http://www.ngrguardiannews.com/index.php?option=com_content&view=article&id=86774:lagos-engages-new-doctors-as-casual-workers-bans-strike&catid=1:national&Itemid=559

Cancels leave, maternity, others for locum

Medical officers to earn N5,000 every four hours

THE public may not have heard the whole truth in the much-publicised employment of 373 medical doctors by the Lagos State government.

From information available to The Guardian, the exercise is one huge web of curiosity. Reason: The doctors are casual workers in plain language as their engagement is classified as an “assignment.” Worse still, they can neither embark on industrial action nor resort to protest to seek redress. All grievances shall be resolved through mediation.

These are part of the details contained in the assignment letters issued to the locum and other documents accessed by The Guardian. The state government issued the letters through the Lagos State University Teaching Hospital (LASUTH) Board, the doctors’ employers, which declared that they are “self-employed” because the “terms of agreement shall not give rise to a contract of employment.”

Watchers of the emerging trend and the impasse among the state government, the Medical Guild, and members of the Nigerian Medical Association (NMA) in the state, said at the weekend that “the absurd and the ridiculous is what we see in every action of the government.

A group, Joint Action Front (JAF), in a statement signed by the chairperson, Dr. Oladipo Fashina, pressed on Governor Fashola to meet the Lagos doctors’ demands.

An elder in the medical profession, who spoke on the condition of anonymity, said that the engagement of locum medical officers is a global practice but “never as replacement for sacked doctors anywhere in the world.”

He added that the condition of engaging the locum doctors “makes the whole process comical and an attempt to bring the medical profession into disrepute. No one can get the best out of a doctor with those terms of agreement,” he said.

A 12-page contract letter, titled: “Offer of appointment as a locum medical officer,” which was made available to The Guardian, indicated the agreement between LASUTH Board and the locum personnel covering the period of assignment:

The locum is considered as “self-employed” and the “terms of agreement shall not give rise to a contract of employment.”

The contract states: “These terms constitute a contract for services between the Board and the Locum and they govern all assignments undertaken by the Locum. No contract shall exist between the Board and the Locum between assignments.

“For the avoidance of doubt, these terms shall not give rise to a contract of employment between the Lagos State University Teaching Hospital Board and the Locum. The Locum is being engaged as a self-employed worker.”

The locum is, however, expected to perform all professional services, pursuant to the agreement in conformity with the prevailing professional standard of care and in conformity with all applicable federal and state statutes and regulations in the healthcare industry.

The appointment letter further states that the locum shall have no right to protest or embark on industrial action. “He or she should note that the position being engaged has been classified as rendering essential services under the Trade Dispute (Essential Services) Act and as such cannot take part in any industrial action or strike to protest any grievance but resort to mediation and arbitration measures to settle such concerns.

“Any dispute or controversy arising under this agreement shall be determined and settled at the option of the party initially seeking relief, either by mediation or by arbitration.

“No contract exists between the Locum and the Board during periods when the Locum is not working on an assignment.

“On remunerations, item seven on the document states: “Payments will be made to the Locum per session worked. Each session constitutes four hours work period at the rate of N5,000- N7,000 per session, depending on the Locum’s year of post-National Youth Service Corps (NYSC) experience.

“The Locum is not entitled to receive payment from the Board for time not spent on assignment, whether in respect of holidays, illness, maternity or absence for any other reason.

“For the avoidance of doubt, the Locum is not an employed salary civil service earner for the purposes of claiming any pension or gratuity benefit from either the Board or the Lagos State Government.”

The Locum has an hour within the commencement of the assignment or shift to inform the hospital and the board of his or her inability to attend work and three days for the replacement of assignment, where found not suitable. The board or hospital, however, may terminate the locum’s assignment at any time without prior notice or liability.

Also, “the Locum may terminate an assignment at any time giving reasonable notice to the LASUTH and board. If the locum does not inform the hospital of the board that he or she is unable to attend work during the course of an assignment, his or her absence will be treated as termination of the assignment and contract.”

According to the “liability” provisions of the document, the locum shall be fully liable for any loss, damage or injury to any part resulting from his or her negligence acts or omissions during the course of the assignment.

Item 9.3 of the document forbids a disclosure of any part of the agreement or facts relating to the state Ministry of Health among others during the term of this agreement.

Signatory to the letter of appointment, LASUTH Chief Medical Director (CMD), Prof. Adewale Oke, however, said there was no secrecy in the procedure and code of conduct of engaging the locum doctors.

He explained that the state government was displeased with the idea of “total strike” by the essential service providers and had taken on the locum doctors to complement services currently rendered by 500 doctors on its employ.

Oke said: “The state government aimed at providing a way out for people whose death can be prevented. The action was not to make the hospitals run at full capacity, but it is the responsibility of the state government to give the people basic health. So, it employed these doctors who are able to attend to emergencies.

“There are about 35 locum doctors that have been deployed to the surgical emergency, medical emergency, paediatric emergency, the haematology, dental, family health, among others at LASUTH,” he said.

The government sacked 788 of the 1,747 doctors for embarking on an indefinite strike and refusal to answer queries after a three-day warning strike to protest the non-implementation of Consolidated Medical Salary Structure (CONMESS).

JAF argued that the logjam is a labour dispute in which the “illegality of a strike cannot be decided by an employer, but by an independent arbiter (the court) that both parties must have confidence in.”

The rights activists supported the sacked doctors and questioned the rationale of the government’s action.

According to them: “The state has a responsibility to protect the citizens, including the provision of adequate healthcare. Yet, Governor Fashola sent his father abroad for medical treatment at the time the doctors’ strike is on.

“Since Fashola spuriously claims he sacked the doctors to protect public interest, we should ask: If the governor is to protect the people, why did he send his own father abroad for treatment? Why are the necessary medical equipment not available in Lagos hospitals since we have medical experts that can treat his father here?

“Why has he resorted to the use of incompetent ‘referral doctors’ who are being enticed with a wage twice what they ought to have been paid if they are in regular employment? CONMESS fully, according to the Lagos NMA, would cause just additional N33.5 million monthly, compared to its looting spree to line private hands and profiteers,” the statement reads in part.

N5000 every 4 hours is roughly $8.33 per hour?

That seems like an excellent deal for labor.

Unless the quality of the doctors is low, then why is anyone complaining?

These guys don't get pensions, benefits, or leave either it seems...purely temporary workers.

Probably a lot cheaper than the other doctors Lagos State has on staff.

So what is the problem?

Lagos has offered ~$8 hour, and has found ~400 doctors willing to accept this wage.

So why is it anyone else's business, unless these doctors are incompetent?

“Why has he resorted to the use of incompetent ‘referral doctors’ who are being enticed with a wage twice what they ought to have been paid if they are in regular employment?

How did he come to the conclusion that these doctors are incompetent?

Is he really claiming that the "regular employment" doctors would command half the salary? I highly doubt this is true. He is probably not factoring pensions, housing, cost of living allowances, etc.

Can someone in the know tell me what the wage rate of the other LASG doctors are? These union guys? Just a ballpark figure will do. Raw cash, then we'll also need to total pension, accommodation, etc.

Pretty sure it won't be difficult to quickly debunk this assertion that the union labor is 1/2 the price. That is never usually the case anywhere in the world...union labor is usually more expensive.

Lagos employs doctors and they pay them 7 pounds per hour equivalent (same as what some cleaners earn in UK) and people think the LASG has got a good deal for itself. This is in the same state where the former Governor earns the same amount as the current Governor (legally i must add), house of assembly members earn ridiculous amounts and Agberos live like lords.

You may not have the need of these Doctor's services today but you never know about tomorrow and don't come back complaining them.

ekt_bear: N5000 every 4 hours is roughly $8.33 per hour?

That seems like an excellent deal for labor.

Unless the quality of the doctors is low, then why is anyone complaining?

These guys don't get pensions, benefits, or leave either it seems...purely temporary workers.

Probably a lot cheaper than the other doctors Lagos State has on staff.

So what is the problem?

Lagos has offered ~$8 hour, and has found ~400 doctors willing to accept this wage.

So why is it anyone else's business, unless these doctors are incompetent?

Well said...

Many Nigerians are emotional thinkers, they don't deal with logic and practicality.

jacobs123: Lagos employs doctors and they pay them 7 pounds per hour equivalent (same as what some cleaners earn in UK) and people think the LASG has got a good deal for itself.

So the only way we will know for sure is if we:

a) know what the total compensation of the union doctors is
b) know the relative quality of these union doctors versus these non-union ones.


Btw, there is no connection between the salary of a cleaner in the UK and a doctor in Nigeria. One is a wealthy first world country with low unemployment, the latter is an impoverished third world country with high unemployment.

5000 Naira per 4 hrs = $8.33 per hr x 40 hrs per week (assuming this is the case) = $333 per week
$333.33 x 4 = $1333.33 per month = Naira 199,998 (x150 exchange rate)

So roughly these casual doctors will earn 200K Naira per month. Seems like peanut compared to what equivalent people earn in banks and oil companies. Perhaps they earn the same as new Ph.D holders at universities in Nigeria.

What about their dedication to duty? Most casual workers usually have no emotional attachment to their duties since their names are written in pencil (can be wiped out easily) rather than in ink.

How can a medical doctor work without leave, gratuity and other extra-salary perks?

They will just be lazying about so they can clock 80 hrs per week and make double that amount.

No house officer or junior resident in LASUTH ever worked 40 hours a week, they were the people on ground ( that's why they are called house officers or residents) the least a lazy house officer could do was 8 hours a day excluding his calls. Most units had only one house officer, so most house officers were on call every day for a month. So imagine if they were to be paid at the rate of 5000 naira for each four hours. In a week when they were on call they would do 24 x 7 = 168 divided by 4 = 42
Multiply by N 5000 = N210,000 in a week. So to replace a house officer they used to pay N170,000 the government now needs to spend about 600k. How smart

So 170k monthly is the salary of the house officers, I take it?

This doesn't include the free accommodation and pension, does it?

What is the rough value of the housing provided?

Also, anyone know what the pension looks like?

With these two latter pieces of information, we'll then have a pretty good sense of how much is being saved (if at all)

Let's say that the doctors in LASG employ work 50 hours per week, on average. Someone will no doubt correct this figure if it is too high or too low.

To replace their labor with those of these casual workers:

octave:6> 5000/4*4.33*50
ans = 270625

So you end up paying 100k more. However, these workers:

a) You don't have to provide accommodation for
b) You don't have to pay them on vacation, holidays, etc
c) You don't have to pay them when they strike
d) You don't have to provide them with a pension


So from points (a)-(d) above, the casual doctors might be a much better value proposition for Lagos State.

And if it turns out that you only extract closer to 40 hours of labor per week on average per doctor, then advantage shifts even further to the casual doctors.

So, can anyone provide a monthly or yearly estimate of the value of the housing accommodation provided to LASG doctors?

Puleeze, there is nothing like free accommodation for the doctors, any doctor with official accommodation has it deducted from his salary. This goes for any civil servant. A doctor with a basic salary of 44k is entitled to a rent allowance of 42k which once given accommodation is deducted from his or her salary. And of course this is a great deal for any young doctor, for a year or 2 just do locum in 2 or more government hospitals and save. You get to choose your own hours, no calls and once your shift is over you go home and relax. Whatever happens to the patients you saw during your shift is someone else's headache, nobody can call you back later that night cos the patient you saw earlier in the morning and stabilized suddenly started bleeding. Whoever is on the next shift takes over. What of the specialty areas, does a surgeon or a paediatrician do 4 hours a day and no calls. What happens to surgical emergencies outside his shift or a distressed baby born outside the paediatricians shift. They wait till the specialist is on duty again? Lagos state government is doing what they feel they have to do but it cannot solve the problem. The patients are getting trash care. It would be better for them to close down some hospitals and merger the work force they claim to have remaining to man one or 2 hospitals properly rather than this makeshift nonsense that is just window dressing.

So 44k+42k salary is what you are claiming? Is this per week, biweekly, month..?

So the 170k mentioned earlier doesn't have any housing allowance added on top?

What of the pension?

I guess rather than asking you guys to provide the numbers, perhaps someone can point me to where the official #s are published. Salary, housing allowance, pension, and any other compensation they receive etc.

[quote author=ekt_bear]Let's say that the doctors in LASG employ work 50 hours per week, on average. Someone will no doubt correct this figure if it is too high or too low.

The average junior doctor in Lagos works nothing less than 100 hours a week. That is if they have back up in their unit. Some are on duty 24x 7 for weeks depending on the unit they are in. That is168 hours per week. So do your maths.
And this is definitely a better deal for any young doctor for short term. Work like this for a year or 2, you have time to read for plab, uslme or whatever exams you have to take without the burden of calls. And you can still work elsewhere if you so desire. Personally I would advice any young doc I know to do this for a couple of years.

Being on call 24/7 doesn't mean you worked all those hours, obviously.

Clearly LASG would prefer to only pay for services rendered rather than also for on-call time

Do doctors really work 100/week on average? I doubt this

If it is a good deal for young docs, then Lagos will no doubt have little difficulty in getting enough doctors. Granted, they may be younger and fresh out of school, but the tradeoff may be worth it.

The question that still remains: what is the total compensation package for the union doctors?

The doctors salary is in two parts, one is the regular civil service salary commensurate with his grade level ie a doctor on grade level 12 step 1 has the same basic salary, rent, leave allowance, transport allowance as an accountant on grade level 12 step 1. Then in addition he is paid call duty, hazard allowance and if in a teaching hospital teaching allowance. These are actually where their salaries deviate from other civil servants salaries.
The difference with being on call 24/7 and working shifts is that when on call you come to work and do the usual 8 hour shift most workers do and then after what is considered close of work you hang around the hospital till the next day. So after the regular clinics or theatre sessions are over the doctors on call are the ones who are called if a patient on admission suddenly collapses, gives IV drugs which may be every 6 hours.or 4 hours depending on the patient, attends to emergencies who could not tailor their sickness to 8am-4 pm. takes deliveries of those women deliver at 1 am or who suddenly require an emergency CS at 3am. For the average young doctor it doesnt matter if you did not sleep a wink all night you are expected to show up at 8 o'clock the next morning and work through till 4 pm. No excuses and if you are on call the next day you continue till your call is over.
For the locum doctors you work for fixed number of hours a day collect your money and go. If you are on the 4 pm to 6 pm shift there are usually no clinics . All you do is what a doctor on call would have done nothing more.
I am a surgeon so most of my experience is with surgery. The surgical house officer or resident is the same doctor that runs clinics, sees surgical patients in the Emergency room and then still has to make out time to attend to those on the wards. He also is the same doctor that goes to theatre with his consultant to act as an assistant. This is world wide not just in Nigeria. Contrast this to nurses who are usually on shift duty. The nurse in the theatre works an 8 hour shift in theatre and goes home. No clinic , no ward , no emergent room. The nurse in A & E works only in A& E no theatre, no wards etc. They are roosters to do one shift a day and when they do nights they have days off. This is the standard any where in the world. Same applies to other paramededical staff.
As I said I personally would encourage any doctor who isn't yet doing a residency ie post graduate course or isn't a consultant to grab this opportunity and chop government money. This locus shift thing is heaven compared to the way one would normally have to work for half that pay.
As for the senior doctors, consultants 7k per 4 hours won't attract anybody. They are so few that the laws of demand and supply set in. To see a neurologist nowadays in Lagos the average you pay is N25 k per visit. My gynecologist also takes 25 k per visit and his hospital waiting room is never empty. Cos you get what you pay for good service. A Urologist will charge about 30 to 45 k to see you privately. Once you see any doctor charging less than 5k as consultation privately you can be sure he is not yet a consultant.

Greedy doctors in the UK are also voting wether to go on strike or not

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