicine specialists (SpPD), heart and blood vessel disease specialists (SpJP), surgeons (SpB), anesthesiologists (SpAn), and several other specialists, is still inadequate.

For pulmonary and respiratory disease specialists (SpP), currently there are only 1,300 doctors, while the national need, according to Faisal Yunus, the chairman of the Collegium of Lung and Respiration Medicine Specialists, is around 2,700 SpP doctors. Likewise, the number of other specialists, such as internal medicine specialists (SpPD), heart and blood vessel disease specialists (SpJP), surgeons (SpB), anesthesiologists (SpAn), and several other specialists, is still inadequate.

Also read: Vaccination Target Data Incomplete

There used to be discussion on bringing in doctors from abroad as specialists or subspecialists. However, would bringing in these doctors solve the problem of the shortage and maldistribution of specialist doctors in the country? The answer is not necessarily.

This is caused by the unequal distribution of specialist doctors in an insufficient number due to various factors, including the high cost of the specialist doctor education system that must be borne by residents themselves, as well as the inadequate provision of hospital facilities/equipment in a number of regions.

Specialist doctor education system

University-based specialist education currently refers to and follows existing regulations, such as Regulation of the Research and Technology/Higher Education Minister Number 18 of 2018 on National Standard for Medical Education (SNPK), Law Number 20 of 2013 on Medical Education, and Law Number 12 of 2012 on Higher Education.

KOMPAS/MEGANDIKA WICAKSONO

Wahyu Dwi, an ear nose throat specialist, from Jenderal Soedirman Purwokerto University, examined the ears of SD Mandirancan students, Kebasen, Banyumas, Central Java, to detect acute otitis media, Thursday (10/10/2019).

There is nothing wrong with these regulations, but they need basic evaluation because they greatly limit the number of program participants\' admissions due to the provision on the ratio of teaching staff/lecturers to students and various other provisions. In addition, the capacity for education vehicles which are all implemented in education hospitals is also limited.

Also read: 9 Million People To Be Vaccinated Soon

Specialist education participants who are known as "specialist doctor education participants" (PPDS) must be registered as "students" who are required to pay tuition of Rp 15 million-Rp 20 million per semester, several others are even more. The general nomenclature for PPDS is “resident”. During 8-9 semesters of education, the residents will definitely spend hundreds of millions of rupiah, in addition to living expenses and daily necessities.

There are prospective residents who are actually capable in terms of knowledge and competence, but must be willing to step back because the financial situation is not yet supportive, or because the entrance quota has been exceeded.

It is very clear that there has been an initial selection of financial support for prospective participants which will be the main consideration for doctors who will continue their specialization education under the current system. There are prospective residents who are actually capable in terms of knowledge and competence, but must be willing to step back because the financial situation is not yet supportive, or because the entrance quota has been exceeded.

By looking at these things, there is some truth in saying that there is an "anomaly" in the specialist doctor education system in Indonesia when compared to developed countries, such as Australia, the United States and Germany, even with other Asian countries, such as India, Thailand, Malaysia and the Philippines.

In these countries residents do not have to pay tuition fees. On the other hand, they are paid or get a sufficient salary because in fact the residents study while working in the hospital. The residents have registration certificates (STR) and licenses to practice (SIP).

Kompas/Emanuel Edi Saputra

Muhammad Asroruddin, a ophthalmologist of Tanjungpura University Hospital in Pontianak, West Kalimantan, (wearing batik shirt) assist fresh graduates of the medical degree of the university\'s medical school. This co-assistance is a profession education program for prospective doctors after finishing the academic program.

On the other hand, it is not uncommon that the rights and obligations of residents, such as excess working time and incentives, seem neglected.

Solution

There are two options that might be taken. First, the education of specialist doctors is entirely entrusted to education hospitals with facilities and qualifications for lecturers that must meet the requirements. Starting from admitting residents to administrative management, all of them are left to the hospital (hospital based). With this system it is possible to receive more residents. However, this requires a lot of funding and collaboration with strong support from professional organizations/collegium.

Also read: The Impact of COVID-19 Virus Mutations

Second, specialist education remains affiliated with the universities, but it must be done to add more education hospitals as network hospitals, thereby allowing far more residents to be accepted.

This option is very likely to be implemented, as well as reforming the current specialist doctor education system. Of course, adequate regulation formulation is required.

Budget planning from hospitals and related ministries absolutely must be regulated to provide incentives/allowances to residents and free the education costs. David Perdanakusuma, the chairman of the Indonesian Medical Collegium Council of the Indonesian Doctors Association (MKKI IDI), used to tell this to the writer, and he called it a hybrid system. This option is very likely to be implemented, as well as reforming the current specialist doctor education system. Of course, adequate regulation formulation is required.

STAFF.UI.AC.ID

Sukman Tulus Putra

In the era of globalization, especially in the current era of the ASEAN Economic Community (AEC), reform of the medical education system, especially specialist doctor education, should be carried out immediately if we want to sit on an equal footing with other countries in the world. Without any significant changes, foreign specialist doctors can enter Indonesia for a very sensible reason: the number of specialist doctors is still inadequate and unable to serve all the people in this country.

Hopefully it does not happen.

Sukman Tulus Putra, Professor of Child Health, School of Medicine, University of Indonesia (FKUI); General Chairman of the Indonesian Pediatric Association (2005-2008); Council Member of ASEAN Pediatric Federation (APF)

(This article was translated by Hyginus Hardoyo)