The period of Medical school cannot easily be forgotten by most Doctors. This is particularly true in Nigeria, not because of the long years (usually between 6 – 12 years depending on the particular predicament of the medical school), but because of the long hours spent day-dreaming and visualizing the ‘good-life’ immediately after med-school.
Most people do not understand this, but this ‘good-life’ has been rehearsed countlessly by many doctors in their undergraduate med-school days. It is the minimum acceptable life that every medical student expects to lead and live post-graduation.
For most, it is simple and uncomplicated, but for a majority of medical students (who are academic gladiators), the good life entails much more than the average earning (among professionals and of equal standing) in the society.
The reality is that over 70% never get to live out the “good life”. This dream is bashed and shattered, a concept not entirely new to the new graduates, who have seen friends and colleagues fail and sent out of medical school. What is most distressing is that this is the ‘normal’ in the society.
As a newbie in med school, all that matters is to scale one exam unto the next exam. Practically, a medical student is constantly on the alert for a surprise quiz, or test that nothing else must be placed above the primary aim. Medical students love the thrill of the moment, of the competitions. It could be exhausting, but that is what keeps the strong going.
But ask, many doctors today if given another chance, what would they rather study do things differently? Would they rather get to be more entrepreneurial? A larger percentage of our respondents in an unofficial study agrees that going to medical school and becoming medical doctors will not make them financially rich. Some even thinks the contemporary Nigerian society no longer values the title, ‘Doctor’.
Evidently, the answers are laced with pain and regret.
The thinking among Doctors is how can it be so hard for the society to let them live out this life. Rather the society is perceived as being a passive observer, while the Government pretends to be helpless in its quest to better their welfare.
What then is the next option? It is clear that the next option is definitely not in the country. So, Doctors ‘reset’ their gaze, their priority, and aspirations onto another clime, another society where they are being valued.
THE MIGRATION BEGINS…
Data from the Medical and Dental Council of Nigeria have it there are about 80,000 registered Medical and Dental professionals on her register, but over 50,000 of them are outside Nigeria practicing in other economies.
The major reasons for these migrations are obvious and have been let to linger for so long.
It has lingered for so long, that I daresay, it has become a topic of choice for most professional Whatsapp group pages, where information about how to hurriedly leave Nigerians are discussed, success stories are shared and significant financial gains seen for those who have made the moves to relocate.
I have been able to identify some major areas that would keep propelling medical and dental professionals out of the country for the ‘Good-Life’;
FOREIGN POSTGRADUATE MEDICAL TRAINING
I should say that not all medical doctors who travel out of Nigeria are actually going for postgraduate training immediately, even though this is usually the ultimate goal.
Nigeria has two Postgraduate Medical Colleges – National Postgraduate Medical College of Nigeria and West Africa College of Medicine (or Surgery depending on specialty). But there have been accusations of corruption and mismanagement of these Colleges. Not even talks about racism in USA, Britain or elsewhere is holding Nigerian Doctors back from moving to these areas.
Medical Doctors who wish to study in any of the two Postgraduate Colleges have to spend another 4 – 9 years of gruesome reading and medical practice. For a specialty like Otorhinolaryngology ie ENT, candidates spend as much as 6-8 years to become a Fellow and Consultant. Specialties like Radiology and Psychiatry require 4-5 years in training before becoming a consultant.
However, in the USA which is the choice destination for most medical doctors, specialty training is not more than 4 – 5 years, even for highly technical and complex specialty like Neurosurgery. A period of 2-4 years is all it takes to become a consultant in more developed climes.
A senior colleague once advised me saying;
“As soon as you finish your House Job, come back to Lagos and begin to put things in place for you to leave this country. Remember, go anywhere else even here in Africa, but do not remain here in Nigeria. Tanzania and Malawi even pay better than Nigeria”.
So, it is no surprise to see droves of medical doctors simply just leaving to any other place, provided it is not Nigeria.
Imagine this: In the UK, a Medical Officer (who is more 2-3 years post-NYSC) earn as much as £50,000 per annum; if he decides to do a locum job, he would rack in somewhere between £1000 – £3000 per month. While in Nigeria, his classmate working in the highest paying government hospitals earns about N300,000 per month which is about N3.6million per annum.
Convert the £50000 to Naira (at the rate of £1 = N500). This translates to N25million per annum (minus the locum jobs) for a UK based Nigerian Doctor.
I hope this puts things in perspective. In the USA, the value is even higher than those of UK based medical professionals.
PROFESSIONAL EXAMS (FOREIGN Vs LOCAL)
Professional postgraduate training is coordinated by two colleges – a National College and a West Africa College. To gain admission and begin the residency program, doctors have to sit for and pass a Primary Fellowship Exam. The cost of this examination is quite heavy.
Doctors in Nigeria willing to practice in the UK would have to pass the PLAB I and PLAB II. Those going to the USA, have to pass the USLME. Another popular clime where doctors go to is the United Arab Emirate – Dubai Healthcare City.
An official from the UAE periodically recruits medical doctors (and indeed other health care professionals) to work in the oil-rich Middle East country.
The cost to sit for the primary examinations is quite expensive when compared to the cost paid by doctors sitting for other foreign examinations.
My observation is that most Nigerian Doctors are simply not applying for the residency programs in the country any longer. To sit for the primary examination, doctors have to pay as much N150,000, which is almost equivalent to the cost of the PLAB exam.
Last year, the West African College was forced to review its price downwards because doctors a few doctors applied for the program. I can boldly predict that the same fate may soon befall the National College.
WORKING CONDITIONS & LOCATIONS
At the moment, the destination of choice for a Nigerian doctor include Canada, United Kingdom, United States of America, United Arab Emirates, Europe etc. African countries include Tanzania, Malawi, South Africa etc
Some doctors who move out of Nigeria to Canada or other developed countries actually start out working from the suburbs of major towns and cities. Then they work their way gradually into the heart of the town or city.
It is no longer news that Nigeria’s health sector is weak and unstable. Professionals love to work in facilities where their expertise can be put to use and where equipment are available for optimal diagnosis and care. Nigeria cannot boast this.
So it is seen as a disservice by a school of medical professionals to keep working in Nigeria, where they are not giving their best to patients, who deserve the best. This was the first motive for the brain drain. But since then, a lot has gone under the bridge.
Note that almost 100% of newly inducted medical doctors would never want to practice in a village if given the option. But, medical doctors leaving Nigeria would not be miffed to start off from the village. Basic amenities of light, food, housing/shelter, electricity and other good things of life are made available to them.
DELIBERATE GOVERNMENT POLICY
Recently, the government of the UK announced new measures aimed at relaxing Visa application policies for foreign Medical Doctors and other health professionals. The news is a great one among medical professionals who are already taking advantage of the new policy.
It appears the Nigerian government is not aware of this trend and would rather remain blind to the active migration of doctors.
Nigeria Government has to sit up and develop policies that would encourage doctors to stay back, and even encourage those who have gone to consider coming back. Like smoke, doctors are being attracted and frisked away to operate in other economies.
This is an albatross for the modern day medical professional working in Nigeria. Truth be told, Medical Doctors are just fed up with the unhealthy rivalry that positions the patients as the worse hit when the squabbles die down.
Even as I do not intend to trivialize the demands of the JOHESU or NMA, I call it squabbles since financial prosperity is the basic underlying motivator for the strike actions, and it is nothing compared to the main crux of the matter, which is that the Health Sector is sick from the roots and it needs a gradual but total overhaul.
The malady is deep-rooted and it is causing major instability in the sector. It must be fixed, but in the meantime, most doctors are making their way to more stable economies, where they are valued and cherished.
CONCLUSION: A-BOMB SOON TO IMPLODE
Even as this sounds easy, it is a hard choice to make when you consider that doctors have to leave loved ones, families, friends etc and relocate to a country you are not familiar with. It is a major change that most times requires a lot of thought.
In Medical School, all we think about is how to be a better doctor; in what ways would our training help humanity. Relocation is not a matter that I consider topmost in the mind of doctors. However, when reality sets in it become the brightest path to follow.
This is where government should come in. To do the needful by encouraging more private sector participation in healthcare service delivery and postgraduate training. Addressing the overwhelming propelling factors supporting the migration of medical doctors and having the will to do things differently, may just be enough to stop the total migration of medical doctors out of the country.
This is the way to go.
This piece follows weeks of intense fact-finding, observations, interviews, chit-chats, and internet searching. Readers should note that this is an active brain drain, that deserves urgent focused intervention for this professional brain drain to be halted.