Last week, I got a mail from a young man who reminded me of a series I once did regarding “choosing a career as a medical doctor”. He said he needed the writings for himself and his siblings. Having found in my archives the two-part column which I wrote in February 2007, (three months before I took up appointment as spokesman to the late President Umaru Musa Yar’Adua) I sent it to him; titled: “Who Wants to Be a Doctor?” I consider the message therein important for a time like this, perhaps so that some of us might temper our anger against members of the Nigerian Medical Association (NMA) who, in clear violation of their professional oath to save lives, have been on strike for almost a month now.
I am not in support of the ongoing strike by the doctors and the timing could not be more inauspicious given the outbreak of Ebola virus within the West African sub-region with serious threats on our shores. With the death yesterday of a Nurse who was involved in treating the late Liberian victim who brought the virus into our country (and five other cases), our striking doctors have now come under local and international spotlight.
Therefore, as much as I have sympathy for their plights, I plead with them to call off the strike because it is not doing them any good, and the cost to the nation is too high, especially at such a delicate period as this. The challenge of Ebola Virus, which also claimed a life yesterday in Saudi Arabia, calls for a rethink of their strategy. They also do themselves no favour with some of their demands which are more political than professional.
Notwithstanding, the essence of the piece is for us to appreciate the men and women who attend to our health and the challenges they also go through, which unfortunately is more hazardous given the recent cases with Ebola Virus. However, readers must note that the reproduction below was first published in February 2007 which makes it more than seven years ago. It is not a defence of the striking doctors but just so we can understand the state of the profession. The sad bit is that it is almost as if it was written yesterday.
When I was growing up, and I guess it is the same with the previous generations, almost everybody wanted to be a doctor, medical doctor that is. It was a profession of prestige. It was not for the average student. You had to be good in mathematics and the sciences.
Some of us knew our limitations and pursued other things. Today, many would look back and thank God for His ‘mercies’ in not nudging us along that career path. It is not that the standard has fallen or that the profession is still not prestigious. It is just that next to policemen and teachers, medical doctors have become the most neglected in our society, at least within the public sphere. The ‘doctors’ we value and promote now are the illiterate moneybags, corrupt public officials and people of dubious characters who are awarded honorary doctorate degrees by our universities and the ‘men of God’ who just add the prefix to their names, including those who never even went beyond secondary schools!
Anytime I encounter medical practitioners and I see the evident lack of rewards for people who save lives, I always feel a sort of pain. To worsen matters, whenever they demand what should ordinarily be their entitlement, we are ever quick to condemn and remind them of their obligation to a society that has scant regards for their own plights. Right now, doctors are on strike but how many people really care?
I have not seen anything, either from the people in government or those of us outside, to show that we appreciate the fact that lives of poor Nigerians are already hanging in the balance as a result of the strike by doctors working in public health institutions across the country. But does it matter in a system so perverted that public officials now announce glibly, almost as routine, that they are travelling abroad for medical check-up?
Last week, I got the mail published below from a friend, Dr. Yinka Buhari, a consultant at the University of Ilorin Teaching Hospital. I felt depressed after reading Yinka’s mail and I sought his permission to run it which he granted. But I also decided to have an insight into how doctors are treated abroad and in the process came across a very exciting web site called NHS BLOG DOCTOR, run by a British medical practitioner, Dr. John Crippen, who works with the United Kingdom NHS. The significant lesson is that there is no perfect system anywhere while we can easily see why the public health system has collapsed in our country. It is a continuation of the culture of decay in which public institutions, from schools to utilities are allowed to die while we all erect our individual cocoons that will soon explode in our faces.
Today, the best of our health workers still seek pastures that may not be green in Saudi Arabia and other Arab countries. But the award winning web site of Crippen, frequently visited by leading publications, provides insight into Medicare in the UK and the life of a doctor. What particular struck me is the letter written by a young man who wanted to enter medical school who sought advice from Dr. Crippen and his reply which is rather instructive as we seek lasting solution to our healthcare problem in this crisis period. It is entitled “Should Sammy go to medical school?”
“Dear Dr. Crippen,
“Do you have anything positive to say on a career in medicine? I ask because I will be applying to university soon, possibly for medicine, and so far the cons seem to outweigh the pros. Competition to get into medical school is crazy-fierce, and yet everyone in healthcare I have spoken to tells me to get out while I still can and become an accountant or a children’s TV presenter or something. So I humbly call upon your mighty wisdom. Are all those straight ‘A’ students so misguided? Or am I just missing something?” —Sammy
Dr. Crippen’s Reply:
“Dear Sammy, “There is something special about being a doctor. It slightly changes your relationship with fellow human beings. It entitles you to put that mystical word ‘doctor’ before your name. Yes, I know, lots of other people are doing it too now (the dentists, the vets and so on) but nonetheless, in the medical context it means something special. Practising medicine really is about helping people. Of course, you cannot say that at a medical school interview. The interviewing Dean of Medicine will fall of his chair giggling and ask why you are not joining the fire-brigade. Actually, not such a stupid question. That is also about helping people too.
“In most countries, doctors are reasonably well paid. As a UK doctor you will never be poor. But you will never be rich. And you are unlikely ever to earn as much money as friends of equal intelligence going into different careers. You will have excellent job security and, unless you start having sex with the patients, will never be sacked. How much will you earn? In today’s terms, if you become a GP you can expect £100,000 a year, give or take. If you become a consultant, your NHS pay will be between £70,000 and £90,000 a year before private practice and merits awards. Most consultants do not have a huge private practice, and few make a great deal from merit awards. A successful gynaecologist or ENT surgeon can make very serious additional money indeed. A psychiatrist, a geriatrician, a haematologist, or a paediatrician may make no more than the basis NHS pay.
“How much money do you want? What a vulgar question. When I was 18 I did not think of that at all. I had a vague assumption I would be reasonably comfortable, and I am. But I could not do the things we do if my wife was not a full-time high earner herself. If you want to live in a salubrious suburban middle class area such as, for example, Kenilworth, and you want to have two cars, a wife who does not need to work, four children all educated privately and a couple of expensive foreign holidays a year, then you are not going to be able to do it on a single doctor’s salary. Unless you are a gynaecologist with a large private practice. You could do all that easily if you were London City solicitor!
“You are right about the current educational entry requirements for medical school. They are absurdly high. If you are clever enough to get into medical school nowadays, you are clever enough to do anything. Personally, I would regard working in the city as a lawyer/fund manager/accountant/stockbroker/investment banker as a fate worse than death, but that is where the money is. My wife and I are both doctors. We have four children all of whom are (if it does not sound too arrogant) clever enough to go to medical school. None of them will, and that is not because we have discouraged them. We have a lot of friends who are doctors. I cannot off hand think of a single medical couple who has a child who is going to follow in their footsteps. That in itself speaks volumes. A generation ago, medicine was almost a hereditary career.
“Doing medicine will deprive you of most of your twenties. Both my wife and I spent the greater part of our late youth working every hour in hospitals. Our social lives closed in. Friends who were not doctors lost patience with the fact that we were usually not available and, when we were, we kept dozing off in the middle of conversations. It is not as bad as it was. But shift work is destructive. And now, there is the real possibility of unemployment for young doctors. The government has realised that it is cheaper to use none medically trained staff to do traditional medical jobs and, to an extent, they are getting away with it. Sammy, all I can say to you is that, if the passion burns deep, then you must do it. But it if it is just one of several options, then I would look elsewhere. I still enjoy my job, when I am allowed to do it. But, knowing everything I know now, looking down the all-powerful ‘retrospectoscope’, would I do it again? “No!”
Who Wants to be a Doctor?…(2) I have heard all sorts of arguments as to why affluent Nigerians would rather go abroad when they have headache than seek medical attention here at home and I refuse to be swayed by most of them. The simple truth is that it is part of the larger malaise in which we all believe we can kill the public system simply because we can afford to send our immediate family abroad. That is why public education has gone to the dogs, the same thing we are doing to healthcare. We have a reward system that more or less puts those who save lives at the bottom of the pyramid but it seems to be a universal phenomenon though nothing excuses the neglect of the health sector in our country, an issue that has to be addressed.
Aside providing the basic infrastructure for the health sector, an issue we would still need to address, that of commensurate remuneration has become a major concern if our doctors must stay in this environment to practice their trade. We must stress it for those who aspire to rule us that in today’s world, three of the key indices for measuring the prosperity of any nation are security, healthcare and education and Nigeria is failing on all counts. And part of the problem in these key areas remains the warped reward system.
Incidentally, the first part of the piece provoked a deluge of responses from Nigerian medical practitioners from all over the world. For the purpose of this column today, I have picked two letters here to drive the point home. The first is to show that the problem is global while the second localises it and puts our situation in its proper context.
While I end this intervention with another letter, I need to point out that a career in medicine still remains a noble choice for those brilliant enough to make the grades and would still recommend it for qualified students in the sciences. There are, however, basic issues we must address, especially in our country, if we are to join civilised societies who take the health of their people very seriously. Right now, we don’t. But in concluding the piece I tend to have raised more questions than answers. I just leave the readers to pause and ponder. The writer is Prof. Femi Oyebode, Head of Department of Psychiatry at the University of Birmingham, Queen Elizabeth Psychiatric Hospital who also doubles as the Chief Examiner, Royal College of Psychiatrists and a Research Fellow at the Centre for West African Studies at the University of Birmingham. A respected medical practitioner of 30 years, Prof. Oyebode’s letter is indeed very instructive:
“I very much enjoyed your article on doctors. You certainly captured the current tensions in the profession by your use of letters. The problem with medicine is at present worldwide. Our students require a minimum of 2As and a B to get in and the work is tireless for five years. Postgraduate medicine is now mandatory for all doctors; even GPs have to train to be specialists. Yet, remuneration is modest and job satisfaction is questionable because of the changes in the work environment. This is an international problem.
“The World Health Organisation (WHO) has a paper out that argues that governments are trying to undermine medicine as a profession. Whatever the case there is little doubt that for a young doctor the stresses are tremendous and the motivation to continue to do this work, which can only be described as noble, must be internal and self-generated. This year I have been a doctor for 30 years and the privilege of serving others has been fulfilling and continually motivating. But, even I now ask whether I can in honesty advise any young prospective student to take up medicine. Such is the state that the profession is in.”