How specialists are recognised and registered in Malaysia
The Medical Act 1971, which was amended in 2012, is the only Act that provides for the establishment of a National Specialist Register (NSR).

The objective of this column is to provide a summary of the registration of medical specialists.

A historical perspective is necessary for an understanding of the current situation.

The Academy of Medicine (AMM), whose members are all specialists, established its Specialist Register (AMMSR) in November 2000.

The AMMSR, which comprised a database of AMM members with their specialist status, was available on the AMM website for public reference and inspection.

Health Ministry (MOH) specialists were gazetted with details about their speciality status.

The impetus to establish the NSR led to the MOH and AMM establishing a joint committee to address the procedures and guidelines for credentialing specialists.

The MOH agreed that the NSR be initiated and maintained by the AMM.

The NSR was launched by the then Health Minister on Aug 24, 2006.

The NSR was overseen by a National Credentialing Committee (NCC) chaired by the Health director-general, who was, and is, also the president of the Malaysian Medical Council (MMC).

The committee’s membership comprised four representatives each from the MOH and AMM, and one representative from the MMC.

The NCC provided standards for specialist practice and directed the maintenance of the NSR.

The NCC chairman appointed members of the specialist sub- committees (SSC) for each of the 47 specialities in the NSR.

The SSCs’ role was to develop criteria for the recognition of specialities, to evaluate applications against the stipulated criteria, and to make appropriate recommendations to the NCC.

A dedicated secretariat was established at the AMM to maintain the NSR and provide administrative support.

The MMC held several meetings with stakeholders to update its 2001 Institutional Memory guidelines, which were used in its evaluation of applications for provisional and full registration.

The Registration Procedures and Guidelines for provisional, full and specialist registration, and temporary practising certificates, were adopted by the MMC on Dec 18, 2012, and was revised in 2013 and 2015.

The Medical (Amendment) Act, which was passed by Parliament and received royal assent on Sept 5, 2012, was implemented on July 1, 2017.

Sections 14A-C and 42(6) of the amended Act provided for the establishment of an NSR.

Section 42(6) states: “Any person who, on or before the date of coming into operation of this Act:

“Had or been registered as a specialist in a registry of specialists

“Had been appointed as a specialist by the Director General

“shall be deemed to be registered as a specialist under this Act.”

The MMC at its meeting on Nov 21, 2017, adopted the NCC list of recognised specialist qualifications and various administrative measures related to the NSR.

Criteria to be listed

The process for applications for placement in the MMC’s NSR was and still is, as follows:

All applications are considered by the relevant SSC, comprising senior members of the speciality;

The SSC’s recommendations are considered by the MMC Evaluation Committee;

The MMC Evaluation Commit-tee’s recommendations are considered by MMC, which decides whether an applicant can be placed in the MMC’s NSR.

Until July 2022, there were two specific pathways for applications to the MMC’s NSR:

If the specialist has qualifications in the NCC list that was adopted by the MMC.

Consideration on an individual basis if the specialist has qualifications that are not in the MMC list.

The assessment standard was that of the local speciality programmes, or if there were no such local programmes, that of international organisations like the Royal Colleges in the United Kingdom, Ireland or Australia.

The MMC was cognisant of the fact that its NSR list was not exhaustive, that there were some Malaysians who had and continue to have speciality training in “non-traditional” countries, and that the public should not be deprived of their skills and experience.

If the MMC refuses to register an applicant, objective reasons for the refusal are documented in accordance with section 14C of the Medical Act, which states:

“(3) The Council may refuse to register any such person as it thinks fit

“(4) Where the Council refuses to register the applicant under subsection (3), the Council shall immediately serve a notice of refusal to the applicant together with the reasons thereof.” (italics added)

The MMC updated its NSR Registration Procedures and Guidelines on Nov 21, 2023, under which the pathway for doctors whose qualifications were not in the MMC’s NSR list was removed.

Clarifications needed

In Asia Pacific Higher Learning Sdn Bhd vs MMC Anor [2019], which is the only known judicial ruling on the MMC’s guidelines, the Court stated: “Once an authority has given guidance on how it will exercise its power and discretion under law, there will be imposed on that authority a duty to adhere to those guidelines...

“It will be open to the MMC to make modifications to the process from time to time, and such changes to the guidelines ought to be communicated to potential applicants.” (italics added).

While the above case was in relation to an accreditation issue, it is difficult to argue that the same principles do not apply to the MMC’s NSR registration guidelines.

There has been much public discussion and disputes in recent months about MMC’s NSR registration.

However, the waters have been muddied with misinformation and disinformation in social media by some who have made references to other Acts, none of which have provision for an NSR as in the Medical Act.

This has contributed to confusion and misperceptions among the public and the medical profession, particularly with regard to qualifications obtained through the parallel pathway vis-a-vis MMC’s NSR registration.

This has been compounded by MMC’s deafening silence.

As such, it is vital that the MMC provide clarifications on the following:

Whether all applications to MMC’s NSR were considered by the SSC, Evaluation Committee and MMC, and if not, what were the reasons for non-consideration and rejection at each stage of the process. What were the number of applications that were not considered or rejected?

Whether MMC rejected applications due to editorial errors in the MMC’s NSR list, and if so, the reasons for these rejections.

MMC’s rationale for withholding the recognition of qualification(s) it had previously recognised, and are still on its NSR list.

Is there any way that Malaysian doctors whose specialist qualifications are not in the MMC’s NSR list get to be registered as a specialist in Malaysia?

When were changes to the NSR registration guidelines published on MMC’s website and why was there no notification of the implementation date of these changes?

What measures have MMC taken to adhere to the best practices of healthcare regulators, i.e. integrity, collaboration, fairness, transparency and consistency in decision-making and administration?

Dr Milton Lum was an elected member of the MMC from August 1995 to July 2022, as well as a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The Doctor Says,Doctors,healthcare,registration,NSR,MMC
The recent derecognition of previously-accepted specialist programmes in Malaysia has created much confusion.