MOH: No Longer Issuing Letters of Need?

For an international medical graduate (IMG) the process of getting into a US training program is a long, tedious and very pricey one. One usually needs several letters of references, USMLE Steps I and II and a good CV.

After the complicated applications are in, you may get invited for interviews. Following that, you rank your programs while they rank the candidates in the order of preference. Come March, the ‘match’ results are released. With a match, foreign doctors must obtain the necessary J1 visa before they can enter the US for training. A prerequisite for this, is the ‘Letter of Need’ by the health ministry. However, whether or not it is official policy, it appears that the Ministry of Health of Malaysia is no longer giving out these letters of need, effectively eliminating the possibility of postgraduate medical training in the US (unless you obtain the H1B visa, but I won’t go into that). I am finding out from several very distressed juniors who have gone far in the application process and have secured residency positions, only to find out at the end of the journey that their request for that letter was turned down. A very disappointing and pricey roadblock. It seemed that rarely ’special cases’ were allowed (ie. string pulling). Certainly, I can understand if you are bound by scholarship and loan responsibilities, but this applied even to self-funded students.

Presumably this was done to curb the brain drain from Malaysia, and while this may prevent doctors from coming to the US for training, personally I feel this is a short-sighted plan which would result in more doctors in Malaysia in general but not result in the increase in subspecialists. For, although many of us may choose to remain in the USA after training, many too, will return to Malaysia. A letter I wrote appeared in the Star yesterday requesting that the MOH clarifies its official policy on the issuance of these letters.

"... recently many of my juniors have shared with me that the ministry is no longer issuing these letters of need, effectively eliminating the possibility for new Malaysian doctors to obtain specialist training here. Presumably, if this is indeed a policy, it is being done to curb the brain-drain as it is true that many will choose to remain in the US after training.
However, one must remember that although some of us will choose to stay, many still will still return to Malaysia after their residencies and fellowships, bringing back the much-needed skills in various medical and surgical specialties.
Therefore, if it is true that the ministry is now preventing us from obtaining training here, although this may result in more fresh medical graduates working in Malaysia, ultimately, it would be a short-sighted plan that would lead to even fewer sub-specialists.
This is because with the recent changes in Britain, post-graduate medical training there no longer seems feasible for many, while Malaysia itself lacks adequate training positions in numerous fields.
Even if half of the US-trained Malaysian specialists choose to remain in the US, we still have half returning home after their training, bringing vital expertise for a growing country.
Therefore, on behalf of my young colleagues hoping to be trained in top US centres like the Mayo Clinic, Johns Hopkins and Harvard, I like to ask the ministry and the president of the medical council to clarify the official policy regarding the issuing of letters of need. For, given the chance, these Malaysian doctors may very well do the nation proud."

Let's hope they come up with a formal answer; I'm sure everyone else isn't comfortable with see-what-happens and see-who-can-pull-strings scenario. We'd all prefer an official stance. In the meantime, a junior did get in touch with me after reading my letter, sharing her recent painful experience, but offering to help give advice on how to appeal, and who to talk to for a letter. Please contact me for her email address.

Addendum: This must be a record for me; an MOH representative has already replied in The Star today.

We are pleased to inform you that, contrary to the claims made by the writer, letters on ‘statement of needs’ continue to be provided for doctors planning to pursue their specialty training in the US.
The main problem, as noted by the writer, is that the majority of these doctors (including his good self) have opted not to return to serve in Malaysia for various reasons, which is contrary to the ground that the ‘statement of needs’ was issued because there is a dire need for professionals in this area of specialties in the country.
To facilitate the processing of the document requested, the doctors intending to be trained in the US are required to furnish their home address, contact number, information on their qualifications and working experience in Malaysia.
In addition, they are also required to provide a written assurance or a statutory declaration that they will return to Malaysia and report to the ministry on completion of their training programme.

This is at least some good news as 'officially' they still are issuing these letters, though many of you have shared with me your totally opposite experience. Keep at it, and if you had been declined, perhaps this response may provide some encouragement to keep trying and appealing. Good luck!