Specialist Doctors: Collaboration, Not Competition
The death of Irene Sokoy, a pregnant woman in Jayapura, Papua, alongside her unborn child in November 2025, has once again exposed the deep-seated flaws in our healthcare system. She endured multiple hospital referrals amidst a critical shortage of specialist doctors, anaesthetists, intensive care units, operating theatres, and adequate funding.
This tragedy serves as a stark reminder. Shortly thereafter, the acceleration of specialist medical education gained momentum. By February 2026, the Ministry of Higher Education, Science, and Technology reported the approval of 160 new specialist and sub-specialist study programmes, exceeding the initial target of 148. However, the addition of these programmes must be integrated with hospital readiness, financing, referral systems, workforce distribution, and inter-institutional coordination.
This represents another facet of chronic disharmony within the healthcare system. When service failures occur, one party blames the shortage of doctors, while another points to hospital readiness, funding, regulation, or the authority of local governments. In a healthcare system, almost no problem exists in isolation.
Therefore, the debate regarding specialist medical education should not focus on which ministry holds more authority: the Ministry of Health or the Ministry of Higher Education, Science, and Technology. The more vital question is how both can share responsibilities and work together to increase the number of specialists, improve their distribution, and maintain the quality of education.
The need is palpable. West Kalimantan provides a concrete example; as of March 2026, the province had only 42 anaesthetists despite an ideal requirement of 115 to serve 58 hospitals. Consequently, the opening of the Anaesthesiology and Intensive Care Specialist Programme at the Faculty of Medicine, Tanjungpura University, in May 2026, is essential, as specialist education acceleration is being implemented in regions that truly need it.
There are two parallel tracks in the government’s response. The Ministry of Higher Education, Science, and Technology is accelerating the opening of specialist and sub-specialist programmes. As of February 2026, 160 new programmes have been approved, consisting of 128 specialist and 32 sub-specialist programmes. With this addition, the total number of specialist medical residency programmes (PPDS) has reportedly increased from 366 to 526, supported by hundreds of hospitals acting as educational networks.
Simultaneously, the Ministry of Health is promoting hospital-based specialist education and affirmative policies for local talent. The objective is clear: to expand access to education, reduce cost burdens, and encourage graduates to return and strengthen services in their home regions. At a conceptual level, such affirmation is commendable. While the institutional details of hospitals acting as educational providers are important and require separate discussion, the direction is positive.
Crucially, these two tracks must not create two classes of students. Article 583 of Government Regulation (PP) 28/2024 mandates that the selection process for specialist and sub-specialist trainees receiving central government funding must follow a uniform national mechanism and system across all providers. Admissions must consider selection results, healthcare service needs, student preferences, and affirmative measures for equitable distribution.
In other words, while the educational pathways may differ, the standards for selection, treatment, rights, obligations, protection, and orientation towards equitable distribution must remain consistent. Differences in providers should not result in disparities in dignity or educational quality standards.
These two tracks should not be pitted against each other; instead, they should strengthen one another through collaborative governance. The Ministry of Health is mandated to strengthen services, hospitals, medical devices, financing, and the utilisation of medical personnel, while the Ministry of Higher Education, Science, and Technology is tasked with maintaining the quality of higher education, establishing study programmes, and ensuring academic standards.
Specialist medical education is vital, but it is merely one node in a much broader healthcare system. In the management of healthcare human resources, education falls under the realm of procurement, whereas utilisation, distribution, welfare, and service strengthening require the involvement of many parties. Therefore, the division of labour must be maintained so that national energy is not wasted on disputes over authority.
History shows the vital role of professional bodies, colleges, medical faculties, and hospitals. These roles should be improved where deficiencies exist, rather than being marginalised. Transformation is necessary, but good transformation improves weaknesses without dismantling the established capacities that have successfully produced thousands of specialists.
Acceleration is important, but quality must not be sacrificed. Specialist education is directly linked to patient safety. Opening new study programmes must be accompanied by sufficient supervisors, adequate clinical cases, prepared hospitals, orderly academic systems, and robust quality assurance.
Conversely, existing educational pathways must not be resistant to correction. If educational capacity is limited, student costs are too high, or the clinical education culture is unhealthy, these issues must be acknowledged and rectified.
In this context, the issue of bullying must be addressed clearly. Allegations of bullying must be investigated and dealt with firmly. However, it is inappropriate to generalise that all specialist medical education is synonymous with bullying. Clinical education is indeed rigorous, demanding, and requires high endurance. However, rigorous education is distinct from violence, insults, exploitation, or destructive power dynamics.