Indonesian plan to hire foreign doctors amid severe shortage faces backlash

A government plan to alleviate a critical doctor shortage by hiring foreign ones is facing a backlash from critics who say it will undermine local expertise, cause communication issues and drain funds that could be used to enhance education and training at home.

The government has said the shortage needs an immediate solution. 

Indonesia has 160,000 practicing doctors but needs 275,000, according to its Health Ministry. 

And most doctors in the sprawling archipelago of nearly 280 million people are concentrated on the densely populated islands of Java and Bali.

However, not everyone trusts those numbers.

The issue of foreign hires has become so contentious in the medical community that the rector of Airlangga University, a state institution, fired the dean of the faculty of medicine, Budi Santoso, in the first week of July after he criticized the government plan for foreign hires.

That dismissal was reversed less than a week later after a fusillade of protests from his colleagues on the faculty and the wider medical community. Many faculty members at Budi’s university threatened to strike if he was not reinstated.

Budi had argued that Indonesia’s schools produce doctors of international caliber. 

Indonesia’s health minister said this month the issue of allowing foreign doctors to practice in Indonesia had been settled with the passage of the health law last year.

“There should be no more debate. Legally, the Indonesian people’s representatives and the government have agreed,” said Health Minister Budi Gunadi Sadikin, although he did not specify where the government plans to hire doctors from.

“If some members of the public disagree, it’s like saying ‘I don’t agree with the election results,’ even though it’s already been decided.”

The World Health Organization (WHO) recommends a standard of one doctor for every 1,000 people. Indonesia falls significantly short of this benchmark, with a ratio of about 0.47 doctors per 1,000 people, according to government data. 

At a recent parliamentary hearing, the health minister said that yeah year, 250,000 Indonesians die from heart disease, while more than 300,000 others die from strokes. He attributed these fatalities to limited access to healthcare, including a scarcity of specialists. 

He said that increasing the medical workforce in Indonesia could potentially reduce the number of deaths from heart disease to 150,000.

“This is not a competition between foreign and local doctors. They are [sought] here because we want to prevent the 250,000 deaths from heart disease,” the minister said.

Any worries about cultural or communication gaps have been addressed in the health law, government officials say. 

Foreign doctors must pass a competence evaluation and undergo an adaptation process at a local health facility, the law stipulates. Those foreign doctors with at least five years of experience outside their countries, or who are widely recognized experts in their fields, would be exempt from these requirements. 

But one Indonesian who goes by the name @Ikhmart- on X, formerly Twitter, wrote on the platform about the perils of language barriers.

“One key to successful diagnosis and therapy is the patient’s history, known as anamnesis. Imagine if a foreign doctor treats patients who only speak local languages; the likelihood of misdiagnosis and incorrect treatment increases,” @Ikhmart-  wrote.

“Even local doctors sometimes struggle to communicate with local communities.”

‘What about financing?’

The chairman of the Indonesian International Association of Doctors and Health Scientists questioned the feasibility of recruiting thousands of foreign doctors.

Iqbal Mochtar said foreign doctors typically seek better salaries than what physicians make in Indonesian public hospitals.

In the United States, a cardiologist typically earns $40,000-$60,000 monthly, enough to pay 3-4 Indonesian cardiologists, he said.

“Hiring foreign doctors is not cost-effective. If they’re paid Indonesian rates, it’s unlikely high-quality doctors will come,” he said.

He also said the government’s claim of a massive doctor shortage needs to be investigated.

“A thorough mapping is needed to determine the actual need: general practitioners or specialists, in which regions, what specialties, how many doctors, and who will pay their salaries?” Mochtar said.

The head of the country’s main medical association concurred.

Mohammad Adib Khumaidi, Head of the Indonesian Medical Association, called for transparent national regulations and a comprehensive analysis of doctor distribution.

“The problem now is that 70% of doctors are concentrated in Java and other major cities. The capacity for specialist services is also uneven,” Khumaidi said during an online discussion on July 9.  

“And what about financing? Should the government pay for it? If so, there are still many local specialists whose livelihoods need to be considered.”

Khumaidi said many local doctors were willing to serve across Indonesia, provided there are clear career paths, welfare, incentives, and security. 

“Rest assured, Indonesian doctors are no less competent than foreign ones,” he noted.

Aside from addressing the shortage of medical personnel, the move is also seen as a step to prevent affluent Indonesians from seeking treatment overseas.

The Indonesian government estimates that Indonesians spend between 100-150 trillion rupiah (U.S. $7-9 billion) annually on medical treatment and services overseas. Some reports estimate that 600,000 to 1 million Indonesians seek medical treatment abroad. 

‘Ticking time bomb’

Meanwhile an academic said Indonesia needs more doctors as its population ages. 

Ascobat Gani, a public health professor at the University of Indonesia, said the current senior population of 29 million is projected to rise to 42 million by 2029 and 68 million by 2045.

“This exponential growth will undoubtedly require neurologists, neurosurgeons, and rheumatologists. Compared to our current production [of graduating doctors], we will not be able to keep up,” he told BenarNews.

This could create a dangerous situation, Gani warned.

“We can no longer contain this and must innovate. It’s a ticking time bomb,” he said.

Ascobat doesn’t believe foreign doctors would encroach on the job market for local doctors, because Indonesia is vast in size and diverse. 

“Our production capacity has never met the rapid increase in demand. The easiest solution might be to import doctors from countries like India,” he said.

“For a long-term solution, the government needs to empower and increase the number of medical faculties. But this process is not easy and takes a long time.”