There are growing concerns about the rising burden of unemployment among medical doctors in the country.
This is at a time when many federal and state government hospitals are struggling to attend to the health challenges of millions of Nigerians with few medical doctors and other specialists.
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Daily Trust Saturday investigations reveal that ironically, some state governments spend millions of naira sponsor their indigenes in Nigeria and abroad to study medicine but do not employ them after their studies.
Others who are trained in the country by their parents also find it difficult to secure employment in both federal and state governments’ health institutions.
Findings by Daily Trust Saturday revealed that the failure of relevant authorities to recruit qualified doctors has led to some of them doing part time employments in several private hospitals to make ends meet.
This is in spite of the inadequate number of doctors in public primary, secondary and tertiary levels of health care, as well as the fact that the country is losing a large number of doctors daily to brain drain.
According to the President of Nigeria Medical Association (NMA), Dr Ojinmah Uche, Nigeria has about 24,000 actively licensed physicians giving a doctor-patient ratio of approximately 1:10,000.
“This ratio of 1:10,000 is a national average but in most states, the situation is palpably worse. Only one doctor is incredibly available to treat 30,000 patients in some states in the south, while states in the North are as worse as one doctor to 45,000 patients. In some rural areas, patients have to travel more than 30 kilometres from their abodes to get medical attention,” he said.
He said fresh doctors, upon graduation, are faced with difficulty getting house job slots, adding that there is also difficulty in gaining employment as a resident.
“It is a very frustrating period filled with many rounds of uneventful interviews. As it stands today, many young doctors in this “hell” suffer immense psychological trauma as they dutifully prepare and attend dummy interviews even though they were well aware that based on current practices, all or most of the recruitment had been concluded before the interview.
“This is called hoping against hope. Residency training employment today is fraught with allegations of bribery, sexual intimidation and lots of underhand practices,” he explained.
Dr Emeka Innocent Orji, president of Nigerian Association of Resident Doctors (NARD), said the problem of unemployment and under-employment is very serious among doctors in the country.
However, he said under-employment is more prevalent among doctors in the country than unemployment, because as a medical doctor, “you will usually find something doing even if you do not have the actual job you are looking for.”
He said doctors work in some private establishments with inadequate pay leading to them moving from one facility to the other, and working round the clock in order to make ends meet, with the associated stress and burn out syndrome.
He said it is an irony that there is acute shortage of doctors in government facilities yet government is not employing, as many doctors migrate out of the country as a result of poor remuneration, welfare package, poor job satisfaction and other reasons.
“There is a lot of bureaucracy involved in employment, especially in federal tertiary health institutions. And these are the things we have been talking about for some time now, that the hospitals are depleted, you have one doctor doing the work of hundred doctors. There is no way the person will be effective operating in that kind of environment. Our members are suffering this and many of them are coming down with stress and other illnesses.
“As a result of being overworked, some simply throw in the towel and leave the country,” he said.
He lamented that many state governments don’t employ enough, and even when they employ, do not pay salaries regularly.
He explained that only few states pay salaries like the federal government, and that the few private hospitals that pay well do not offer a pensionable employment and yet subject the doctors to a lot of work that they may not have time to do other things.
Living on crumbs
Dr Yusuf Mohammed Jamiu, a resident doctor in Kwara State, said the statistics of unemployment among younger doctors is about 60-70 per cent but for the older doctors or consultants, their complaint is overwork and poor working condition.
He explained that doctors who stay for too long without finding jobs usually contend with low paying jobs at private hospitals to fend for themselves and their families.
Dr Yusuf, who is also the Publicity Secretary of the Nigerian Association of Resident Doctors, Kwara State, said the effect is more palpable for the young doctors.
“When doctors finish, they are supposed to have internship and then engaged for job. But if they are staying too long before they get the job, they have to start looking for jobs that may not pay well to fend for themselves. This problem is not just the doctors, it cuts across all other para-medicals.
“The experience for young doctors has been very challenging and the best we can say is that the work is overwhelming and the fatigue is very serious for the doctor’s health and detrimental for the patient because of the poor service outcome. Imagine a hospital that is supposed to have 10 to 20 doctors in a unit having just five or less than that and they are expected to do the work of the 20,” he said.
Minister of Health, Dr Osagie Ehanire, had during a briefing said government was working towards smoothening the employment process.
He said the ministry was working with the Office of the Head of the Civil Service of the Federation to have a one-for-one policy of employment.
“So, if one doctor resigns today and goes abroad, we will employ one doctor. If it is one nurse, we replace it with one nurse. So, if we adopt a one-for-one replacement, we are not likely to have a shortage,” he said.
A commissioner of health in one of the states in North West admitted there was the need to address the contradiction.
“It is true that many medical doctors are not employed or are underemployed and we are all culpable…You cannot isolate brain drain from the existing problem of doctors not getting well- paid jobs despite the struggles they passed through to get to where they are.
“The money needed to maintain the services of a medical doctor especially those that are consultants is huge and when some governors looked at the implications, you see them maintaining a cold posture.
“But sadly, this is not helping the situation and we have to face the reality sooner than later. Nigeria has the capacity to train and retain qualified doctors to attract patients from other climes,” he said.
Our experiences with unemployment – Doctors
Dr Ibrahim Musa Ibrahim studied medicine in Egypt and graduated in 2019. After his housemanship at the Katsina State General hospital and his National Youth Service Corps (NYSC) in Kaduna, he now works in a private hospital because he is unable to secure employment in a government hospital.
He told Daily Trust Saturday that many of his colleagues were unable to secure employment with government hospitals and have resorted to lower pay in private hospitals.
“A friend of mine, with whom I graduated at the same time, who did his housemanship in Abuja, is still struggling to secure a job with the Kano State Health Service Management Board. And when you visit any of the government hospitals, you will discover that only few doctors are working there, yet they do not employ,” he said.
He said this is why many look for alternatives in either private hospitals or travel abroad. “Many doctors are now taking English tests to move to the United Kingdom and other countries with good working conditions,” he said.
He described as abnormal, having just two doctors in a department who will equally have to be on call, adding that the issue of working conditions and adequate man power in government hospitals must be tackled.
“By employing more doctors, I think the workload will reduce. Another thing is the issue of salary and good hazard allowances as well as good facilities that should be provided in government hospitals,” he said.
Dr Khalifa Usman Abdullahi is a young doctor and private physician, who worked as a physician with the Federal Medical Centre, Birnin Kudu, Jigawa State.
He said he recently left government job for a more lucrative organisation all in a bid to achieve financial stability and he’s now being paid thrice his government salary.
He said, “People generally, especially family members, don’t believe you when you say you don’t have money and it’s a fact.
“I had always thought of leaving the country also before my recent appointment with the NGO. Most of our people are leaving not because they just wanted to, but the issue of welfare, inadequate manpower and lack of working facilities are part of the problem.
“Most of the countries we are going to, we don’t enjoy staying there but we want financial stability. We just want to go there, spend some years and then come back to establish what will enable us to be financially stable.”
Some young medical doctors in Rivers State said they are finding it difficult to get employment in government hospitals.
A young medical doctor, John Harry, said three years after graduation, he was not able to secure employment in any government owned hospital.
He said his inability to secure employment in government-owned hospital forced him to seek alternative employment in private hospital.
“During the Amaechi administration, the state government employed many medical doctors to serve in over 60 primary health care centres built across the 23 local government areas of the state. Many young doctors were employed and deployed to various hospitals in the rural communities. But when this present administration came on board, it could not maintain the hospitals and many of them are not functional. This made it difficult for doctors to be engaged,” he said.
Another young medical doctor who pleaded anonymity said, “I am managing in one private hospital just to make ends meet. What I am being paid is nothing to write home about but I have to manage it till I get something better. It is difficult to get employment in government hospitals. Many of the primary health centres in the rural communities are not functioning and that is the reason why government is not engaging doctors,” he said.
Our reporter could not get the statistics of the number of unemployed medical doctors in the state just as efforts made to speak with the State chapter of the Nigeria Medical Association was not successful.
A source from the state hospital management board that was not authorized to speak told our reporter that the state government will soon engage medical doctors.
“The state government recently entered into partnership with PEMO Medical University to train about 100 Rivers State indigenes in medicine. I’m sure that the state government will make provisions for their engagement after graduation,” the source stated.
Experts view across states
A consultant Paediatrician and Neonatologist, Special Care Baby Unit (SCBU) of the department of Paediatrics, Aminu Kano Teaching Hospital (AKTH) Kano, Dr Hadiza Ashiru Usman, has revealed that the Doctor to Patient ratio in Kano State is 1:16,529.
She said while the population of Kano is estimated to be 20 million, the total number of medical doctors in the state is 1,210.
While 533 are with the state hospitals, some are administrators, some with the ministry and Hospital Management Board, 436 are with Aminu Kano Teaching Hospital (AKTH), 95 with the National Orthopaedic Hospital, Dala (NOHD) while 41 are lecturers and Sick Bay.
“Beside all these, 105 are either on private practice, working with NGOs, retired, not practicing or into business. There is gross inadequacy.”
She expressed with dismay that the paucity cuts across all cadres from doctors, nurses, to pharmacists, laboratory scientists and other supporting staff in the hospitals.
Dr Hadiza further noted that while women of reproductive age group ranging from 15-49 years of age constitute 25 percent of the population, the ratio of obstetrician to woman of child bearing is 1-156,250.
She pointed that while the total number of obstetrics and gynaecologist consultants stands at 32, Aminu Kano Teaching Hospital (AKTH) has 22, Muhammad Abdullahi Wase Specialist hospital has four, Murtala Muhammad Specialist Hospital gets one.
Others are at the National Orthopaedic Hospital Dala (NOHD), which has one, Yusuf Maitama Sule University Teaching Hospital YUMSUTH also one while three are with private hospitals.
“Total number of paediatricians is 37 and Aminu Kano Teaching Hospital (AKTH) has 30 and only six are with the state government while children of age 0-14 years forms 42 percent (8.4 million) of the population.”
However, in his reaction, the Kwara State Chairman of the Nigeria Medical Association (NMA), Dr Ola Ahmed, said the problem of unemployment among doctors is linked to brain drain and the bottlenecks that hinder the replacement of doctors that have left the country.
“Doctors are leaving the country for greener pastures. From the state, people are leaving for federal jobs and to foreign countries because of better pay. And then, replacement is taking a lot of time as well as the procedure because of Civil Service bottlenecks,” he said.
He said delay in such replacements was creating a gap that is compounding workload problem on those in service. The NMA chairman urged the government to take urgent steps to curtail Civil Service bottlenecks and to recruit more doctors into the system.
“The Kwara State Commissioner of Health, Dr Raji Rasaki, did not comment on the unemployment rate in Kwara as several calls to his phone were unanswered and a text message sent to him was not replied.
Dr Emeka Innocent Orji, president of Nigerian Association of Resident Doctors (NARD), said the way out is for the federal government to increase budgetary allocation to the health sector.
“If you don’t have enough funds, you are not going to have enough manpower, welfare package, incentives, remuneration, improved conditions of service, and equipment,” he said.
He said budgetary allocation to the health sector in Nigeria is still a far cry from the 15 percent “Abuja declaration”.
He explained that in 2001, heads of state of African Union countries met in Abuja and concluded that for any country to make improvement in healthcare delivery, it must budget minimum of 15 percent of its annual budget to the health sector.
He however said that Nigeria has not kept to that declaration to date, saying even the 2023 budget presented by the president few weeks ago is, less than six percent of the annual budget.
Dr Yusuf Mohammed Jamiu, the Publicity Secretary of the Nigerian Association of Resident Doctors, Kwara State, said “The reality is that is it becoming a common trend and the solution should be a holistic one. But the reality is that we need more health workers in the hospital across board because of the shortage of manpower.”
Kwara State Chairman of the Nigeria Medical Association (NMA), Dr Ola Ahmed, suggested that the government need to look at the remuneration of doctors.
“‘We have issues with remuneration of doctors across board at the federal and state levels. It is even worse at the state level because they are being paid lesser than those at the federal hospitals. The government needs to review salaries of doctors in order to be able to keep them in service,” he added.
State government’s mum
The Kwara State Commissioner of Health, Dr Raji Rasaki did not comment on the unemployment rate in Kwara as several calls to his phone were unanswered and a text message sent to him was not replied.
Efforts to reach the Kano state ministry of health was not successful as calls put across to the Public Relations Officer of the ministry, Hadiza Namadi rang out unattended.
Attempts to reach the Kaduna State Commissioner of Health, Dr Amina Mohammed Baloni to speak on the unemployment figure in the state was unsuccessful as her phone number was unreachable. A text message sent to her was yet to be replied at the time of filing this report.