The reality of "White-Shirt Workers"

Photo by Luthfiah VOI

JAKARTA - In 2026, medical education - especially the specialist track (PPDS) - is seen at the crossroads between the massive expansion of the national health system and the educational culture crisis that has not yet completely changed. The government is indeed accelerating the opening of hospital-based specialist tracks to catch up with the shortage of tens of thousands of specialist doctors in Indonesia. The quota is enlarged, new education hospitals are opened, and the hospital-based residency model is beginning to be expanded so that more local sons can enter.

The government through the Ministry of Health (Kemenkes) opened a hospital-based specialist doctor education track, which is an affirmative policy to expand access for regional sons and daughters to specialist education while encouraging service equity.

According to the Minister of Health Budi Gunadi Sadikin, the designation of hospitals as the main organizers of education opens wider access for general practitioners to continue specialist education, while overcoming the limitations of university quotas in the specialist doctor education program (PPDS). Through the hospital-based education model (hospital-based), the specialist education pathway is expected to be more evenly distributed and easily accessible by doctors throughout Indonesia.

This program prioritizes the children of the region, especially general practitioners who have served at the RSUD, so that after graduating they can return to strengthen health services in their home areas. The government also ensures that the quality of education is maintained through the implementation of global standards, including work hour arrangements and transparent evaluation systems.

"We can ensure the standard, the quality standard just now. It's not just a graduation standard," he said.

According to the Minister of Health, the designation of hospitals as the main organizers of education opens wider access for general practitioners to continue specialist education, while overcoming the limitations of university quotas in the specialist doctor education program (PPDS). Through the hospital-based education model (hospital-based), the specialist education pathway is expected to be more evenly distributed and easily accessible to doctors throughout Indonesia.

In 2013, member of Commission IX of the Indonesian House of Representatives, Surya Chandra, also criticized the medical education system in Indonesia which was said to be very feudal and oppressive so that a systematic change was needed.

But behind the ambition of acceleration, young doctors still face a very heavy and massive workload. Residents not only study, but also become the backbone of hospital services: long night shifts, cross-department rotations, direct clinical responsibilities, to working hours that can go beyond the limits of reasonableness.

In many cases, teaching hospitals rely heavily on resident staff to keep the service rhythm going. This pressure often creates chronic fatigue, mental health disorders, and even a sense of loss of learning meaning as education turns into a mere labor force production machine.

What makes the situation more complex is the feudal structure and seniority that is still thick in specialist education. Formally, seniority is needed for the transfer of clinical experience and gradual decision-making.

But in practice, it is not uncommon for this culture to shift into a rigid hierarchy: juniors are positioned as executors, seniors as controllers, and criticism is often considered disobedience. Relationships like this create space for bullying, social pressure, and even non-academic burdens that are not relevant to medical competence. A number of cases that emerged in 2025-2026 show that the seniority problem is still a structural wound that is difficult to remove.

The big picture, the education of doctors in 2026 is a system that is being quantitatively raised, but is still struggling to cure the cultural problems within it. The state wants to produce more specialists quickly, while the students are still grappling with extreme workloads, psychological stress, and a feudal cultural legacy that makes the learning process feel more like a mental exam than the formation of professionalism. The Ministry of Health wants to achieve.

Until now, the balance of positions between medical personnel and the number of residents with specialists in inequality. If the reform only focuses on the number of graduates without correcting the culture of seniority and welfare of residents, then the old crisis is at risk of being reproduced on a larger scale.

"If we produce 2,700 with a population of 280 million, while in England production has produced 12,000, there must be something wrong. We should increase it at least 4 times," said Budi.

The Minister of Health added that this increase is necessary to catch up with Indonesia compared to developed countries in the ratio of specialist doctors to the number of residents.

The increase is needed to catch up with Indonesia compared to developed countries in the ratio of specialist doctors to the population.

To maintain the quality of graduates of specialist doctor education with the hospital-based concept, the government collaborates with trusted institutions from America to carry out accreditation of educational hospitals. In addition, the government will also create a financing scheme that will not burden prospective specialist doctors.

"We will make it easier, make it cheaper, and even we will pay, and for quality if it can be better," said Health Minister Budi. This news was broadcast by the Ministry of Health's Communication and Public Service Bureau.

This program prioritizes the children of the region, especially general practitioners who have served at the RSUD, so that after graduating they can return to strengthen health services in their home areas. The government also ensures that the quality of education is maintained through the implementation of global standards, including work hour arrangements and transparent evaluation systems.

"We can ensure that there are standards, the quality standards are just that. It's not just a graduation standard," he said.

According to the Minister of Health, the designation of hospitals as the main organizers of education opens wider access for general practitioners to continue specialist education, while overcoming the limitations of university quotas in the specialist doctor education program (PPDS). Through the hospital-based education model (hospital-based), the specialist education pathway is expected to be more evenly distributed and easily accessible to doctors throughout Indonesia.

The Minister of Health added that the increase was needed to catch up with Indonesia compared to developed countries in the ratio of specialist doctors to the population. "If we produce 2,700 with a population of 280 million, while England produces 12,000, something is wrong. We should increase it at least 4 times," said Budi.

The Minister of Health of the Republic of Indonesia, Budi Gunadi Sadikin, admitted during a virtual press conference, Thursday (2/6/2022) that he received many complaints from young doctors who claimed it was difficult to get recommendations from senior doctors to take specialists.

Law Number 17 of 2023 on Health changes the relationship between doctors by centralizing licensing to the government (central/regional), replacing STR with a lifetime, and strengthening legal protection (including restorative justice) if they work according to standards. Professional organizations are no longer the sole determinant in issuing practice license recommendations.

The Minister of Health Budi added that medical education in various countries in the world uses hospital-based or is carried out in hospitals. The Minister of Health said that Indonesia will also implement the same concept for specialist doctor education.

"For the education of specialist doctors, it will be carried out based on collegium based in collaboration with hospital based. General doctors will continue to work with universities," said the Minister of Health.

To maintain the quality of graduates of specialist doctor education with the hospital-based concept, the government collaborates with trusted institutions from America to carry out accreditation of educational hospitals. In addition, the government will also create a financing scheme that will not burden prospective specialist doctors. "We will make it easier, cheaper, and even we will pay, and for quality if it can be better," said Minister of Health Budi, as broadcast by the Public Communication and Service Bureau.

As emphasized, one of the problems in the health sector is the still low number of health workers, especially doctors. In fact, the number of doctors in Indonesia is still far behind when compared to developed countries in the world. For this reason, the government through the Ministry of Health (Kemenkes) will strive to increase the number of doctors in Indonesia.

As explained, Law Number 17 of 2023 on Health has changed the relationship between doctors by centralizing licensing to the government (center/region), replacing STR with a lifetime, and strengthening legal protection (including restorative justice) if they work according to standards. Professional organizations are no longer the sole determinant in issuing practice license recommendations.

Control over the practice of doctors is totally transferred from the profession organization to the bureaucracy to the state. The same is true of the existence of the Registration Certificate (STR). The Health Law changes the STR from the previous period (5 years) to a lifetime. This is as stated in Article 260 paragraph (4) of the Health Law which states that the STR is valid for life.