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Background
Under the Medical Act 1971, medical practitioners who practise in this country have to be registered with the Malaysian Medical Council. This register is for all medical practitioners, based on their basic medical degrees, whether specialists or non-specialists. There is no provision for a specialist register under this current Act.

The Ministry of Health (MOH) has its own gazettement exercise for specialists working in its hospitals and healthcare facilities. This is a requirement under the General Order. Specialists have to be gazetted in order to be employed to the respective grades of service, and given appropriate remuneration. This process has worked well for the MOH. The gazettement exercise, however, is not extended to non-MOH organizations and the private sector. Different institutions may have individual processes and criteria and therefore differing standards.

The Academy of Medicine of Malaysia (AMM) has its own Specialist Register, established in 1999, and officially launched in November 2000 by YBhg Tan Sri Dr Abu Bakar Suleiman, the then Master of the AMM and Director General of Health. The AMM Specialist Register is available in the website for inspection and reference.

The MOH and the AMM have worked together to establish the National Specialist Register. The two bodies have collaborated for over two decades, through successive Director-Generals of Health and Masters of the Academy. Numerous meetings and workshops at national level were held to discuss, debate and fine-tune the various aspects of a National Specialist Register. Various professional bodies have contributed in defining the criteria for training and competence in the respective specialties.

The Process
The AMM Specialist Register will be automatically transferred to the National Specialist Register: i.e. names of the specialists will appear in NSR in the respective specialties as in AMM Specialist Register. However, individual specialists still have to fill in the standard form for purpose of updating the database, and pay the relevant fees. Specialists who are not in the AMM Specialist Register will have to apply to the Secretariat of the National Specialist Register, housed in the Academy of Medicine Malaysia. The application will be forwarded to the respective Specialty Subcommittees. The President of the Malaysian Medical Council, who is also the Director General of Health and Chairman of the National Credentialing Committee, appoints members to the various Specialty Subcommittees. Every Specialty Subcommittee has representatives from the Ministry of Health, the Academy of Medicine and the respective specialist society. The Specialty Subcommittee will review and approve the application if there are documented proof of qualification and training according to agreed criteria. The Specialty Subcommittee will then recommend to the NCC that the applicants be credentialed as specialists.

A fee will be charged to the specialist who applies to be registered with the National Specialist Register. This fee will go towards paying for the expenses incurred by the Specialty Subcommittee, maintenance of the Registry, as well as administrative costs. Other than the initial funding from the Ministry of Health to establish the Permanent Secretariat, the National Specialist Registry will be self sustaining.

The specialist register is time-based and renewable every 5 years upon proof of continuing professional development and continuing medical education activities by individual specialists. The National Specialist Register will draw from the experience of the gazettement exercise of the Ministry of Health. With National Specialist Register in place, we are looking forward to having j ust a single specialist register for medical specialists in all sectors, including the Ministry of Health, the universities, as well as the private sector.

 
Purpose of the National Specialist Register
The National Specialist Register will ensure that doctors designated as specialists are appropriately trained and fully competent to practise the expected higher level of care in the chosen specialty. With the National Specialist Register in place, doctors will be able to identify fellow specialists in the relevant specialties to whom they can refer either for a second opinion or for further management. Importantly, the National Specialist Register protects the public and will help them to identify the relevant specialist doctors to whom they may wish to be referred or may wish to consult. The National Specialist Register is in fact an exercise in self-regulation by the medical profession, striving to maintain and safeguard the high standards of specialist practice in the country, having the interest and safety of the public at heart.

Once the new Medical Act becomes law, the Malaysian Medical Council (MMC) will be in a position to ensure that those admitted to the register are competent and fit to practice. The maintenance of a register of competent specialists is fundamental to the regulation of a profession.

Without a National Specialist Register, we do not know the total number of specialists, nor the number in individual specialties. This has certainly been an impediment to strategizing and planning for specialist manpower training and provision of health care services.

In meeting the requirements of the Private Health Facilities and Services Act, private hospitals will need the NSR as essential reference, as the Act requires these facilities to have a credentialing mechanism in place. With the impending implementation of National Health Financing Scheme, payment for service will be based on the qualification and skills of the practitioners. National Specialist Register will be essential here as a reference resource.

Under the umbrella of the World Trade Organization, Malaysia will be opening its doors to foreign medical practitioners in compliance with the General Agreement on Trade in Services (GATS). It is essential to have the National Specialist Register in place to ensure that only appropriately qualified and competent foreign doctors are permitted to practice their respective specialties in this country. This will safeguard the interest of the public, and ensure that standards of specialist practice are not compromised.

The New Medical Act
The Medical Act 1971 has no provision for registration of specialists. A new Medical Act has been proposed to provide for registration of specialists. This Act has to go through due processes before its final approval. While awaiting the New Medical Act, there is a need to sensitize the specialists in the country on the impending National Specialist Register. The Ministry of Health has therefore agreed that until the Act is passed, credentialing of specialists will be undertaken by the National Credentialing Committee (NCC), established in the MOH under the chairmanship of the Director General of Health, Malaysia. The NCC consists of members from both the MOH and Academy of Medicine of Malaysia. This Committee will be advised by the various specialty subcommittees who are best placed to define training criteria and standard of practice of their individual specialties. Presently, we have over 44 specialty subcommittees as listed in the NSR website.