when the Federal government ordered the sacking of 16,000 resident doctors across the Federation, in 2014 there was a huge outcry not only from the medical community, but from the entire health sector. The decision was not only considered drastic, but ill advised and potentially catastrophic because resident doctors a.k.a. trainee doctors, constitute the main support force and backbone for medical practice in the public sector.
Doctors
The Seasonal medical experts take a critical look at the challenges of training, employment and distribution of medical personnel, particularly doctors and recommend a multifactorial approach as solution. Excerpts:
As an institution established to promote higher standards for specialised medical and dental practice in Nigeria, the National Post Graduate Medical College of Nigeria has its work cut out.
Since it was established in 1979 by Law CAP N59 LFN 2004 for the conduct of medical examination after training in the various specialised branches of Medicine and Dentistry, the College has been constantly under pressure to accredit more amd more training institutions across the country for the purpose of residency training for the sole purpose of producing enough doctors for the country.
A former National President of the Nigerian Medical Association, NMA, and the current Registrar of the College, Prof. Oluwole Ayoola Atoyebi, laments the dearth of medical doctors in the country, but observes that in addition to the problem of shortage of medical personnel, their distribution is an even bigger challenge.
Atoyebi, who was one time Provost, College of Medicine, University of Lagos, however accepts that the issue of inadequate personnel is global. But even though very few countries in the world have met the minimum standard set by the World Health Organisation, WHO, the magnitude of the problem in Nigeria is in a class of its own.
“In America and Europe, they have not met the required standard of one doctor to 500 people. But in Nigeria, we have one doctor to almost 20,000 people. There are two categories of doctors, the general duty doctors who just qualified, finished their internship and can practice, and the specialists. What we do here, in this College, is to produce specialists,” he says.
Too few specialists produced
Right from the beginning, the number of doctors in Nigeria, even at general level has been insufficient for the population because the number of doctors produced in the entire Colleges of Medicine across the country is less than 3,000.
Atoyebi, who should know better, puts it succintly. “We are not producing enough specialists yearly. For instance during our convocation in September 2014, we produced only 247 specialists in different areas. Some specialties experience acute shortage than others.”
But what is probably more worrisome is the imbalance in distribution of doctors, insufficient as they are. When probed, the Registrar confessed: “Overall, there are just about 30,000 actively practicing doctors in Nigeria, out of which no less than 6,000 are in Lagos alone compared to a place like Taraba State where there are less than 50 doctors overall. The remaining doctors are distributed across the other 34 states plus the FCT, Abuja.”
Investigations reveal that a number of factors ranging from low turn out of trained doctors from the few accredited colleges of medicine in the country, to brain drain, amongst others are actually responsible for this shortage.
“Doctors are not commodities,” Atoyebi remarked. “You can just be producing doctors like you are in factory. For the fact that they are to be dealing with human beings warrants their proper drilling. Also, there is limited number of institutions to be accredited just as there is limited number they can train because the number is pegged by the Medical and Dental Council based on the facilities and number of teachers.
Essentially there is a limit to the numger of doctors that can be trained by a medical institution at a particular time.
According to Atoyebi: “It usually varies from 50 to 200. But quite a number of medical schools cannot graduate more than 50 at a time. Even the maximum allowable for any institution is at the University College Hospital, UCH, Ibadan, being the first medical school. The maximum the institution has been allowed to admit in a year is 200.”
Brain drain palaver
External and internal migration of doctors is a big issue. The big issue is that the nation is not retaining even the small number of doctors it produces because of brain drain.
“Not less than 10 per cent of doctors produced in this country over the last 10 years have migrated to other countries in the quest for greener pasture. The payment in Nigeria compared with standard of living is not encouraging. Also, many doctors migrate due to inadequate facilities, and the large numbers of doctors who migrate because of inadequate facilities are specialists,” Atoyebi explained.
On internal migration, he asserts that many doctors have moved from the north east to Abuja and its environs while others opt to go to Lagos.
To improve the situation, the medic calls for committed political will to ensure teaching hospitals are built with the right facilities.
“If institutions are not equipped with the right facilities we can’t produce more because the number is pegged based on human resources and facilities. The shortage is usually a facilities problem.
“We have been asking that government should make sure that each medical school is funded by the Tertiary Education Trust Fund, TET Fund, to have Clinical Skills Stimulation Laboratory, CSSL so that many people can practise on inanimate object, this way more numbers can be taught on stimulators so they would have become expert on stimulators before they come to see actual human being, because if you are going to teach them on human beings it will take a longer time because you can only teach one person at a time as you have to guide him so that he will not injure the patient.
But if we have stimulators, practise on those is easy because simulators cannot die, they just stimulate humans. So the students will have perfected what they want to learn before moving to human beings. So when they now move to human beings the facilities should be upgraded to that capacity. That way, more doctors can be produced both at under graduate level and post graduate level.
“At post graduate level, we have made several moves to the Ministries of Health and Education for the TET Fund because we want a clinical skill and stimulation laboratory to be provided here so that more specialists can be produced.”
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The Seasonal medical experts take a critical look at the challenges of training, employment and distribution of medical personnel, particularly doctors and recommend a multifactorial approach as solution. Excerpts:
As an institution established to promote higher standards for specialised medical and dental practice in Nigeria, the National Post Graduate Medical College of Nigeria has its work cut out.
Since it was established in 1979 by Law CAP N59 LFN 2004 for the conduct of medical examination after training in the various specialised branches of Medicine and Dentistry, the College has been constantly under pressure to accredit more amd more training institutions across the country for the purpose of residency training for the sole purpose of producing enough doctors for the country.
A former National President of the Nigerian Medical Association, NMA, and the current Registrar of the College, Prof. Oluwole Ayoola Atoyebi, laments the dearth of medical doctors in the country, but observes that in addition to the problem of shortage of medical personnel, their distribution is an even bigger challenge.
Atoyebi, who was one time Provost, College of Medicine, University of Lagos, however accepts that the issue of inadequate personnel is global. But even though very few countries in the world have met the minimum standard set by the World Health Organisation, WHO, the magnitude of the problem in Nigeria is in a class of its own.
“In America and Europe, they have not met the required standard of one doctor to 500 people. But in Nigeria, we have one doctor to almost 20,000 people. There are two categories of doctors, the general duty doctors who just qualified, finished their internship and can practice, and the specialists. What we do here, in this College, is to produce specialists,” he says.
Too few specialists produced
Right from the beginning, the number of doctors in Nigeria, even at general level has been insufficient for the population because the number of doctors produced in the entire Colleges of Medicine across the country is less than 3,000.
Atoyebi, who should know better, puts it succintly. “We are not producing enough specialists yearly. For instance during our convocation in September 2014, we produced only 247 specialists in different areas. Some specialties experience acute shortage than others.”
But what is probably more worrisome is the imbalance in distribution of doctors, insufficient as they are. When probed, the Registrar confessed: “Overall, there are just about 30,000 actively practicing doctors in Nigeria, out of which no less than 6,000 are in Lagos alone compared to a place like Taraba State where there are less than 50 doctors overall. The remaining doctors are distributed across the other 34 states plus the FCT, Abuja.”
Investigations reveal that a number of factors ranging from low turn out of trained doctors from the few accredited colleges of medicine in the country, to brain drain, amongst others are actually responsible for this shortage.
“Doctors are not commodities,” Atoyebi remarked. “You can just be producing doctors like you are in factory. For the fact that they are to be dealing with human beings warrants their proper drilling. Also, there is limited number of institutions to be accredited just as there is limited number they can train because the number is pegged by the Medical and Dental Council based on the facilities and number of teachers.
Essentially there is a limit to the numger of doctors that can be trained by a medical institution at a particular time.
According to Atoyebi: “It usually varies from 50 to 200. But quite a number of medical schools cannot graduate more than 50 at a time. Even the maximum allowable for any institution is at the University College Hospital, UCH, Ibadan, being the first medical school. The maximum the institution has been allowed to admit in a year is 200.”
Brain drain palaver
External and internal migration of doctors is a big issue. The big issue is that the nation is not retaining even the small number of doctors it produces because of brain drain.
“Not less than 10 per cent of doctors produced in this country over the last 10 years have migrated to other countries in the quest for greener pasture. The payment in Nigeria compared with standard of living is not encouraging. Also, many doctors migrate due to inadequate facilities, and the large numbers of doctors who migrate because of inadequate facilities are specialists,” Atoyebi explained.
On internal migration, he asserts that many doctors have moved from the north east to Abuja and its environs while others opt to go to Lagos.
To improve the situation, the medic calls for committed political will to ensure teaching hospitals are built with the right facilities.
“If institutions are not equipped with the right facilities we can’t produce more because the number is pegged based on human resources and facilities. The shortage is usually a facilities problem.
“We have been asking that government should make sure that each medical school is funded by the Tertiary Education Trust Fund, TET Fund, to have Clinical Skills Stimulation Laboratory, CSSL so that many people can practise on inanimate object, this way more numbers can be taught on stimulators so they would have become expert on stimulators before they come to see actual human being, because if you are going to teach them on human beings it will take a longer time because you can only teach one person at a time as you have to guide him so that he will not injure the patient.
But if we have stimulators, practise on those is easy because simulators cannot die, they just stimulate humans. So the students will have perfected what they want to learn before moving to human beings. So when they now move to human beings the facilities should be upgraded to that capacity. That way, more doctors can be produced both at under graduate level and post graduate level.
“At post graduate level, we have made several moves to the Ministries of Health and Education for the TET Fund because we want a clinical skill and stimulation laboratory to be provided here so that more specialists can be produced.”
Click here to read more: