Malaysia’s Doctor Shortage: Causes, Consequences, and the Urgent Need for Reform

Malaysia’s Healthcare Crisis: A Nation Grapples with a Doctor Shortage

Malaysia’s public healthcare system is facing a critical shortage of doctors and nurses, threatening the quality and accessibility of care for millions. Overburdened hospitals, long patient wait times, and an exodus of medical professionals have brought the issue to the forefront, with patients and healthcare workers alike feeling the strain. The crisis is the result of complex, systemic factors that have developed over decades, and its impact is being felt across the country, especially in less affluent states and specialist roles.

Patients like Manisha, who suffered serious injuries in an accident, have experienced firsthand the consequences of understaffing: long waits and delayed treatment. The number of housemen—newly graduated doctors in training—has plummeted from 6,134 in 2019 to just 3,271 in 2023. Only 5 percent of public healthcare facilities report having adequate manpower, and the shortage is especially acute in specialties such as cardiothoracic surgery and oncology. For example, there are only 14 cardiothoracic surgeons in public hospitals nationwide, leading to long waiting lists for critical procedures. Oncology faces similar shortages, with about 180 oncologists for 50,000 new cancer cases annually.

How Did Malaysia Get Here? The Roots of the Doctor Shortage

The roots of Malaysia’s doctor shortage stretch back over 30 years. In the early 1990s, Malaysia had only three medical schools, producing about 300 graduates annually. As the population grew, so did the need for more doctors. By the 2010s, the country boasted over 30 medical schools, surpassing even developed nations in per capita medical school numbers. This rapid expansion led to a surge in medical graduates, but the number of available positions in the civil service did not keep pace.

By the late 2000s, Malaysia was producing more doctors than it could employ. To address this, the government imposed a moratorium on new medical programs in 2011, later extending it and capping annual student intake. However, the effects of previous admissions lingered, resulting in a peak influx of 5,000 to 6,000 house officers annually between 2017 and 2020. The mismatch between graduates and available posts created a bottleneck, with some graduates waiting up to a year to begin their housemanship—a phenomenon known as the “glut.”

In 2016, the government introduced a contract system for new doctors, offering three-year contracts instead of permanent positions. This system initially excluded doctors from specialization opportunities and key benefits, causing anxiety and dissatisfaction among young doctors. Although some improvements have been made, the initial rollout left lasting scars on the profession.

By 2023, the number of housemen had dropped sharply, reflecting declining interest in medical education and a growing brain drain as doctors sought better opportunities abroad. The country now faces a potential shortage of medical professionals due to these systemic mismatches.

Working Conditions: Long Hours, Low Pay, and Burnout

Doctors in Malaysia’s public sector often work up to 84 hours a week, with some on call for 33 hours at a stretch. Salaries are low compared to the cost of medical education and to what is offered overseas. These factors have diminished the profession’s prestige and led to widespread dissatisfaction.

According to the Malaysian Medical Association (MMA), in 2022 alone, 1,696 medical officers left the public sector, with more than half moving to the private sector. Between 2019 and 2023, 917 specialist doctors resigned, further deepening the shortage. The rigid salary structure and limited civil service positions make it difficult for the public sector to compete with private and overseas opportunities.

Workplace culture also plays a role. Reports of bullying, high-stakes environments, and lack of support have come under scrutiny following the tragic suicide of a young doctor in Sabah. Surveys reveal that a significant percentage of healthcare workers have experienced bullying, but many do not report it out of fear or uncertainty. The culture of bullying is sometimes justified as necessary to prevent errors, but this has led to its institutionalization and further eroded morale.

The Impact of Burnout and Mental Health

Research conducted during the COVID-19 pandemic found that longer working hours were associated with lower physical and psychological health scores among healthcare workers. Nurses reported higher quality of life scores than doctors, but all domains of quality of life were lower among those working more than 10 hours per day. Burnout, stress, and mental health concerns are widespread, exacerbated by chronic understaffing and overwork.

As one healthcare worker explained in a recent study, “Long working hours and high patient loads make it difficult to maintain a healthy work-life balance. Many of us feel exhausted and undervalued.”

These conditions have contributed to a decline in the number of students pursuing medicine and a growing trend of doctors leaving for better opportunities abroad.

Nursing Shortage: A Parallel Crisis

The shortage of doctors is compounded by a parallel crisis in nursing. Malaysia currently has 14,000 nursing vacancies, with the shortfall expected to worsen by 2030. The nurse-to-population ratio stands at only 3.6 per 1,000 people, far below the OECD average of 9.2 per 1,000. High resignation rates, poor working conditions, limited career growth, and migration for better pay and conditions have all contributed to the crisis.

Nurses face overcrowded hospitals, long hours, inadequate compensation, and administrative burdens. Many migrate to countries like Singapore and Saudi Arabia for significantly higher, often tax-free, salaries and better benefits. The consequences are severe: decline in patient-care quality, increased workload and burnout, longer waiting times, and overcrowding in hospitals.

Research shows that higher patient-to-nurse ratios are associated with worse outcomes for both care quality and patient safety. Nurses caring for more than 11 patients per shift reported significantly worse outcomes compared to those with fewer patients. The shortage of nurses, like that of doctors, is a global issue affecting healthcare quality, patient safety, and health outcomes.

Broader Systemic Challenges: Pandemics, Policy, and Public Health

The COVID-19 pandemic exposed and exacerbated existing weaknesses in Malaysia’s healthcare system. During the crisis, shortages of personal protective equipment (PPE) and medicines highlighted vulnerabilities in supply chains and the need for better preparedness. The World Health Organization (WHO) has warned that such shortages put healthcare workers at risk and undermine the ability to respond to health emergencies.

Pandemics place sudden, intense pressure on health systems, especially in low- and middle-income countries like Malaysia. The diversion of resources, increased patient loads, and risk of infection all contribute to staff burnout and attrition. Effective mitigation requires investment in public health infrastructure, rapid response capacity, and support for healthcare workers.

Malaysia also faces rising rates of non-communicable diseases such as cancer and diabetes, driven in part by unhealthy diets and aggressive marketing of unhealthy foods to children. The surge in patient visits—over 81 million in 2023—reflects both the affordability of public healthcare and the growing burden of chronic disease.

Brain Drain: Why Are Doctors Leaving Malaysia?

Over the past decade, more than 5,000 Malaysian doctors have left the country, seeking better pay, working conditions, and career progression in countries like Australia, Singapore, and the UK. The contract system, lack of permanent positions, and limited opportunities for specialization have all contributed to this exodus.

Many doctors report feeling undervalued and overworked, with little hope for advancement. The new generation of medical professionals values work-life balance, which is often lacking in Malaysia’s medical profession. As a result, fewer students are choosing to pursue medicine, and those who do are increasingly looking abroad for opportunities.

As Datuk Dr Kalwinder Singh Khaira, president of the Malaysian Medical Association, explained, “Many doctors leave for better opportunities abroad, though most would prefer to stay if conditions improved.”

Brain drain is not unique to Malaysia, but the scale of the problem threatens the sustainability of the country’s healthcare system.

Impact on Patients: Delays, Inequality, and Quality of Care

The shortage of doctors and nurses has direct consequences for patients. Long waiting times, delayed treatment, and overcrowded hospitals are now common. In specialist fields like cardiothoracic surgery and oncology, patients face months-long waits for critical procedures. The distribution of doctors remains uneven, with acute shortages in rural and less affluent areas, exacerbating health inequalities.

Research shows that inadequate staffing and high patient-to-nurse ratios can jeopardize care quality and patient safety. Patients with chronic conditions such as diabetes and cancer are particularly vulnerable to delays in care, which can have life-threatening consequences.

Medicine shortages, such as the recent scarcity of Ozempic (a diabetes medication), further illustrate the strain on the system. Increased demand for the drug as a weight-loss solution led to shortages for diabetic patients, highlighting the need for better regulation and supply chain management.

Proposed Solutions: Reform, Retention, and a New Vision for Healthcare

Addressing Malaysia’s doctor shortage will require bold, systemic reforms. Experts and professional associations have proposed a range of solutions:

• Establishing a Health Services Commission: Advocates argue that a dedicated commission would provide autonomy in managing healthcare human resources, ensuring equitable distribution, competitive compensation, and streamlined decision-making.
• Improving Working Conditions: Increasing salaries and benefits, reducing workloads, and providing better support for mental health and well-being are essential for retaining talent.
• Expanding Training and Career Development: Broader access to specialist training and clearer pathways for career progression would make medicine a more attractive and stable career choice.
• Enhancing Transparency and Accountability: Implementing real-time dashboards to monitor doctor distribution and establishing clear criteria for permanent positions would improve trust and morale.
• Addressing Workplace Culture: Stricter anti-bullying policies, better reporting systems, and support for mental health are needed to create a safe and respectful work environment.
• Strengthening Retention Strategies: Retaining experienced doctors and nurses through improved job security, recognition, and opportunities for advancement is critical.
• Public-Private Partnerships: Collaborating with the private sector to share resources and expertise can help alleviate pressure on the public system.

Visionary leadership and political will are essential to implement these reforms and prioritize the well-being of healthcare workers and patients alike.

In Summary

• Malaysia’s public healthcare system is facing a critical shortage of doctors and nurses, threatening care quality and accessibility.
• The crisis stems from decades of systemic mismatches between medical education, workforce planning, and available positions.
• Doctors and nurses face long hours, low pay, and challenging working conditions, leading to burnout and brain drain.
• Specialist shortages and uneven distribution of healthcare workers exacerbate health inequalities, especially in rural areas.
• The COVID-19 pandemic and rising rates of chronic disease have intensified the strain on the system.
• Proposed solutions include systemic reform, better working conditions, expanded training, and a dedicated Health Services Commission.
• Addressing the crisis will require bold leadership, investment, and a renewed commitment to valuing and supporting healthcare professionals.