MUST READ......Unemployment Among Medical Doctors

hehehehe......It used to be unthinkable to see a Medical Doctor unemployed or has failed to get a job within a few days after graduation.  Infact what delays a Doctor s employment is the mandatory swearing  in ceremony by the Medical and Dental Council before he takes on any employment.  It is common for your friends from other faculties to envy you; by saying you are lucky6 as you are assured employment as soon as you graduate.

 

Housemanship or Internship is the first point of call for a Medical graduate as a pre-registration employment for 1 year before full registration is given to practice as a medical practitioner.  This 1 year employment is mandatory and a Medical Doctor is supposed to do it within 2 years of graduation or his license will be revoked until he writes another exam which is set by the Medical and Dental Council of Nigeria.

 

The situation on ground presently is far from the picture painted above.  Medical Doctors in Nigerian are presently in an unemployment crisis that many are wondering whether the many years spent (ASUU strike inclusive) were actually worth it after all.

 

I am not an angel of doom, and neither am I a pessimist but I think I can say without fear of contradiction that the future is to say the least gloomy for the Medical Profession in Nigeria.  This is a profession to which I belong so I stand to gain nothing painting it this way, but the truth must be told.

Now, that was a digression.  A freshly graduated Doctor now takes an average of eight  sixteen months to secure a place for Internship and by the time he or she completes the programmes,. His provisional license would have expired and he would have concluded his Internship without a license.

 

These group of Doctors are the lucky ones because at lease they have secured a place for the internship within the 2 years of their provisional license.  The other group and I personally know many can not get a place within the 2 year period and by this time, they are legally speaking unqualified Doctors.

 

This situation has now extended to medical officers who are the next step after House officers who may or may not have done their 1 year mandatory youth service scheme depending on age.  A Medical Officer is either pursuing his residency in an accredited hospital or is working as a general practitioner in a general or private hospital.

 

There are many Medical Doctors now who have passed their primaries exam which qualifies them to start their residency programme in a recognized hospital but have failed to gain employment into these hospitals.

 

Over 20 of my classmates along have this qualification but are either sitting at home or at best offering locum services at private hospitals far less than the national minimum wage.

 

Many Doctors who can afford it have now resorted to writing foreign exams which would enable them to practice either in the UK or USA.  These exams come at great cost but they are more reliable than the Nigerian equivalent in terms of relevance to the field and also as a means of getting employment because despite our numerous problems, Nigerian Doctors are highly regarded in foreign countries.  It is estimated that there are over 20,000 Nigerian Doctors in the USA alone and this est6imate is conservative because there are many that bypass immigration laws of these countries.

 

Dear reader you may ask what is the genesis of this crisis in this noble profession you respect so much.  My simple answer is the systematic neglect of the health sector by successive government of this potentially great country.  No health policy or plan has been adhered to for more than 10 years by any government and some of these policies are well articulated if only they are implemented.  Poor budgeting allocations over the past 20 years to the health sector at between 2  3% have hot helped matter.

 

Teaching hospitals were established to serve as tertiary level of medical care for the training of Medical Doctors at both the undergraduate and postgraduate levels.  Presently many teaching hospitals need resident Doctors in various departments to fill up the spaces created by former resident Doctors who have completed their residency programme and are now consultants, but are enable to employ these residents because of lack of funds in the last 2 year.

 

Some teaching hospitals that have done interviews for resident Doctors over 8months ago, some of which have given letters of appointment to the Doctors cannot afford to allow them to commence work because they cannot pay them.  This is as bad as that.

 

Some years back, the government in an attempt to increase the number of hospitals that offer residency programmes in the country upgraded some general hospitals to the status of federal medical centres, but this noble idea has been bastardized by the same lack of funds for the employment of staff, for which purpose the hospitals were upgraded in the first place.  Thee hospitals now have beautiful infrastructure without manpower to run them.

Dear reader, with all these myriad of problems outlined, you must ask what are the solutions to them.  A well articulated health policy backed by adequate budgetary allocated and a determined political will to implement them is my humble suggestion.  A target should be set for each teaching hospital, Federal Medical Centres and other accredited hospitals for the number of residents and house officers they can employ and this should be backed by enough funds to achieve the target.  There are many state owned general hospitals that can be accredited to offer residency programme in liaison with Federal Ministry of

Health or other teaching hospitals as this will help in decongesting the teaching hospitals to which most residents run to for their residency programme.

 

I believe a hospital does nothave to be affiliated to a University for it to be able to run a postgraduate programmes as long as it satisfies the criteria for the programme as stipulated by the National Postgraduate Medical College or the West African Postgraduate Medical College.  This will go along way in expanding the opportunities for Medical Doctors to pursue specialist courses, improve the quality of health care they offer to their patients and also contain the present brain drain tide now facing the health sector.

 

It is very unfortunate for the government of this country to spend tax payer s money in training Medical Doctors over many years only for these Doctors to be lured away by foreign countries just for the simple reason that there is no space for them in these hospitals or not incentives for them to stay and work.

 

Some of the best trained Doctors you have encounter in Europe or Asia are Nigerians trained in Nigeria and exported to serve thee countries to the detriment of their own nation.  The implementation of some of these and many other policies will go a long way in bringing back those days during which it was unthinkable to have an unemployed Medical Doctor.

DR. SHEHI ALI ABUBAKAR

NO. 1B LAPAI ROAD, KADUNA

shehiali@yahoo.com

"One thing we have also realised is that because of unemployment, those who have been admitted for internship are now reluctant to leave. Of course, the interns are paid. If you are a medical doctor on housemanship, you are paid like a doctor; same applies to pharmacists.

"Some of them do not want to finish and leave. So they recycle themselves. They will finish internship here and still go to repeat it in a different hospital. They are sure of their pay if they remain in the hospital. This is what we have discovered and it has worsened the situation," he said.

He further said that insurgency in some parts of the country was fuelling the exodus of doctors to the southern part of the country. "Because of security challenge right now, you can hardly get a house officer who wants to go to the University of Maiduguri Teaching Hospital," he said.

He suggested that government should expand the scope of the institutions in terms of adequate funding while the regulatory bodies should allow them to absorb more interns.

The chief medical director of the Lagos State University Teaching Hospital (LASUTH), Prof. Wale Oke, said the problem could be addressed by accrediting private hospitals for the training. He said there were many private hospitals in the country with facilities to train house officers, but they need government accreditation.

He added, "There are many people waiting for housemanship and not finding spaces because some people want to do housemanship in Lagos, Abuja and Port Harcourt. They don't want to go to Borno or Adamawa."

It was gathered that these young doctors may lose their provisional licences if they are unable to secure spaces for internship.

Shortage of consultants

The MDCN accredits medical colleges to train doctors in the country, and grants provisional licences to medical graduates to practise.

The provisional licence expires in two years if the young doctors are unable to go for the mandatory housemanship.

The MDCN accredits medical schools to train doctors in Nigeria, and it indexes every student in that school from year one till the end.

The provisional licence enables the young doctors to do their housemanship. If a doctor spends two years without doing housemanship, then his provisional licence expires.

Findings show that Nigeria's doctor-patient ratio is far behind the global best practice. The current ratio in Nigeria is one doctor to 3,000 patients, which is against the World Health Organisation (WHO's) one doctor to 200 patients.

For the housemanship, the ratio is one consultant to four house officers. This means that only four young doctors would serve under the tutelage of a consultant throughout the duration of their internship.

Checks at the MDCN website show that there are 27 medical and dental colleges fully accredited to produce doctors and dentists across the country.

In proffering a solution to the “no internship slot” crisis, it is necessary for a broad-based stakeholder engagement which will include the Ministry of Education, accreditation agencies, training institutions and state hospital management boards. There should be a target to accredit more secondary health facilities to accept medical interns. As a last resort, an embargo or reduction in admission quota should be placed upon medical schools until the backlog is sorted out.
It is also time to consider a more transparent process for recruitment into these internship roles, not just in medicine, but also in pharmacy and other health professions that require such programmes, to ensure that merit and fairness are the bedrock of filling these very scarce positions.
The inability to commence internship immediately upon graduation is tantamount to an internal “brain waste” and the Government of Nigeria needs to do something about this urgently. The experience of these newly qualified doctors will certainly shape their motivation and future career pathways, and at the moment, the growing army of disillusioned young doctors does not look promising for the future of the Nigerian health system.