OPINION ACADEMIA
Recruiting more doctors: A solution, or creating new problems?
Iqbal Mochtar
(The Jakarta Post) PREMIUM Doha Sat, January 11, 2025
The narrative of a physician shortage, often highlighted by Health Minister Budi Gunadi Sadikin, has captured public attention. He has even declared that Indonesia is in a state of “doctor emergency”, saying the country needs an additional 160,000-170,000 doctors.
This claim has driven various policies, including the opening of 19 new medical schools, admitting large numbers of medical students and the development of hospital residencies to train specialist doctors. There is even a plan to recruit foreign doctors.
However, is this narrative truly supported by facts and data, or is it merely a myth?
One of Budi’s main arguments refers to the World Health Organization’s standard of one doctor per 1,000 people. Indonesia’s population of approximately 280 million indicates a need for 280,000 doctors. According to the minister, Indonesia currently has just 140,000 doctors, creating a shortfall of 140,000.
However, this claim needs to be reassessed. The WHO has never set the 1:1,000 ratio as a universal standard. It is merely a comparative metric between countries, not a fixed benchmark. The WHO recognizes that the need for medical personnel depends on many local factors such as demographics, geography and the healthcare system in each country. Hence, rigidly applying this ratio without considering the local context is inappropriate.
Moreover, the number of doctors the minister cited is not entirely accurate. According to the Indonesian Medical Council (KKI), the country has over 213,000 doctors with active registration (STR). Using the 1:1,000 ratio, Indonesia has a shortfall of approximately 67,000 doctors, far less than the 140,000 claimed. With 11,000-13,000 new doctors graduating annually, this shortfall can be addressed in 5-6 years without rushing policies.
The data on physician numbers in Indonesia lacks consistency. Different sources show significant discrepancies: the Health Ministry reports 140,000 doctors, the KKI says 233,404, while Indonesia Statistics (BPS) recorded 183,694 doctors in 2023. This raises a critical question: which data is reliable for policymaking?
These discrepancies highlight the importance of an integrated and validated data system. Policies based on inaccurate data can lead to risk or misdirection and negatively impact the effectiveness of national health care.
Both the health minister and former president Joko “Jokowi” Widodo also pointed to Indonesia’s low doctor-population ratio compared to other ASEAN countries. According to Jokowi, Indonesia’s ratio is just 0.4 per 1,000 population, far below that of Singapore, Malaysia and Brunei, all of which exceed 1:1,000.
However, using KKI data, Indonesia actually has a ratio of 0.79:1,000, nearly double Jokowi’s figure, ranking it sixth in ASEAN, not ninth as previously claimed. Furthermore, comparing Indonesia to small countries like Singapore (population 5.9 million) or Brunei (population 400,000) is less relevant. As an archipelagic nation with a large population and complex geographical challenges, Indonesia has vastly different medical workforce issues. As advanced nations, Singapore and Brunei have significantly larger health budgets. Additionally, Singapore and Malaysia have more centralized and integrated health systems, enabling optimal utilization of doctors. Meanwhile, Indonesia has over 17,000 islands and thus faces geographical challenges that require a more complex distribution strategy for its medical workforce. Using the doctor-population ratios of other countries as benchmarks for Indonesia is therefore not contextual.
The minister also cited long patient wait times as evidence of physician shortage. However, long wait times are not caused solely by the number of doctors; they are also affected by limited health facilities, including operating rooms and medical equipment, as well as hospital capacity. For example, cardiac surgery is usually performed only at tertiary hospitals with adequate facilities. If a hospital is at full capacity, patients must wait regardless of doctor availability. Long wait times are also influenced by poor management of the referral system.
Many patients in remote areas are referred to urban hospitals due to the lack of medical facilities in their regions. This underscores the importance of strengthening primary and secondary health facilities across Indonesia, rather than merely increasing physician numbers.
An exaggerated narrative of “doctor emergency” can lead to long-term negative policy impacts. If the number of doctors increases sharply without proper planning, the risk of oversupply becomes real.
Even now, many doctors in Indonesia struggle to earn a decent income. Surveys indicate that 25 percent of doctors earn less than Rp 3 million (US$184.58) per month, far below the recommended Rp 12.5 million from the Indonesian Medical Association (IDI).
This phenomenon could lead to intellectual unemployment among doctors, ultimately lowering the quality of medical services. An oversupply of doctors could also trigger unhealthy competition, potentially eroding professional and ethical standards. Coupled with the government’s limited budget to absorb medical workers, a massive increase in physician numbers might worsen conditions in the national health service. Instead of aggressively increasing physician numbers, the government should focus on more strategic and data-driven solutions.
Equitable distribution of medical personnel should be a top priority. Adequate incentives for doctors to work in remote areas, improved healthcare facilities in disadvantaged, frontier and outermost (3T) regions and continuous education and training are more effective measures.
The government must also establish an integrated and transparent data system. All data on physician number and distribution should be verifiable and accessible to ensure accountability.
Additionally, a workload-based approach can be used to calculate medical workforce needs more accurately, rather than relying solely on doctor-population ratios.
The government should involve all stakeholders, including the IDI, the Association of Indonesian Medical Education Institutions (AIPKI), the Indonesian Hospital Education Association (ARSPI) and regional administrations in planning physician needs. This collaboration ensures that policies are not simply based on a narrative, but on comprehensive facts and analyses. With careful planning, better distribution and cross-sector collaboration, Indonesia can meet its medical workforce needs without drastic measures that might create new problems.
Decisions should not be made hastily only to backfire in the future.