JMIR Publications

ABSTRACT

Background:

Indonesia faces a profound and persistent specialist shortage, projected at 70,000 by 2032, compounded by severe maldistribution, hindering healthcare access. The traditional university-based specialist education model lacked scalability and failed to meet demands. To address this, the 2023 Health Law mandated a transformative reform, introducing a hospital-based specialist program (Rumah Sakit Pendidikan Penyelenggara Utama, RSPPU) alongside existing university-based programs.

Objective:

This paper aimed to examine the rationale, policy design, and early implementation of Indonesia’s dual hospital–university specialist medical education reform.

Methods:

An integrative qualitative policy process review was conducted to evaluate Indonesia's specialist education reform. Data triangulation involved systematic analysis of key documents (laws, regulations, manuals), in-depth interviews with policymakers, hospital leaders, program directors, and residents, and comprehensive media tracking. All data were interpreted using Kotter’s change management framework.

Results:

The reform established six referral hospitals as co-organizers of residency training alongside universities, with curricula co-developed by professional collegia and quality assurance aligned with both ACGME International and Indonesian (IAAHEH/LAM-PTKes) standards. The pilot enrolled 52 residents in high-need specialties who received comprehensive student incentives: full tuition fees, stipends, and structured clinical mentorship and guaranteed deployment to underserved regions. A unified national digital platform enabled transparent, equitable selection across Indonesia’s archipelago, while an integrated e-logbook supported competency-based assessment, real-time monitoring of the 80-hour weekly duty limit, and anonymous reporting of well-being concerns, including bullying. Hospitals implemented preliminary educator compensation mechanisms, such as temporary honoraria, though a standardized national framework is still under development. Despite early challenges in dual accreditation adaptation, variable remuneration for clinical educators, and inter-institutional coordination, the pilot demonstrated strong institutional commitment and operational feasibility, affirming the viability of a digitally enabled, competency-based, and equity-oriented residency model.

Conclusions:

Indonesia’s dual hospital–university residency model offers a scalable, equity-focused, and competency-based approach to accelerate specialist production and improve geographic distribution, advancing national health system transformation.