The current impasse between Nigerian Resident Doctors and
Federal Government is a course for concern. There is no doubt Nigerian populace
need the service of specialists since 70% of Nigerian can’t afford the
ticket
to Ghana if they need specialist or tertiary care talk less of advanced medical care in
India if need be.
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The bulk of resident doctors in Nigeria are directly under
the Federal Government in Nigeria, as much as 80%. Others are in the employment
of the State government and private (for profit and non-for-profit) hospital.
Although some of the state employed doctors are sent to Federal owned
institutions for training as supernumerary. Very few wealthy individuals or
those with wealthy sponsors go through the programmme with their funds. The
implication of the latter example would mean the person is proving free service
to the Government. This would be explained in latter course of this piece.
Medicine as a course has an undergraduate part and
postgraduate part just like most other course under the sun. One of the
strongest ways it depart from others is the level of competence at each stage. At
undergraduate level the product comes out at lower level of competence compared
to the postgraduate level. This again is like most every other course; however
in this ongoing example the degree of competence is overwhelming. It can be
described simplistically like assigning undergraduate product as maybe a
toddler and a postgraduate product who is a fellow of one of the postgraduate
college as a full adult with responsibility. Interestingly, he or she owns the
patients in clinical settings.
A fresh input called registrar into a postgraduate training
programme of West African College of physician or Surgeon& National
Postgraduate Medical College is most time green once entering most of specialty
programme. His previous knowledge from undergraduate programme is like ABC. A
good example is a Neurosurgical Resident, his first few days in residency
training programme is not likely to be entirely be déjà vu.
The question I know in many people’s mind is, do we really
need residency training programme in Nigeria? It is like asking do we need
Sub-lieutenant, Lieutenant, Captain and Major in Nigeria army or any army for
that matter. The lower rank would rise to be Generals who have competence to
control the whole army while the lower rank commands the platoon, squad, and
units.
The consultants are not just mere nomenclature of a high
Civil Service post. In America they are called Attending which is gotten by
level of tested competence attained.
Worldwide medical residency is an established pprogramme
which most countries strive to have and a strategic Human Capital development
at that. A unique thing about it is they provide us with services while they
are training and do some research. They all go pari passu. They can’t train
without service and vis versa. The programme can’t be run online except
patients to be managed by outputs are going to cyborgs and robots! The place
they render service is also where they undergo training.
The labour market has a way of responding to this scenario.
The market for the product of medical school can’t be substituted for the
products of the postgraduate programme who are fellows of the various colleges.
Though legislature prevents that but the deeper reason is to protect the
patients from being sacrifice on the altar of differential level of competence
if it is not in place. A first degree medical graduate is a general medical practitioner
who has a lower level of capacity compared to a postgraduate fellow who has
undergone a specialist programme. The former can manage certain range of
disease while the latter can manage certain range of diseases. Usually the
medical school training can range between 6-7years without ASUU strike while
the postgraduate residency training varies between 4-7years for good candidates
and also depend on specialty. This period is not without it vigour and
intensity at both levels.
In Nigeria, this training of resident doctors are done in
Teaching Hospitals mainly, although the Federal Medical Centres does too.
Anyway as hospital they would require manpower, doctors inclusive. However, the
best doctors to fill such centres or facilities aside the consultants who are
authority in their sphere of knowledge, are Resident Doctors. This is an
efficient path to follow because resident doctors would render their service;
they have on average motivation to specialized having in the first place gotten
into one and replacement for the consultants who would one day leave the
system.
The question one would ask is why the programme not ran like
Phd programme in many universities? The answer is not farfetched. Clinical
Medicine in all it ramification is both an art and science. Clinical Medicine
cannot be learnt without a form of apprenticeship! So the specialist trainee
should have a programme that is clinical and residency based.
Someone maybe quick to add that there are Phd programme in some medical fields but one should not confuse the academic nature of such programmes and clinical nature of residency programme.
Back to our issue of discussion, the tertiary hospitals which
include Teaching Hospitals and Federal medical Centres fill their manpower need
for doctors in the most efficient manner. The resident doctors need the
training while the Federal Government need their service to cater for the
populace. Such residents are in level 12 and 14 of Federal Service grade
levels. They are civil servants but a temporary one. After training they seek
appointment as a consultant. Finishing the training programme by passing
relevant examination does make the doctors specialist in field they have
undergoned training. Also they are conferred fellows of the training college
but it is appointment in a suitable hospital that makes them a consultant.
Achieving this process using doctors who have to rise by
bidding time in Civil Service would be counterproductive. Assessment they say
drive learning. Deep learning is important in Medicine because they are
responsible for life of patients.
By placing in civil service grade as contract staff more or
less while other civil servants are on established tenure reveals a departure
between the two categories. Same is analogy is applicable to medical officers
and their resident counterpart who start off in Civil Service together. The
former has established tenure which he or she can bid the time and rise to the
peak. The Resident doctors in Nigeria after completion of training seek a place
to practice as a consultant. This may mean being trained in Yenagoa and taking
up appointment in Sokoto.
Now there is a no major difference in salary of medical
officers and Resident Doctors as it is today. They are being paid for the
services they are rendering.
Now it must be said that some centres pay Residents
examination allowance and update course allowance. They are ameliorative
expenses and it should not be misconstrued. All civil Servants undergo on job
training and opportunity for courses etc. These payments are just mere human
capital investment which are necessary. All organization that aim to grow
should invest in man, with money and machine to grow. It is sensible for such centre
that calls themselves specialist centre to invest in specialist training.
Another place some may quickly point to the National
Postgraduate Medical College but the answer is not far fetch. Medical
specialists are distinct professional group, although higher in a broader group
of Medicine, a Government should have a say in the matter. It should be noted
that there is West African Health Organisation which has West African College
of Physician or Surgeons. Therefore the aforementioned is not mere funding but
the need for regulatory input which in itself is a general responsibility of
Government.
As it would have been layout, the Government own facilities
where Resident doctors work, services are rendered. That is almost similar to a
Master degree holder employed by University Graduate Assistant where he or she
participate in research and teach and these services are paid for.
The argument of some people that Nigerian Resident doctorsshould not be paid rather they should be paying Federal Government should not
suffice. The question to such people should be that should tax paying citizen
be rendering pro bono service at the prime of their life. The scenario such
people want maybe applicable if Medicine
can be adequately learnable online and distant learning and not apprenticeship.
Medical residency training should not only stay but should be
improved as means of upgrading Nigeria health sector.
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