Foreign Doctors: What Do We Expect?
In the current era of globalization, the entry of foreign doctors into a country is imminent, and regulations must be in place to anticipate this. Several issues must be addressed, especially by the government.
Mobility or movement of doctors between countries is common in the world.
Quite a lot of doctors in various fields of expertise move from (generally developing) countries to developed countries, such as the United States, Australia, the United Kingdom and Germany. Either they have been recruited because their expertise in a particular medical field is needed, or they have moved on their own initiative in the hope of better rewards or welfare than those offered in their country of origin.
At the Southeast Asian level, in accordance with the mutual recognition arrangement (MRA) in the era of the ASEAN Economic Community, doctors can engage in job mobility or move between countries by complying with and adhering to the regulations of the country of work.
ASEAN countries have agreed that medical job mobility revolves on five issues, which are limited practice, education and training, humanitarian missions, expert visits and research.
First, limited practice refers to limited service time for foreign doctors with the obligation to follow the regulations in the destination country. For Indonesia, foreign doctors are allowed to practice for one year and this can be extended once.
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Second, doctors from ASEAN countries can take part in education or training at several institutions.
Third, foreign doctors may embark on a humanitarian mission to a country to provide medical treatment or assistance in the wake of a natural disaster, such as the Aceh tsunami in 2004.
Fourth, foreign doctors may visit another country as experts in the field of medicine in the framework of transfers of science and technology.
Fifth, doctors can engage in cooperation in the field of health and medical research between ASEAN countries.
Policymakers have yet to draw up a roadmap and strategy to overcome this perennial problem.
Except in terms of limited practice, doctor mobility for the other four categories have so far gone well in Indonesia. There are still very few foreign doctors who are legally involved in limited practices in Indonesia and the practices require prudent management.
A shortage of doctors seems to persist in Indonesia, especially in peripheral and remote areas, including outermost islands. Unfortunately, policymakers have yet to draw up a roadmap and strategy to overcome this perennial problem.
Educational process
A few days ago, President Joko Widodo instructed the Education, Culture, Research and Technology Ministry and Health Ministry to facilitate the process of specialist and subspecialist education. Producing doctors, specialists and subspecialists remains a challenge for the government because of the problems in funding, medical education and placement system. In addition, the uneven distribution of doctors has not been resolved either.
The latest data at the Indonesian Medical Council (KKI) shows that we currently have 165,678 general doctors and 49,909 specialist doctors, or 215,587 doctors in total. Home to some 275 million population, Indonesia still needs around 60,000 more doctors to achieve the standard doctor-to-population ratio of 1:1,000. To make things worse, most doctors are concentrated in big cities, especially in Java, and very few in eastern Indonesia. So, is it urgent to bring in foreign doctors, in addition to the efforts to accelerate the production of domestic doctors?
In the current era of globalization, the entry of foreign doctors into a country is imminent, and regulations must be in place to anticipate this. Several issues must be addressed, especially by the government, as to how foreign doctors, including specialists and subspecialists, should be employed in order that their presence can help tackle the shortage of doctors in the country.
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It may happen they arrive in a big city working for a hospital with complete facilities, amenities and high salaries. Another concern is whether the doctors who come from several countries do have the qualifications and professional competences that cannot be fulfilled by domestic doctors. Working for an international-level hospital, they of course will treat patients who can afford to pay high medical fees.
Some say the operation of international hospitals, like the one being built in Sanur, Bali, and employment of foreign doctors with specific qualifications, will help reduce the potential losses in foreign exchange up to Rp 165 trillion per year because around 2 million Indonesians travel abroad for hospital treatment.
The question is whether those affluent patients who have the habit of holidaying while getting medical treatment abroad will automatically be lured to domestic international-class hospitals. Not necessarily.
Working for an international-level hospital, they of course will treat patients who can afford to pay high medical fees.
Some estimate that this high-end hospital will only attract 10-15 percent of people who usually seek treatment abroad. Affordable medical services is one of the main reasons for people to travel abroad for treatment, because unlike in Indonesia, medical devices and medicines are generally exempted from taxes there.
A fast, efficient and professional service is what they expect overseas. In fact, in terms of competence and expertise, our doctors are on a par with those in other countries. In certain fields, Indonesian doctors even hold the upper hand with more experience. Several years ago, a high-ranking government official backtracked from taking his grandchild to Singapore for surgery upon receiving information that our doctors had far more experience in treating his grandchild’s disease. Thank God, the operation went well with satisfying results.
Regulating foreign doctors
It is common across the globe that foreign doctors who enter another country must go through a strict and measurable scrutiny process, and sign up to follow the prevailing regulations because medical treatment is related to human life. To obtain permits to practice in the US or Australia, a visiting doctor must take exams and undergo rigorous selection and evaluation procedures.
How is it in Indonesia? The notion that Indonesian doctors are resisting the entry of foreign doctors is completely untrue. We welcome them as long as they comply with prevailing regulations. However, we expect the government not to use double standards. For example, Indonesian doctors with overseas medical certifications are required to adapt to regulations, but visiting foreign doctors have their entry facilitated without going through an evaluation nor having their qualifications and competencies scrutinized before work, as planned by the Sanur Special Economic Zone (SEZ) authorities for the recruited foreign doctors.
Concerning organizing hospital services in the SEZ-designated areas, Health Minister Regulation No. 1/2023 stipulates that foreign doctors and Indonesian doctors with overseas medical certifications can work in the Sanur SEZ without having to go through an adaptation process at a domestic university. It is regulated in detail in the Indonesia Medical Council’s regulations No. 14/2023 for foreign doctors and No. 97/2021 for Indonesia’s overseas medical graduates.
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The construction of an international-standard hospital in Sanur, in collaboration with the Mayo Clinic, deserves to be applauded with world-class and quality health services available not only for domestic patients but also those from outside the country. However, it is absolutely necessary to evaluate the competence of the doctors who will work there. It is very risky not to impose adaptation procedures or competency evaluation on foreign medical graduates.
This policy is not only inappropriate and discriminatory, but also potentially threatens patients’ welfare. Being open to outside expertise does not necessarily entail rolling out the "red carpet" for foreign doctors, which is not the usual policy in many countries.
There indeed are good prospects for the future with the presence of foreign doctors and international-standard hospitals in Indonesia, though we cannot expect too much at the moment. They will only serve a fraction of Indonesia's 275 million people. Transfers of technology and of knowledge must be very limited. Neither do we deserve to expect foreign doctors to be placed in remote areas across the country, but the government’s hopes that revenue can be held back from spilling out of the country may not materialize significantly either because in fact there is still much to be done to improve the healthcare system, including the financing mechanism and other government policies related to the issue.
Sukman Tulus Putra
Sukman Tulus Putra, Chairman of Indonesian Association of Pediatric Cardiology (Perkani); Council Member of Asia-Pacific Pediatric Cardiac Society (APPCS); Member of Indonesian Medical Council (KKI), 2014-2020
This article was translated by Musthofid.
