GYN CHRONICLES is catering for the remuneration of interns during this period .
Once through with internship one can decide to work as a General Practitioner / Medical Officer or pursue a post-graduate ( masters ) degree . In days long gone most courses dictated that you should have worked a minimum of 3 years prior to joining the programme but this has since changed and one can join straight from internship . Majority of the courses are about 4 years give or take a year based on the specialization .
Initially majority of doctors were government employees and for specialist training the first were fully sponsored to pursue the courses even outside the country . Over time the number of doctors and our universities grew to the extent that the number requiring specialist training by far exceeded the funding available for the same . The universities were also tasked to increase revenue , which they could use to increase emoluments . Enter the parallel system , and with it the start of self-sponsored students in Medical school for all the courses . Unlike other degrees the parallel students in medicine study in the same classes with the regular students . For the masters students this is no different the issue is that there is now no income unless you have another sponsor .
Please note that again one must obtain speciality recognition , which entails working for 2 years under supervision . For those who have energy , the current trend is that after post-graduate one can do a fellowship course for sub-specialization . For those in academia there is now a requirement to have a Doctor of Philosophy ( PhD ). As you can see the training path is very long and very arduous for the medical doctor .
Counting official training internship and speciality recognition using the current standards , it means to get a fully qualified specialist such as an obstetrician gynaecologist , paediatrician and so one one needs to do 13 years post completion of secondary school . This is not a small undertaking and when put on paper it is mind blowing . I would like to congratulate all my colleagues who have managed to complete this fete and also like the Salaries and
Remuneration Commission to be cognizant of this as they consider all workers on a similar scale when you have a masters degree .
I appreciate that the governors mentioned that they support training but want the burden shifted to somenone else i . e . the national government . What they forget is that should this responsibility move back to National government what stops the government from deciding that this specialist ’ s newfound skills are best suited elsewhere ? They are also not being honest as they have been given funds for salaries and should this move be cleared are they prepared to have the monies sent to them reduced by this amount for salaries as that is what this would dictate . Has the national government agreed to pay for these doctors ? So what is the meaning of this ?
The answer is that now all postgraduate students will do their training as self-sponsored students . I support the model but the challenge lies in the fact that the course is a fulltime course not part-time . Majority of post-graduate courses at masters ’ level for doctors is 4 years . 4 years on no salary and you probably have a family to feed . Unless you are related to some “ dynasty ” and even then at that age mostly mid-twenties to early thirties society expects that you be an independent person having started your own life . This means that these student resorts to doing odd shifts what in our jargon are known as locums . This compromises both the standard of care as believe me postgraduate course is not a joke .
In most countries especially in the west , residency ( post-graduate training ) is a paid position from the hospital . The challenge lies in the number of hospitals available and the number the hospital is able to absorb on a paid basis . This is the correct way of doing things but currently this would result in a huge decline in the number of trainees . There is a collegiate system going on but the numbers would be limited to facilities that can afford to pay the residents .
Now back to the council of governors . Are they saying they do not want specialists in their facilities ? I feel very clear guidelines should be given on the minimum number of various cadres that should be available for a hospital to be called a county hospital . Governors in an attempt to reduce costs have opted to hire low-level personnel and reduce the number of doctors they need .
I see one of the great leaders in our profession turned politician Dr . Nyikal saying how Kenyatta will close if the students are withdrawn . All I know is nature abhors a vacuum , yes I would not want to seem not to appreciate the invaluable service rendered by the residents who indeed as currently constituted are the back bone of service delivery in this great institution but should decisions be made otherwise a mechanism on the running of the facility would be found and instituted .
I applaud the governors for executing a great PR gimmick . When elephants are fighting it is the grass that gets trampled on , in this case the unfortunate doctor , who wants to pursue a post-graduate course in their country . I believe I am patriotic to my country but the country either does not understand the role or the impact the medical profession has . If the country will not support doctors to pursue their career there are many alternatives out there . All countries from the US , Canada all the way to down under in Australia are looking for medical personnel especially in the current storm called coronavirus pandemic . Not wanting it to sound like a threat but , why should someone be desperate when there are countless opportunities begging for them to grab .
The solution lies in the formation of a health service commission and devolve the training , employment and deployment of health personnel from both the central government and the devolved governments whose interest is solely on cost cutting and not quality service delivery . Until a mechanism is found to address the training gaps in the country for doctors , which may not happen even in my lifetime do have a prosperous 2022 and may we pray for reason to prevail . ■
MAL 46 / 22 ISSUE 17