Ban on doctors’ private practice: Mere threat?

Doctors - Ban on doctors’ private practice: Mere threat?
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The federal government recently said it has begun steps to ban doctors in public service from engaging in private practice, a decision viewed by many stakeholders in the health sector as ‘mere threat.’ AJUMA EDWINA OGIRI writes on feasibility of the threat and its impact on the health sector as well as reaction of practitioners

Industrial disputes

Federal government has been having a running battle with health workers in the country over time, which often leads to industrial action over issues bothering on allowances and equipment.

The latest of such face-off resulted in the strike action by the National Association Resident Doctors (NARD) and the Joint Health Sector Union (JOHESU). Patients in public hospitals always bear the brunt whenever strike actions are declared by doctors and other health workers.

This many Nigerians have always condemned. Government has also in many instances tried to coerce the doctors to either shelve or suspend their strike actions through such threats as “no work no pay” which in most instances are always ignored by the striking workers. However, government appears to have found another coercive measure in stopping incessant strike actions by doctors. This is to stop any doctor working in public hospitals from private practice.

In a recent joint media briefing after the Federal Executive Council (FEC), Minister of Health, Prof. Isaac Adewole, and his counterpart in the ministry of Labour and Employment, Dr. Chris Ngige, said most unions that recently embarked on strike action contravened the Trade Dispute Act.

On this premise they said a committee would be set up to evaluate jobs done by workers, especially in the public sector, and also look at the Yayale Ahmed report on the health sector.

The Yayale Ahmed report

The Yayale Ahmed report was the outcome of a panel set up by former President Goodluck Jonathan to look into ‘unhealthy rivalries’ among healthcare professionals.

While submitting the report, Ahmed, a former head of the service of the federation, said the panel identified 50 areas of conflict after receiving memoranda and interacting with about 40 professional bodies in the public health sector.

He said the areas of conflict were broadly categorised into: organisational management; leadership and teamwork; remuneration and motivation; career management; capacity building; professional practice; Labour; as well as legal and governance issues.

Statistics of Nigerian doctors

Recent reports by the World Health Organisation (WHO) and Nigeria Medical Association (NMA), show that out of 75,000 doctors registered with NMA, only 35,000 practice in Nigeria, with the remaining 40, 000 currently searching for jobs abroad. The reports also showed that 77 per cent of black doctors in the United States are Nigerians.

They also revealed that Nigeria requires 237,000 doctors to meet WHO’s doctor-to-people ratio of 1:1000. With a population growth at 3 per cent annually, experts say Nigeria must produce at least 10,000 doctors annually for the next 50 years. $3 billion is spent annually by Nigerians on medical tourism, according to the reports.

“This is N1.1 trillion approximately, which is 14 per cent of the nation’s 2017 budget appropriation.” Also, 47 per cent of doctors in Nigeria are said to be currently seeking jobs abroad due to knowledge gap between practitioners overseas and those at home. Ninety-two percent of doctors in Nigeria are also seeking jobs abroad due to poor job satisfaction, poor salaries and heavy tax deduction on the salaries, the reports said.

Doctors’ reactions

Ebubechi Ibegbula of Annunciation Specialist Hospital, Enugu.

First of all, we are supposed to be in a free country. We should be free to practice our profession as long as we are not contradicting any law. Assuming somebody is supposed to be in the office from 8am to 4pm, that means after 4pm that person is free to do whatever he wants to do.

For example, a consultant in a Federal Medical Centre has ward round on Mondays and Tuesdays, and is free on Wednesdays, what do you expect him to do?

He can’t be idle. He will want to work elsewhere and attend to people that need his services. O u r h e a l t h c a r e indices is bad, it is less than one doctor to 1000 patients, and you are saying a doctor who works in the public hospital should not e n g a g e in private practice.

President Buhari who said doctors should not engage in private practice did not go to a teaching hospital for treatment when he was sick. If he as the number one citizen in the country is encouraging medical tourism, why will he want to bring a law banning doctors in public hospital from private practice? There are a lot of people who don’t like going to government hospitals.

Teaching hospitals are clustered and there are a lot of stress and challenges in accessing them. Sometimes the funds are even made available, but both the medical and administrative arms of the hospitals mismanage the funds. If the federal government succeeds with the ban, it will push more doctors to leave the country; and as it is, there is already a massive brain drain going on in the country.

Dr. Isaac Akinrele, former President, Association of Resident Doctors, Abuja.

There is nothing to it, it’s just political, a mere rhetoric from the government.

To the best of my knowledge, our members are not afraid of their work. Anyone is free to engage himself in any practice after work. There shouldn’t be any issue. The only area which I have issues is on office service rule. There are even p r o v i s i o n s and Acts that have already given us the leverage that our spare time can be utilised. That law has not been repealed.

If we have any of our m e m b e r s , w h o a b a n d o n e d their workplace, then the rules can be applied. It shouldn’t be something that should be taken seriously. I think the government should pay attention to more important things, rather than trying to chase shadows.

Dr. Biodun Ogungbo, Neurosurgeon and PRO, Guild of Medical Directors, FCT

The problem the government is attempting to tackle is multifactorial.

The real problem being addressed by the government is the numerous strikes. Unfortunately, it is often a result of failed government promises. There is unfortunately a lack of sincerity in government, combined with a lack of competent and trustworthy leadership.

This level of distrust resulted in many federal hospitals being open for less than four months in total in 2015. First of all, we have to accept some basic faults in the medical practice. There has been abuse of privileges by some doctors in running parallel practices in private and public practice. Some, of course, also do divert patients to their private practice. It is at times difficult to appreciate whether this is in the patients’ best interest or the doctors.

On the other hand, there is the incompetence and failure in government. Most government hospitals at the federal and especially the state levels are grossly underfunded and poorly equipped. Many are death traps. This results in doctors particularly specialists being placed in situations where they are underpaid and poorly supported and still, are expected to produce miracle cures. Many have therefore created safe havens for their paying patients in private establishments.

The potentially draconian approach of instituting a ban is myopic and fails to recognise, talk less of addressing the core issues. It is akin to the knee jerk reaction of previous governments in announcing the cancellation of residency training for doctors in the public sectors. As you know, resident doctors are trained to become consultants and specialists.

So, cancelling their training was a stupid idea in a country so acutely short of well-trained doctors. Another factor is that the doctors are under equipped and cannot practice at a level on par with current standards.

Many hospitals lack the basic equipment for training doctors and for treating patients. Imagine that most doctors did not train with basic, standard equipment common to their speciality. So even doctors, who have the right attitude and aptitude, may still find that they cannot practice at a level close to current best standards in the government hospitals.

Banning Private Practice will possibly fi x one problem, but likely create many unintended new problems. For example, the good doctors will leave the public service to open private facilities leaving the chaff behind.

Many others will also swell the numbers of Nigerian doctors leaving the country for greener pastures abroad. It happened in the past and this ban will accelerate the further decline of the public healthcare sector. This policy or ban will lead to the total collapse of the public healthcare sector.

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