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Inside the minds of young doctors

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After enduring seven years in medical school, sometimes extended by disruptive academic workers’ strikes young doctors lament that their future is often enmeshed in frustrations as they seek to make a career in clinical practice, reports Associate Editor ADEKUNLE YUSUF.

It was an evening of emotions as young doctors, drawn from public and private hospitals in Lagos State, expressed their frustrations and disappointments in their first few years on the job. After spending seven years in medical school, sometimes extended by disruptive academic workers’ frequent strike actions, young doctors lament about the nightmare of having to find places to complete the compulsory one-year housemanship within two years of graduation. This took place last weekend at a form organised for young doctors by the Lagos chapter of the Nigerian Medical Association (NMA).

The young doctors complained that it is hellish for them to find a job after completing the compulsory one-year National Youth Service Corps (NYSC), forcing many of them to roam the streets in search of elusive jobs. Yet, paucity of medical professionals is one of the problems afflicting the country’s moribund health sector. They also protested the poor payment during NYSC and post-NYSC years. Another frustration for many doctors is getting into residency programmes or completing a specialist training to qualify as a specialist, an experience that is said to be worsened by prohibitive cost of qualifying primary examinations as well as high rate of failure in the examinations. Young doctors also detested how many of them are used as supernumerary doctors (without being paid for the service they render) and queried why medical elders prefer to hoard knowledge.

After a long session, the following questions were put forward: How can incessant strikes in the health and education sectors best be prevented in order to stop worsening the plight of medics? How can the process of appointing house officers be better simplified and more transparent? When is the practice of using house officers as supernumerary doctors going to stop in Lagos? How can the process of applying to specialist training programmes be improved? How can the issue of unemployment for doctors be addressed? How can issues of poor remuneration, late or non-payment of salaries of doctors in the private hospitals be handled? Can there be more innovative ways of financing the initial costs of specialist training or are there ways to make it cheaper? Is there any justification for the high failure rates in the specialist training programmes? Can the process of appointing consultants and other health workers be more transparent and accountable?

First to allay the fears of young doctors was Dr. S.K. Adebayo, past NMA chairman, who admitted that the challenges are real but not new. He cautioned his younger colleagues not to feel any regret for studying medicine, stressing that they should not allow anyone or anything to frustrate their future. While stressing the need to impress it on medical elders to consider mentorship as an obligation they owe new doctors, he said his colleagues who are in the habit of hoarding knowledge are “making themselves to look unpopular and unreasonable in the future. When you help the junior ones, the respect you get from them later in the future makes you feel fulfilled.” As for the poor pay in the private hospitals, he admitted that there is no fixed amount in the industry, but he promised to speak with his colleagues in the private practice to “because we should have a minimum amount we pay medical officers.” He added that “it is time we start blackmailing hospitals that don’t treat the young doctors very well.”

Responding, Dr. Saliu Oseni, Lagos NMA chairman, said he was delighted by the way the doctors bared their minds, saying the reason behind the forum was to feel their pulse with a view to coming up with practical steps towards solving the problems. Specifically, those targeted included doctors who are less than five years post induction, house officers as well as doctors in private and public practice who are less than five years. “The primary essence of this forum is to address strategic issues affecting us as professionals. We focus on issues relating to employment for young or newly qualified doctors. While it is your right to demand for what is your due from the association, we must also remember to be conscious of our responsibilities to the association. This forum is to address welfare-related challenges that are peculiar to the newly qualified and immediate post-NYSC doctors. It is a known fact that placement for housemanship, placement for residency training, regular employment of doctors and inappropriate remuneration for doctors in private employment have become major challenges for young doctors.

“In our determination to find lasting solutions to these challenges, we have been making frantic efforts to ensure government put in place mechanism for adequate employment of doctors with seamless exit-replacement plan. Though the shortage of manpower in the health sector has been ascribed to brain drain, there are still so many young doctors seeking employment or placement for residency training without the hope of finding one.

“While there are only two institutions in the state for the training of doctors with the total capacity of over 300, we have more than four hospitals with placement for more than 400 house officers. Thus, the question that arises is how come the newly qualified doctors have difficulty with placement for housemanship? We are convinced that seamless exit replacement and yearly periodic employment will improve the medical manpower in our hospitals, improve placement for training residency and housemanship and provide opportunities for employment for young doctors,” Oseni said.

He promised to table all the concerns at the next meeting of the association so that issues that require immediate attention can be quickly resolved. However, the NMA chairman lamented about the poor attitude of many doctors towards the NMA activities generally, urging his younger colleagues to be more up and doing in their membership dues and always attend NMA meetings, stressing that the association belongs to everyone – not only the elders of the profession.

The forum was, however, not only about lamentations and frustrations. The association also brought in seasoned medical and business management experts to discuss and share their knowledge on emerging business perspectives and new opportunities in clinical practice. Delivering a paper on healthcare as a business and its several facets available, Dr. Ademolu Owoyele, managing consultant with Harley and Wall Consulting, a healthcare and business consulting firm, first drew a line between medicine and healthcare, saying medicine is a profession while healthcare is pure business. He stressed that new doctors need to be adequately prepared for the challenges they are likely to face in the open market in terms of career paths and how to access same.

While imploring the medics that innovation is a vital ingredient for success for anyone seeking to make a difference in medical field, he added that it is a sad reality that many still suffer from having a myopic view of healthcare marketplace from the core medical perspective. Because many young doctors are not properly aware of variety of career paths available to them in clinical practice, Dr. Owoyele stated that they often feel they are stuck with residency programme, leading to frustrations and brain drain. He urged his colleagues to open their eyes to limitless business opportunities that abound in pharmaceutical medicine, healthcare consulting, managed care, laboratory and imaging diagnostics, stressing that the world of medical practice is now so wide and dynamic that new doctors can focus and specialise in any area and make a success of it.

“There is the need for us as medical doctors to be well prepared right from medical schools for what we are likely to face in the open market in terms of career paths. While in medical school, we all have feelings and coming out of medical school, we feel a bit lost because we are not prepared for what we are going to face in the open market. The only we are taught is medicine, medicine and medicine. But it is really more than that. What are the key problems in the healthcare space?

“The first thing is that there is lack of awareness about career paths in healthcare. The next thing is that we have a myopic view of healthcare marketplace from the core medical perspective. It is more than that; we need to expand our view. I also found out that there is a poor hierarchical structure and culture among our medical elders. It may be a bit difficult to say it, but we need to say it. The culture means we need to break down barriers.

“Our elders need to be mentors for the younger ones; we need to lead them. If you find it hard to break open, then make it easier for them. That is mentorship. That is leadership. It is not about you; it is about what you are going to leave behind. And that is what has spurred a lot of people to success. In the corporate world right now, especially in big pharmaceutical companies, there is what is called the matrix structure, which means there is no vertical reporting lines. It means you can be in a department and interact sideways with other people,” Owoyele said. He urged the young doctors to be ready to tolerate a poor hierarchical structure in work place and culture among medical elders, which may pose as challenges as they ascend the professional ladder.

While delivering a paper on alternatives to clinical practice, Dr. Niyi Osamiluyi, founder of Premiere Medical Systems, touched on the anatomy of learning experience, which emphasises continuous learning and focus. Osamiluyi, who pioneered the use of a mobile tech (sms and voice) to deliver heath education to pregnant and new mothers in the country, also spoke on effective leadership and how such skills can be acquired. He urged the new medics to embrace mentorship, training and retraining and anything than can help them to achieve success in their chosen career, adding that doctors that can also be innovative by leveraging on technology to expand healthcare coverage for the people, especially the underserved and add value.

“As young doctors, it is important and critical to be focused on developing ourselves. We need to focus on our personal development. Young doctors cannot be complacent; you cannot say you have arrived as a medical doctor. You have to decide what you are going to do with yourself.  Five or 10 years from now, what do you want to do with yourself? You have to set a goal as to where you want to be. After you have become a medical doctor, what next? If you decide you don’t want to practise or you want to go into digital app and you need to learn programming, you have to determine for yourself.

“This is how your journey will be as young doctors; the journey of personal development. There must be continuous development at whatever you want to do. You must be focused. Know what you want to do and develop yourself. You also need to have a good mindset. When somebody with a good mindset faces challenges, he or she embraces the challenges, while the person with poor mindset runs from the challenges. Somebody with a good mindset also learns from criticisms,” Osamiluyi said.

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