The plan, however, has been met with skepticism from medical professional associations and universities, who instead argued for the optimization of existing policies to address the government’s poor administration and distribution of specialists.

The omnibus health bill seeks to supplant 10 existing laws and is aimed at bringing in sweeping changes to the health sector. Health Minister Budi Gunadi Sadikin handed to lawmakers on Wednesday a document of inventory of issues (DIM) the bill should cover and the government's latest opinions and proposed changes to the bill following weeks of public discussion, as deliberations are set to continue at the House of Representatives.

To achieve the World Health Organization’s recommended ratio of 0.28 specialist doctors per 1,000 people, Indonesia, with a population of about 271 million, needs an additional 30,000 specialists on top of its existing 51,000, Health Ministry Director General for Health Workers Arianti Anaya told a public discussion last week.

“The total of 21 [post-graduate medical schools in the country] produce about 2,700 specialists per year. Knowing that we need another 30,000, it means that we need over 10 years [to catch up],” she said.

Aside from a slow production line, the country’s problem with specialist doctors also extends to poor distribution. According to ministry data, around 40 percent of regional general hospitals (RSUD) throughout the country cannot fulfill the minimum seven branches of medical specialists, since most specialists are centralized in Jakarta.

Omnibus changes

As an alternative to the often costly and limited seats offered by medical schools, the omnibus health bill champions a new collegium-based approach that would allow hospitals to offer their own postgraduate medical education (PGME) programs.

This is provided hospitals can pass an accreditation test and secure approvals from the government and the Indonesian Medical Council (KKI), a nonstructural body that answers to the president.

Hospitals can either affiliate themselves with an existing medical school or have at least a five-year experience in doing so to train their own specialists. They will be required to undergo routine evaluation and follow a national curriculum.

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The approach also grants the government greater control in how specialists are distributed throughout the country, as it requires the quota for PGME programs be set in consideration of the country’s need for health workers, which are determined by the Health Ministry.

The government can offer financial assistance, but the recipient, in turn, would have to fulfill a mandatory working period at a predetermined hospital set by the government.

“This arrangement helps to align [the process of educating specialist doctors] with the needs of each region,” Minister Budi told a public discussion last week.

The approach, Budi said, not only fell in line with the practices being done by more developed countries, but would also benefit the doctors themselves.

“They can study and prepare themselves to become specialist doctors, while still working and without having to lose their incomes,” he added.

Resistance

However, the Indonesian Medical Association (IDI), which has long put up resistance against the omnibus health bill, said allowing hospitals to offer their own PGME courses might result in an overabundance of specialist doctors in the long run, particularly since the government had also revoked a moratorium on the opening of new medical schools in December.

“[The potential overload] would not make medical services better, but would instead lead to unemployment among doctors,” IDI central board head Mohammad Adib Khumaidi told a recent public discussion.

Citing the overabundance of specialist doctors in Jakarta, West Java, Central Java and East Java as an example, Adib said the country’s seeming lack of specialist doctors was more down to the poor distribution of specialists.

“The disparity [in distribution of specialists] is what hampers the standards of medical service nationwide,” he added.

Adib’s statement stands in contrast to the Health Ministry’s claim that only Jakarta had an overabundance of specialists, while West Java, Central Java and East Java combined lacked a total of 3,605 specialists.

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The University of Indonesia’s Medicine Faculty (FKUI) also said the specialists’ education should still be handled by medical schools, arguing schools were irreplaceable in maintaining the national curriculum’s standards.,

“Although this kind of model has been adopted in several countries […] it is better for [the country] to adopt it more slowly, since it needs to be contextualized to Indonesia’s own characteristics,” said a statement issued by FKUI’s board of professors last month.

FKUI highlighted the fact that a hospital running its own PGME courses would have to take on a medical school’s responsibility of preparing the funding and procurement of facilities and lecturers, on top of its primary task of servicing the public.

“Maintaining [high] qualities in service and education is the cornerstone of [a collegium-based approach], which is difficult for [a hospital] to suddenly do without the proper preparations,” FKUI said.

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