The Senior Staff Association of Universities, Teaching Hospitals, Research Institutes and Associated Institutions (SSAUTHRIAI) of Nigeria has expressed worry on the spate of strike actions by the resident doctors in our teaching hospitals and federal medical centres and called on the secretary to the government of the federation to redefine the status of these resident doctors
According to the SSAUTHRIAI letter released, it said this year alone, the association of resident doctors (not a registered trade union) has gone on strike three times within six months with negative consequences on the health of the citizens. This is so because top government officials of the federal ministry of health as well as chief executive officers of our tertiary hospitals who themselves are members of the Nigerian Medical Association aid such strikes. The situation is always critical because our teachinghospitals do not have thier own permanent staff doctors. The Categories of doctors in the teaching hospitals are: House officers who are interns, the resident doctors are training to pass their fellowship examinations while the Honorary consultants are staff of the university
CURRENT STATUS OF RESIDENT DOCTORS
The resident doctors are graduate medical practitioners who are undergoing postgraduate residency program for the award of the postgraduate diplomas (fellowship) of the postgraduate Medical Colleges (Nigerian or West African). By design, they are not staff of the hospitals in which they train but they are paid salaries and allowances and most often thier strikes are over remuneration issues. This should not be so.
In the early 1970s up to the early 1980s, all trainings in the federal tertiary hospitals are done on in-service basis when Nursing, Radiography, Medical Laboratory, Health Records students and Resident Doctors are paid salaries in training and absorbed into the hospital service after thier training. Later, with the increase in the number of students and paucity of funds, payment of salaries to all students except the resident doctors stopped and up to date students of the various schools of the hospital pay school fees and are not absorbed into the hospital service automatically after their training. Even though, Resident doctors are also no longer absorbed after the training, they are still paid salaries and allowances and to a ridiculous extent dictate what they should earn and what other permanent staff of the hospital should earn.
In essense, they are trained free of charge, get salaries and allowances and yet disrupt services at will hence the need to reappraise the program and redefine the status of the Resident Doctors.
Currently, Resident doctors behave as if they are on in-service training and government treat them as such whereas they do not follow the criteria for in-service training. They are not employed as permanent, pensionable staff on probation until appointment is confirmed nor placed under bond for the period of the training since the intention is not continuation of service after training. This is one of the causes of disharmony among health professionals who feel the doctors have preferential treatment.
In order to bring sanity to the training, make sure that training of Resident doctors with taxpayers money is done in critical areas of need for the benefit of the citizens and reduce strike actions especially in this era of economic downturn, Resident Doctors should be categorized into three
i) Hospital Sponsored Residents: who will be appointed as Medical officers, serve the hospital for a minimum of two years and upon confirmation be qualified for sponsorship for residency program in the areas of need of the hospital. This category of residents will be appointed as Hospital consultant after training and be under bond for the number of years of the training.
ii) Government/ other Agencies sponsored Residents: Medical doctors sponsored for residency by state or local governemnts or other government agencies. They will pay prescribed fees to the teaching hospitals for the training and will not receive any remuneration from the training institution. The Residents after the training will serve their sponsors
iii) Private Residents: Medical Doctors who are self sponsored or sponsored by private organizations for residency training. They pay prescribed fees for training, will not receive any remuneration from the training instituion and are free to seek employment anywhere after training
The current practice is that more than 95percent are sponsored by the teaching hospitals, paid salaries and allowances by the teaching hospitals. They seek employment in universities and if employed automatically become honorary consultant to the teaching hospitals. They may equally seek employemnt elsewhere. This is the only program currently fully sponsored by government without any bond.
As a corollary, there is also the need to reappraise the appointments of honorary consultants in our teaching hospitals because of the implications on the resources of the hospital and consequently the effects on the services rendered by the hospitals.
IMPLICATION OF THE PREPONDERANCE OF HONORARY CONSULTANTS OVER HOSPITAL CONSULTANTS ON THE EFFICENCY AND RESOURCES OF THE TEACHING HOSPITALS
Honorary consultants who are university staff are employed as Chief Medical Directors of the teaching hospitals. They are appointed as Chairman Medical Advisory Committee and also as Heads of the various clinical departments. Of recent, they are appointed as Deputy CMAC, and there may be up to six deputy CMAC’s in a teaching hospital. This was the case in UCH, Ibadan and many other teaching hospitals
It is obvious that with these appointments the resources of the teaching hospitals are controlled by the Non-full time staff of the hospitals who are university staff. They spend the hospital money on course abroad for Hon. Consultants and will not hesistate to incur huge medical expenses on the staff of the university while the full time staffs of the hospitals are often neglected. This invariably causes disharmony among the various staff in the hospital
Rather than performing the medical duties for which they have been appointed in line with section 5.5 of the hospital act to justify the over N800,000 allowances collected monthly, they hold administrative positions as deputy CMAC Engineering, deputy CMAC Energy, deputy CMAC Laboratory services, deputy CMAC special duties not provided for in the enabling act. They head hospital departments, head administrative panels and fight for offices even when and where full time staffs have no offices
These they do with the support of the chief medial directors in contravention of the enabling Act and the laws of the land and with negative consequences on the medical duties for which they have been engaged as adjunct staffs
PROPER DEFINITION OF THE HONOURARY CONSULTANTS APPOINTMENT
There is the need to define in clear terms the nature of appointment of honorary consultants. From current practice, it is more or less a permanent appointment and it should not be. Once appointed Honorary consultant, the appointment is never reviewed. There are Honorary consultants who have served more than 35 years in the teaching hospitals. There is no performance appraisal even though full time staffs are appraised annually. Thre is no contract term or renewal terms which make most honorary consultants do whatever they like
In summary, a servant cannot serve two masters effectively at the same time as it is the case with the honorary consultants in our various teaching hospitals where the appointments of hospital consultants who will serve the hospital fully and bring more effectiveness and efficiency to hospital services are prevented by the Honorary consultants. The government should be bold enough to reverse this situation in the general interest of the public and to reduce medical tourism to the barest minimum in this country.
We are ready to make clarifications on any aspect of this our submission