The Health Ministry has just announced that it will now provide a funding scheme as financial aid for those who are struggling with funding issues. While this program deserves appreciation, there are reasons to believe that scholarships are not a fit solution for medical residency inequality and fairness.

This concern arises from Indonesia’s medical residency system itself, which is managed by universities, instead of a hospital-centered system as in other countries. Thus, the Indonesian residency system is usually known as a university-based system.

In this system, if a general practitioner wants to apply for a residency position, they need to apply to the university and pay tuition fees each semester for four to five years. The resident doctors will remain unpaid throughout the course of study and be unable to provide a professional medical service before graduating from university.

With this kind of system, the resident doctor’s family will be the one in charge of all the expenses of their study. Hence, those who come from a better socio-economic background stand a better chance of getting into a medical residency earlier. Therefore, considering the limited number of providers (mostly state universities) and high cost, Indonesia is still dealing with a specialist scarcity, especially in the remote regions since most specialist doctors prefer to stay in urban areas, which promise better opportunities, safety, convenience and higher pay.

To date, some government institutions, such as the Finance Ministry through its Endowment Fund for Education (LPDP), private organizations and foundations have provided some funding schemes to assist the prospective specialist doctors who have to cope with financial constraints. Unfortunately, this approach offers only short-term assistance and not a long-term solution.

Providing a scholarship does not necessarily solve the core problem of the Indonesian medical residency system. The fundamental reason why the Indonesian residency program has become a privilege not everyone can experience is because Indonesia adopts an anomalous approach in implementing the medical residency program.

In other countries, resident doctors are not university students. Therefore, there is no need to pay huge tuition fees each semester. There are also clear regulations on work hours as applied to other workers. The same thing will not work in Indonesia since resident doctors are not considered professional medical service providers.

In most countries across the globe, except Indonesia, resident doctors are employed by the hospitals while at the same time they deepen their competency under the supervision of experienced specialists in a particular medical specialty. In exchange for their services, the hospitals will pay them.

General practitioners do not have to think about scholarships to undergo a residency program since they are employed and paid by the hospitals they work for. This is where the logical fallacy of the Indonesian residency system resides.

It is obvious that Indonesia’s residency system is the source of the problem and providing scholarships is not a sustainable approach. Scholarships may help some general practitioners who face financial constraints. However, there are only limited scholarships available each year and those choosing this path will have to go down a highly competitive road.

In the end scholarships do not help meet the rising demand and solve the uneven distribution of specialist doctors throughout the country. This situation will likely persist if no major breakthrough is initiated.

Worse, taking a residency through scholarship funding will require stricter administrative conditions. In this case, candidates are unable to pick their medical specialty based on their personal preference and passion but on the availability of the scholarships.

Another weakness of the Health Ministry funding scheme is that it is not a merit-based scholarship. The selection of awardees is not based on their capacity, intellectual ability, track record or experience but a ladder of administration and bureaucracy. Hence, to some extent, personal connections matter.

Indonesia’s concern has always been the same for years. The gap between the availability of specialist doctors and the growing population has been the same old story. Unfortunately, the problem will be unaddressed if the same medical residency system remains in place.

Indonesia should start thinking about reforming its medical residency system and not rest on providing funds or scholarships. Our neighbors such as Singapore, Malaysia and the Philippines adopt hospital-based medical residency, while we confusingly maintain a system that has proven to be part of the problem rather than the solution.

So, what is holding Indonesia back from changing its residency system?

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A medical doctor and master’s student at the Institute of Cardiovascular Science, University College London, under the Endowment Fund for Education (LPDP) scholarship.