Use incentives not sense of nationalism

The response towards the UKEC preliminary report on non returning graduates especially doctors continues. I blogged about it here and here and there were many constructive comments posted. Higher Education Minister, Tok Pa, also responded in a talk held in London and reported in the Star.

The gist of Tok Pa's reply goes something like this:

"Higher Education Minister Datuk Mustapa Mohamed said the students must have a strong sense of nationalism and patriotism, and should return home to serve the people and the Government after completing their studies."

Having attended some of these talks whilst studying in London, I am aware that most of the comments reported by our journalists reflect the 'official' part of the event, usually the speech portion. The more interesting part of the talk, by far, occurs in the Q&A session where students voice their honest concerns and criticisms of government policy and Ministers or government officials try their level best, usually off the record, to address some of these concerns.

So some of my criticism of Tok Pa's general approach might seem off base to some who actually attended the talk and heard him address some of the concerns I am about to outline.

First off, while it is understandable that Tok Pa, as a politician, has to bring up the standard appeal to one's sense of nationalism and patriotism, it cannot and should not be his only or main point of persuasion to attract Malaysian doctors to come back home.

People respond to appeals to nationalism only in very unique circumstances. For example, after the tragic Highland Towers collapse, there was a rush to donate blood to help possible surviving victims. Or during a time of war, citizens are more willing to accept certain restrictions such as food rationing or curfews. But these responses usually last only for a relatively short period of time. It is not a long term solution.

Malaysian doctors overseas are not going to come back in droves just because you appeal to their sense of nationalism or patriotism. Sure, there might be a few altruistic doctors that might return to 'serve the country' but surely, you can't base any sort of remedial policy purely on these kinds of appeals!

Perhaps it is the economist in me speaking but I think most people are generally practical minded. They will respond to structural incentives more than appeals to nationalism.

I, for one, would like to see the various ministries who have oversight on this issue to adopt a more honest and practical approach.

Tok Pa is right when he said that "As a developing country, it is impossible for Malaysia to match the salaries of doctors in Britain. We don't have such deep pockets."

For those doctors whose only concern is monetary, they are a lost cause. It is almost impossible for the government to attract them to come back to Malaysia. But I think that there is a large majority out there for whom money is just one factor out of many factors. An honest policy would be to admit to some of the concerns surrounding the non-monetary factors and find practical ways to overcome them.

For example, a Malaysian doctor who can get a housemanship position in a major research hospital in London or Manchester would probably not want to come back to Malaysia and risk being sent to a rural hospital that lacks resources. While the government might not be able to guarantee a posting in Penang, Ipoh or KL, there might be ways to ensure that those who come back and want to become specialists to be posted to major teaching hospitals in the urban areas which are equipped to train these specialists.

There might also be concerns in regards to whether a Malaysian qualification will be recognized in other countries. I don't know anything about medical qualifications but one of our readers had this to say:

"However there is one distinct disadvantage of local training. The UK or Australasian qualifications such as FRCS, MRCP and the likes are internationally recognized. Malaysians who have such qualifications and who choose to live in an overseas country may be admitted to professional bodies of the country either with no further examinations or with the maximum exemptions"

If this is a concern, can the ministries with the proper oversight (Health Ministry) and medical bodies such as the Malaysian Medical Association (MMA)come up with a strategy to ensure that Malaysian qualifications are recognized abroad?

Or is there some specific shortcoming with our local training program that discourages Malaysian doctors from coming back? Again, I turn to this comment but one of our readers:

"Coming back to the topic - I can speak for doctors only, but among this group, the primary aim is to get the best training possible. If going/remaining abroad is the price to pay, then it will be paid. Pay isn't among the reasons - we all know how much further our Ringgit goes in Malaysia compared to, say the Pound in Britain. If we had a proper training programme, and it doesn't have to have a long history (look at Singapore), many doctors overseas would jump at the chance to go back. Sadly, despite what our politicians say, our training system is NOT on par with those abroad, coupled with the fact that meritocracy is pushed aside in favour of... well, you know what it is, in gaining entry to such programmes. And by the way, whoever heard of the passing rate for postgraduate training being more than 90%?"

I am also surprised that Tok Pa didn't take this opportunity to reprimand JPA sponsored medical students who default on their bonds and not come home. Incentives do not involve only carrots but also sticks. If the government sends a strong message to JPA sponsorees that they will crack down on defaulters or bond breakers, I'm sure they will think twice before nonchalantly deciding not to return home. Another insightful comment from one of our readers:

"regarding bonding and defaulting of loans. there is no contract agreement available that will force any student to return home. i have an example to share. my friend is pursuing her medical stuides in london under a JPA scholarship. a value well over half a million, but i think more likely to be close to a million ringgit. do u guys know what are the clauses if she defaults on it and not return? she will only be rquired to pay a measly RM160k, which is nothing when you're a doctor in UK. what kind of clauses and stipulations the government creates?!? we need to crackdown on these selfish scholars who think of personal wealth and not wanting to come back and serve after being given the opportunity to study in UK for all 5 years of their med school."

I think that highlighting both carrots and sticks would be way more effective than appealing to one's sense of nationalism and patriotism. I would be very happy if the relevant ministries can clean up its act in this regard. It's not as if the powers that be don't know what some of the problems and concerns are. But the lack of political will to implement and carry out unpopular reforms stymie any efforts at trying to improve the system.

Finally, I hope that the politicians and the civil servants can get it into their heads that if they want Malaysian doctors to return home, they have to do a great 'sell job'. Companies who want to hire the best and most talented staff usually pull out all the stops for potential employees. I am not advocating for ministers or senior civil servants to take Malaysian doctors overseas to fancy restaurants in London to convince them to come back home to Malaysia. But a change of mindset and a better understanding of the thought process of a Malaysian doctor overseas would help the government create better tailored remedial policies.

I'll end with this comment from another reader:

"Human being makes decision on their perception of dreams and hopes not political arguments. Period."