Thekabarnews.com—Yesterday, I met with an 85-year-old patient. The patient is still in good health, has a clear mind, and speaks intelligibly. Former TNI. When I performed an echocardiogram on him, he shared his stories freely. He was once assigned to Irian for years, living in the jungle, going months without brushing his teeth because there were no toothbrushes. Life was tough, but his body was actually strong. He was still able to come to the hospital alone. I listened with amazement—this is a portrait of a generation shaped by resilience, not comfort.

Then in the middle of the story, he smiled and said, “Both of my children are doctors, Doc.” I smiled too. But the smile faded when he continued, “But they say there’s no money in being a doctor now. Both of them are aesthetic doctors now.”

That sentence is honest. And precisely because it is honest, it delivers a gentle slap. Not because the aesthetics are wrong, but because this reflects a significant change in the medical world that is rarely discussed openly.

Many people are wondering, why are esthetic clinics thriving now, while general practitioners and specialists in curative services are becoming increasingly exhausted? One of the answers is the national health insurance program (JKN). Yes, the system that has greatly contributed to expanding access to healthcare services also brings side effects that are often not included in public discussions.

Simply put, esthetics is the only branch of medical services untouched by the JKN system. The Health Care and Social Security Agency (BPJS Kesehatan) doesn’t cover esthetic treatments. There are no claims, no packages, and no INA-CBG rates. This means aesthetic doctors are free to determine their time, rates, and workload. The savings system does not impose any limitations.

Meanwhile, the pattern of people’s medical visits is also changing. The logic makes sense. If BPJS Kesehatan is available to you, it seems unnecessary to pay out of pocket. As a result, the number of general patients has drastically decreased. Clinics or doctors who don’t cooperate with JKN gradually lose patients. Are there hospitals that do not provide services to BPJS Kesehatan? Many are deserted, and some have even been forced to close.

For doctors who choose to join the JKN system, the consequences are also not light. High patient volume, short time per patient, services must be efficient, and costs must be minimized. Don’t prescribe too many medications, and don’t perform excessive procedures. Such behavior isn’t due to the doctor’s lack of concern but rather because the system requires it.

This is where the dilemma arises. On one hand, doctors want to provide the best service. On the other hand, the system encourages minimal service that is still considered “sufficient.” Over time, the exhaustion becomes not just physical but also moral. Many doctors feel they are no longer medical practitioners but system operators.

Meanwhile, outside the JKN system, there is one relatively pressure-free path: esthetics. Patients come by appointment. The consultation time is longer. Actions are carried out calmly. The reward is commensurate with the effort and risk. Economically, this is rational. Humanely, this is a survival choice.

The problem isn’t with the doctors who choose esthetics. The problem is the system that makes that choice feel like the most sensible option. When the best doctors move away from curative services, who is left on the front lines?

This isn’t about blaming BPJS or glorifying esthetics. This is about looking at the long-term impact. When one system becomes a market leader that nearly monopolizes patient access, the choices for practitioners become limited. Follow the system or lose patients. And when the choices become narrower, idealism often loses to reality.

The healthcare system shouldn’t be measured solely by the number of participants and claims. It should be evaluated based on its impact on healthcare workers. Because without doctors who are physically and mentally healthy, no matter how large the system is, it will be fragile.

Hopefully, in the future, we can discuss this more honestly and maturely. Not with emotions, but with data and empathy. Because maintaining the healthcare system isn’t just about numbers but about the people within it—doctors and patients.

If this writing feels disturbing but relevant, maybe it’s time to discuss it more broadly. Feel free to share. Who knows, from honest conversations, fairer policies for everyone might emerge.

By: Dr. Erta Priadi Wirawijaya, Sp. JP (Wednesday, February 11, 2026)