CHALLENGES AND SOLUTIONS TO THE CRISIS FACING THE PRACTICE OF MEDICINE BY DOCTORS IN NIGERIA.

The medical profession evolves, it grows and the doctor is the leader. This self-evident fact will not change. The profession did not start in Nigeria and will not end in Nigeria. It is universal. The Nigerian aberration of the universal norm in the healthcare industry, like other aberrations will only add to the reasons we are the world’s laughing stock.
The present challenges are a manifestation of failures of members of the profession starting especially from the 1980s .
We went against the grain of government policy in the mid-1970s designed to train doctors who at the end of medical
school would be mini specialists in the four broad fields of Medicine viz: medicine, surgery, paediatrics and obstetrics and gynaecology. He is meant to be able to hold his
ground in any of the four fields and provide primary and secondary expertise with ease.
Everyone who went to medical school in Nigeria will attest that the training is along this policy. However, as we as a people in Nigeria have done in all sectors, we put personal
ego and interest over and above the common interest and trivialized the MBBS
What we are using today as the basis for how medical doctors are trained in medical school’s in Nigeria, bore in mind the all import fact that once you graduate from medical school you are already a BASIC SPECIALIST in every field, this is the system that is employed in the UK and we simply carried it over in Nigeria,
Whereby your medical training is divided into two parts, the 1st part being the pre-clinical where you do anatomy, physiology, biochemistry and community health. Then, you now proceed to the clinical where you do medicine, surgery and community medicine.. the rotation is such that to go through all the different subspecialty‘s under these three including pharmacology and pathology.!
So once you leave medical school your degree isn’t the same thing as some-one who went to for example, school of nursing and midwifery, a diploma certificate or even a 1st degree(Bsc).
You become a General Practitioner with Basic specialist knowledge in every field and as you progress along the GP cadre also known as the medical officer cadre the expectation is on promotion to an SMO, PMO and finally CMO. You will have acquired commensurate surgical and medical skill to make you poly-efficient and self-sustaining to provide satisfactory health services to an average Nigerian who lives in the rural setting, without making it binding on him(the rural dweller) to mandatorily come to an urban centre before he can access such quality health care, and also serves as the basis for referrals from the rural/semi-urban centre’s to the cities when the services of a specialist in a particular field are required.
This is the reason and still remains the only reason why medical training as a student is so stressful and vigorous, because the founding fathers have seen that the medical and surgical needs of the Nigerian Nation will not be achieved adequately if the system that produced the doctors is not properly tailored in a direction that is sustainable.
And they also acknowledged the fact that producing unidirectional specialist in every field is not self-sustaining in meeting the multiple health needs of the nation. Since it is not realistic to have every specialist in all the fields, all in the same place, at the same time and in every health facility in the country.
But it is possible and very practicable to have a well experienced General Practioner in all the rural health facilities in every local government area of this country meeting the health needs of Nigerians.
98% of SR’s, Consultants, Profs and Medical Elders today as has being stratified by themselves will on no account want to work in a rural setting, so they have concentrated themselves in the Big cities/Urban centres and have with so much disdain and utter disrespect trivialized the MBBS that is the basis of medical practice in Nigeria.
We went against the grain of government policy and trivialized the MBBS. We carry on like being a Consultant is sine qua non for a "proper" doctor and Medical Officers/General Practioners are retards that managed to become doctors and should not be taken seriously. Everything was for and about the Consultant in this country whether or not he had the “Expected” skill, exposure and knowledge on how to handle the Job, it was principally about acquiring the title of consultant, not because they wanted to get their hands dirty by being more involved at the levels of healthcare where different cadre of medical officers are working to further boost on their job capacity building but because it was seen as a relaxation spot where you get more salary purely because of status.
A young doctor who is convinced from his observation of the treatment meted out to non consultants, that the fastest way to making the elusive" it" is by becoming a consultant. He seeks out the fastest and easiest path to becoming a consultant usually residency in laboratory medicine (less Histopathology) or public health. To worsen matters they leave all procedures to the JOHESU people while they just flaunt their doctorhood. Leadership that is not based on anything other than status can never be sustained, especially not in a knowledge and skill based environment.
The JOHESU people recognized the fact that there is nothing the doctor in the laboratory brings to the table which they don't have and probably even more. They set out to take over the laboratory via hard nosed politicking, lobbying and bare faced impunity. They have achieved this. Now they seek to take over the hospital because they misconstrue the other hospital doctors to be the same as their laboratory colleagues and all they need do is acquire the title" Dr." via genuine and phony PhDs and get appointed Consultants. By virtue of decree 10, that is what you must be to be appointed Chief Medical Director of a Federal Teaching Hospital. Next they will have the decree amended to accommodate consultants other than medical doctors.
The JOHESU people took a cue from that. They don't just want to be equal to doctors ( they have achieved that through CONHESS) ; they want to be consultants.
The medical officers also didn't help matters. They tacitly accepted that they're second rate and not good enough. Thus you see a doctor 15 years post registration, on the rank of PMO1 going "back to school" to commence residency. Subconsciously he is convinced that the decade and half he has practiced is useless because he didn't have the designation "Consultant", obviously because he has noticed that an average consultant feels he has sacrificed “too much” to become one so he believes he is entitled to special treatment and demands for it. He treats all who are not with disdain and utter disrespect.
Because as it stands today the is practically no financial difference between CONMESS and CONHESS, by the actions of our consultants and medical elders who have over trivialized the hard earned MBBS by making it look cheap in the eyes of other professionals.
The honest truth is that even our colleagues’ who assume the top positions of the medical profession as doctors have contributed significantly to where we are today, unfortunately the residency programme as it is designed today ends up producing timid doctors instead of giants.. Doctors who don't have the guts to standup for their fellow colleagues’ purely because they want to pass an exam or the want a certain favour from the so-called "oga at the top".
Residents in my centre are totally un-aware of what is going on in the health sector, simply because they believe that once they become consultants they are on-top of the world..
so they don't even know what is happening around them, an allied professional asked the question that how many even pass to become consultants and the answer is a staggering few..
Has passing the exams become a tribal/religious affair? Where doctors from a certain part of the country pass while other from some other part fail, must a doctor turn another fellow doctor to a houseboy or a driver so that he can influence what happens when he goes for exams? Must i dress shabby to show that i am a resident doctor?
during my houseman-ship my own consultant said that house officers shouldn't be paid salary, shouldn't have teaching allowance, should have their call duty allowance halved in two or better still removed.! The SR's under them agreed that we where "medical students+"..
and this is the degrading and sadly unhealthy view of over 85% of residents, because they have become cowards instead of giants, and carrying over the myopic mentality of our senior colleagues’..
2/3rds of NARD is composed of house-officers and medical officers.. And incidentally this unacceptable thinking of consultants has infiltrated afew members of this noble body to begin to act like the leadership of NARD belongs only to Resident doctors.. Undermining the real reason why NARD was setup..!
It breaks my heart to see how low we have fallen in the general scheme of things..
Our allied professionals are doing internship [nurses/pharmacist/physiotherapist/radiotherapist. etc..], receiving shift & call allowance, Specialist allowance, Offs[PH, Night Off, etc], going on career developing courses..
yet my own doctor colleague who is my senior in this noble profession of medicine believes i should remain a slave under the guise of what i am doing is humanitarian? as such i don't need to be paid salary or receive any allowance? are we the only persons doing humanitarian service??
It will never be well with these individuals, because i can name Doctors [SR's/consultants/profs] who are still advocating for other cadre of doctors to remain as beggars till today and who are still practicing in our hospitals.. and unfortunately want to be policy makers in the health sector.
Every other sector is protecting their own except our highly protected and over-ratted "OGA's/Chiefs/Consultants/Medical Elders" when there is a salary increase. Theirs is 10times that of any other person.. Nobody is complaining about that.. we are simply saying protect us because we are one and the same body.? but this is to big a request to make and therefore our elders cannot accept.
nurses moved from grade level 5 to 7, their own Oga's didn't say that the salary was to much for those young nurses..
when our own Oga's where approached for us to move from grade level 9 to 11, they said that the salary will be too much for the young doctors, and instead of the move to 11, our salary should be halved and all allowances stripped off, some even advocated that we start paying school fees??
for God's sakes...
At-times i really regret why i even read medicine and why i am even a resident to begin with.?
it has become a cause to be a doctor in this country..

Today all a nurse needs as qualification to become a CNO (Chief Nursing Officer) is RN&RM i.e Registered Nurse & Registered Midwife, which is not even equal to a diploma not even to mention a Bsc and yet they are on the same rank as a PMO or a Consultant and this has being the weather forecast in almost every sector of the hospital as it stands today.
The solution lies in reforming the system of remuneration of doctors. As it stands now doctors' remuneration is not geared to the complexity, the skills and training needed to carry out procedures . A neurosurgeon gets paid the same amount as a chemical pathologist if they both are on CONMESS 5. A Chief Medical officer who carries out surgeries like thyroidectomy and hip replacement gets paid less than a public health physician on CONMESS 7 because he doesn't get paid specialist allowance.
Each procedure should be evaluated and costed by Actuaries and a doctor who performs them should get a percentage of the cost according to his rank , expertise and experience. What we have now CONMESS should be the base pay each doctor earns.
2. We must all skip 1 level and for those already on 7, CONMESS 8 must be created to accommodate them
3. Retirement age for all doctors at 75ys
4. Specialist allowance for all doctors
5. Excess workload allowance commensurate with the work we are doing
6. Revert to call duty being a percentage of our basic salary
7. All doctors on salary grades equivalent to that of assistant directors and above should get the things that come with such offices such as allowances for domestic servants, drivers, newspaper, vacation etc.
This I believe will finally put to rest all the agitation going on in the health sector as all their aspirations can be reduced to asking for a bigger portion of resources allocated to emolument of healthcare labour Provided.
DR. JIMMY IDAMA [FORMER ARD PRESIDENT KSSH LOKOJA-KOGI STATE].

Wow..thank you for this.

I so much have been trying to get a comprehensive analysis of what is going on but haven't until now. This could be one sided, however. But it gives a large window through which I can fully understand what is going on.


Respect is reciprocal and the oga doctors should really respect their fellow doctors. Everyone is an adult and should be treated as one.

I wonder what they have to gain by not allowing the younger ones get good salaries. I believe many of them have children studying to be doctors too. what is the beef about?


so @Op, how is the matter being addressed? Is there progress? Is there hope for a 'reconciliation' or whatever would bring back the pride associated with the profession?