Saturday, 9 January 2016

Why young doctors, others experience internship placement difficulties – Survey

It is now a perennial problem for fresh medical graduates and others in related medical sciences to secure placements in the nation’s tertiary health institutions for further training and specialisation. Also, some of them like fresh Dietitians and Nutritionists, specialists in the study of food and nutrition in relation to health, have only four institutions where they can go for their internship.

These are the Lagos University Teaching Hospital (LUTH), Idi-Araba, University of Nigeria Teaching Hospital (UNTH), Enugu, University College Hospital (UCH), Ibadan and Obafemi Awolowo University (OAU), Ile-Ife.

A national survey by the News Agency of Nigeria (NAN) indicates that the situation is so because of inadequate funding, lack of infrastructure and regulation of the number of medical students.
Some stakeholders in the health sector believe that these were some of the factors hindering the absorption of doctors, pharmacists, medical laboratory scientists, radiographers and physiotherapy graduates in the institutions for internship or housemanship.

NAN reports that it is mandatory for fresh medical graduates to embark on a 12-month uninterrupted housemanship/internship in approved hospitals and health institutions.
However, in recent times, it has become increasingly difficult for this crop of medical personnel to get their placements.
This has led to a large number of them staying at home for two years, being the time limit for the provisional licence without getting
placement.

Some medical experts who spoke to NAN also identified insecurity in some parts of the country, increase in the number of graduates from medical institutions and inadequate health institutions as part of the problems.
Others, they said, included lack of uniform curricula, non-functional general hospitals and lack of political will on the part of government officials.
Dr Lekan Ojo, a Nephrologist and Senior Consultant with the Federal Medical Centre, Owo, Ondo State, said the country did not have enough institutions to cater for the teeming number of interns that were seeking for internship placements.

“Many training centres have exceeded their quotas, yet they still go ahead to take more people until the council starts sanctioning them.
“Many candidates also insist on where they want to do their internship because of payment involved.
“This resulted in non-accreditation of many training centres because of poor funding from the government.

“Also, there should be synergy between the regulatory agency, medical directors and the respective training institution as well as the Medical and Dental Council of Nigeria,’’ Ojo said.
Dr Jide Idris, Lagos State Commissioner for Health, attributes the situation to the non-availability of spaces compared to the number of medical students being churned out every year from universities.
“There are more medical graduates than the available spaces and the resources.

“We are churning out more doctors, pharmacists and other medical personnel every year because everyone wants to study medicine and the universities are admitting students excessively.
“The case is peculiar to Lagos because it is saturated,’’ Idris said.
Dr Grace Ijarogbe, a Consultant at the Federal Neuropsychiatric Hospital, Yaba, Lagos, agrees that non-availability of spaces for housemanship posed a serious problem to effective healthcare delivery.
She also said that funding and non-alignment of uniform curricular were major deterrents, adding that non-availability of spaces for housemanship was a serious problem.

“I think it is the incapacity of government to pay for the internship period.
“There are many teaching institutions across the country where they can train, and what is needed is a firm policy and restructuring of the academic timetable to accommodate every individual.
“The different institutions graduate people with different policies and they also employ doctors with these policies. There should be a uniform timeline.

“For example, if it is August or November that students are to be graduated or taken in, it should cut across all the institutions.
“So, as they are being absorbed immediately, others will perhaps be leaving. It can also be twice a year,’’ Ijarogbe told NAN.
“But, where you have some institutions finishing in June, some in August and others in January, it poses a bit of challenge as most
recruitment can be in November and definitely, there will be overlaps.

“Again, governments should increase funding to ensure that the curriculum for medical schools is the same in all the institutions.’’
Commenting, Dr Oyetayo Jeje, a Senior Registrar at the Federal Neuro-Psychiatric Hospital, Yaba, said the difficulty was as a result of the number of graduates being produced yearly.
Jeje, who is the President, Association of Resident Doctors (ARD), also blamed the insecurity in some parts of the country for the problem.

“Lots of people, because of insecurity in the northern part of the country, do not want to go to that area for their internship or housemanship.
“There is now a lot of concentration and pressure on a particular region where there are no security challenges.

“The Federal Government can help in this area by intensifying the fight against terrorism,’’ Jeje said.
In Ibadan, Oyo state, Dr Tosin Odulami of Ifetayo Hospital, said: “Government should scale up funding and rehabilitate tertiary hospitals so that many medical graduates will be admitted without putting further strain on the health institution’’.

Also a pharmacist, Yemisi Oluwo, said that the issue of internship placement was not as difficult for others as that of doctors.
“The reason why many pharmacists want to do their internship in a hospital is because of the attractive pay.
“However, once you overlook the pay, there are many community pharmacies that have been approved by government to provide internship,’’ she said.
In his contributions, Prof. Oluronbi Odunubi, the Managing Director, National Orthopaedic Hospital, Igbobi, Lagos, said: “We admit according to the dictates of the Medical Guild of Nigeria and West Africa.

“The supervisory college prescribes the number of students we can take out of a list of students that apply in relation to our capacity.
“We cannot take more than the quota giving to us as this may attract sanctions; we operate under strict guidelines and rules by the guild.
“What they take into consideration is the number of patients, how many consultants and they will also tell you how many trainees you can have,’’ Odunubi said.

Dr Theophillus Umeizudike, a Consultant Nephrologist at the Lagos State University Teaching Hospital (LASUTH), Ikeja, identified limited training positions and increase in medical schools as some of the factors.
“There are limited training positions for internship in the last few years and this has hindered fresh doctors and pharmacists from getting placement for the mandatory one year housemanship.
“In essence, there is a direct relationship between the number of training spaces for internship and the number being turned out by the various institutions,’’ he said.

The Nephrologist said that to close the gap, there was need to create more training positions by encouraging the state governments to employ more consultants to manage the various state general hospitals.
According to him, this will definitely provide the increased manpower to cater for the new trainees.
Umeizudike said that the private sector or hospitals should be encouraged to engage more trainees than they currently do.

“The state and federal governments can offer to pay these graduates while on internship.
“The Nigeria University Commission (NUC) should impress it on the universities and teaching hospitals to retain up to 75 or 80 per cent of their graduates to ensure that they have an internship position.
“The Medical and Dental Council of Nigeria (MDCN) needs to be proactive in resolving this situation where medical graduates wait for more than two years after graduation to get placement for internship,’’ he said.

From Ondo State, Dr Ismaila Busari, the Secretary, National Association of Government General Medical and Dental Practitioners, called for the regulation of students being admitted into medical schools.
Busari said that if MDCN could take this step, it would go a long way to mitigate the challenges of fixing young doctors for internship.
“If admission into the medical schools is not regulated on time, the problem of fixing or getting doctors for internship will rise to an alarming rate.

“Hospitals are scared of taking in many doctors on the programme because of the cost implications.
“I do not think any hospital can pay less than N150, 000. Now, imagine having like 20 or 30 at a time,’’ Busari, who is a Senior Medical Officer in the state said.
In Umuahia, Abia, Dr Nnamdi Ojimadu, says the revival of moribund state general hospitals across the country will create room for fresh medical graduates to serve their one year internship.
Ojimadu, who is the chairman, Nigerian Medical Association (NMA), Umuahia Zone, attributed the worrisome development to the few number of accredited hospitals.

He said that general hospitals in Aba, Ohafia and Uzuakoli were no longer functional.
He added that the only accredited centres in Abia were the Federal Medical Centre (FMC), Umuahia and Abia State University Teaching Hospital.
He noted that each accredited centre had its quota, ranging from 25 to 30, and that for any hospital to be accredited it must satisfy the standard laid down by the MDCN.
Ojimadu said that at least 500 potential interns wrote the tests at FMC, Umuahia but regrettably, only 30 persons were taken.

“There should be a synergy between the Federal, State and Local Governments to revive and equip the non-functional general hospitals and consultants to train the interns,’’ he said.
Also, Prof. Paul Ezeonu, a former Chief Medical Director, Federal Teaching Hospital (FTHA), Abakaliki, appealed to government at all levels and wealthy individuals to rescue the nation’s health facilities.

He decried poor subvention to the teaching hospitals, describing it as major constraint affecting the absorption of these categories of medical personnel.
“Available records show that intake of medical and health graduates, including doctors, pharmacists and laboratory scientists for housemanship is on the decline.
“Funds are not made available for the hospitals to engage these personnel for the programme in view of the huge cost involved in remunerating them,’’ Ezeonu said.

A former Commissioner for Health in Ebonyi, Dr Zigy Nwagene, expressed regret that many medical students passed through difficulties in securing placement for internship.
He identified inadequate funding of health institutions and limited space to absorb the large number of graduates for the programme as some of the problems.
Nwagene urged government at all levels to increase budgetary allocation to the health sector to enable it to accommodate more medical students for the programme.

From Benin, Edo, NAN learnt that medical doctors and pharmacists decried the inability of medical students to secure spaces for their one year compulsory housemanship/internship.
Dr Omorogbe Owen, the president, Association of Resident Doctors, University of Benin Teaching Hospital (UBTH) Chapter, said that accommodation of graduate doctors for housemanship varied from one hospital to another.

According to him, while some hospitals have increased the number being absorbed, others have reduced the number due to several factors.
“I don’t have the current statistics for doctors on housemanship in UBTH, but I know there is a decline in the number being absorbed due to financial issues and personnel cost,’’ he said.
A pharmacist on internship in one of the government hospitals in Benin, who pleaded anonymity, said the Nigerian factor had made it difficult for pharmacy graduates to undergo internship.
According to the intern, you need to know someone before you can be absorbed in a government hospital to undergo the programme.

She said that most of her friends, who graduated the same time with her, had yet to get spaces in hospitals for internship.
In Lafia, Nasarawa State, some medical experts want the state government to build more medical facilities and upgrade the existing one to cater for the increasing number of patients in the state.
Dr Omolei Friday, state chairman of NMA, said that fresh doctors usually encountered difficulties in getting where to undergo the one year mandatory housemanship in the state.

Friday said that the difficulties were largely due to inadequate public health facilities to provide the training, mentorship and supervision of the interns.` `Apart from that, there is also inadequate number of required specialists and consultants that will train the interns.
“If government at all levels can build more medical facilities and upgrade the existing ones, then medical students will have places to undergo their housemanship,’’ he said.
Dr Egba Edego, the Chairman, Medical Development Committee of Dalhatu Araf Specialist Hospital (DASH), Lafia, blamed the challenges on the limited slots provided by MDCN and shortage of resources.

Edego said that the number of doctors and pharmacists graduating every year from medical schools was more than the existing medical facilities.
From Birnin Kebbi, NAN reports that the rejection of fresh medical doctors and pharmacists for housemanship and internship respectively, was due to limited spaces allocated to the hospitals by the regulatory bodies.

Dr Balarabe Aliyu, the Head of Clinical Services, Federal Medical Centre (FMC), Birnin Kebbi, said that presently, only 12 medical students were absorbed at the centre.
“The previous year, the centre received 12 students on housemanship but it has the capacity to absorb 24 to 30, but we were compelled to abide by the limit of the regulatory body,’’ Aliyu said.
He said that the centre had applied for additional slots for doctors on housemanship for effective service delivery.

Aliyu said the centre also built a 20-apartment hostel accommodation for medical students on training and they were placed on monthly salaries commensurate with what the policy stipulated.
From Kaduna Zone, the survey indicated that no fewer than 2,000 medical doctors graduated without undergoing housemanship.

A medical practitioner, Dr Abdulrahman Shehu, who is also the NMA secretary in the state, said that government at all levels should create more vacancies for doctors and pharmacists to undergo housemanship.
He said that most general hospitals did not have the required manpower and equipment to enable the doctors to undergo their housemanship.
“This is a pre-requisite for a doctor to acquire before he/she is registered, if not, the person cannot practice,’’ Shehu said.

He said that private hospitals could also be upgraded and accredited for the medical doctors to use for housemanship.
Shehu said: “We have a situation where doctors graduate and stay for over four months without securing a place for housemanship.
“Some of the accredited hospitals in turn sell forms for as high as N5, 000 to thousands of applicants and later employ just 30 or less. This situation needs to be addressed.’’
In Kafanchan, Dr Zakka Musa, a private medical practitioner with Sauki Hospital, Kafanchan, urged governments to make it mandatory for the absorption of medical doctors temporarily in their places of primary assignment as National Youth Service Corps members.

In Yenagoa, Mr Solomon Edere, the Director, Medical Laboratory Science, FederalMedical Centre (FMC), blamed insufficient health facilities for the inability to absorb fresh medical doctors and pharmacists for housemanship.
Edere said that if adequate health establishments were available, many medical graduates would be absorbed for the mandatory internship or housemanship.
“The main reason is that admissions into the universities are more than the training institutions on ground.

“Government at all levels should initiate plans to overcome these challenges.
“On our own part, we have been taking the number that we can accommodate.
“Normally, we have 60 interns approved for us, but we cannot not take such a number because of limited available facilities,’’ Edere said.
Also, Dr Godspower Eseimokumoh, the Director, Medical Science, Bayelsa State Ministry of Health, said the ministry was up-to-date in absorbing fresh medical doctors, pharmacists and laboratory scientists for their internship.

According to him, the Ministry of Health in Bayelsa absorbs 300 fresh graduates annually and has taken the number for 2015.
“Well, absorbing them depends on what is in the budget, we do not restrict them, but we are doing things according to budget.
“We are taking 150 doctors, 75 pharmacists and 75 for medical laboratory scientists, totalling 300 in the ministry,’’ the director explained.

The NMA Chairman in Bauchi State, Dr Muhammad Yusuf, blamed the Federal Ministry of Health and MDCN for the restriction placed on the training of house officers at a given time.
Yusuf said that as a result of this, most house officers had to wait for one year in some cases before proceeding for their training.

 He said that each training institution was expected to train house officers in four departments — Gynaecology, Obstetrics, Paediatric and Surgery — for a period of three months each.
“Therefore, since the number of graduating students is increasing, they probably have to wait for those that are already receiving their training,’’ Yusuf said.

The story is not different in Katsina State as Dr Kabir Suleiman; NMA Chairman, says that lack of adequate training centres was militating against the absorption of fresh medical doctors and pharmacists for housemanship.
Suleiman said that there was a criteria set up by the regulatory body for a hospital to qualify as a training centre for fresh doctors and pharmacists.
He said that before a hospital could qualify to serve as a training centre, it must have consultants that would train the new doctors.

He said that the situation had impacted negatively on some health institutions in the northern part of the country.
According to him, Katsina State has shortage of medical doctors due to the mass movement of doctors and consultants out of the state and lack of training centres for fresh doctors.
Suleiman appealed to the regulatory body to provide more training centres for the doctors and pharmacists to enable them to contribute to the development of the nation.
Some of the affected interns expressed their displeasure over the unpleasant situations they were passing through in seeking for placement.

Mr Martins Francis, a final year medical student at Usman Danfodio University, Sokoto, urged unemployed doctors to take advantage of their period of waiting to acquire additional qualification.
“The world is increasingly becoming competitive and as such, one must be up to date to have an edge over his or her peers,’’ Francis said.

Also, two final year medical students at the Lagos State College of Medicine, appealed to the federal and state governments to build more hospitals that would absorb more house officers.
One of the students, Mr Moses Ibrahim, said that he applied for internship at the LUTH in September with the hope to be absorbed.
“If I am given the licence and I do not get a placement by December, 2016, my licence will expire.
“What it means is that I will have to apply for another examination to be conducted by MDCN.
“It is really a challenging experience for house officers,’’ he said.

Another student, Mr Yusuf Abdusalam, appealed to governments at all levels to build more hospitals.
“I also applied at LUTH and about 1,000 house officers applied in the same institution and the chances are very slim.
“Most house officers concentrate more in the Southern part of the country to do their housemanship due to the crisis in the North-East.
“This is a contributory factor to why there are more house officers looking for placements where there are no facilities to work,’’ he said.
Also, Mr Ogbonnaya Chukwu, an intern at FMC, Yenagoa, attributed their ordeals to “too much politicking in the health sector’’.

According to him, politics that is inherent in the hospital management boards and small size capacity of the laboratories are major contributing factors.
“Some hospitals are in the habit of selling forms to thousands of candidates and end up taking less than 30.
“The process is far from being transparent and from my own perspective, this amounts to taking undue financial advantage of the hapless candidates, who are desperately looking for placement for housemanship.’’

Another intern, Mr Joe Anya, blamed the situation on poor funding of health institutions.
Also, Chinazam Onwusiribe, said that many hospitals were willing to absorb interns within the limit of their resources and urged the Federal Government to increase funding of the institutions.
“Engaging interns for the one year training is additional burden to the hospitals.
“Although, they may be willing to take as many as possible, they are constrained by the paucity of funds,’’ Onwusiribe said.

Reacting, Mr Moses Onwe, a graduate of laboratory science, University of Nigeria, Nsukka, said that since 2013 when he graduated, he had yet to find an approved health institution for his housemanship.
Onwe urged the medical bodies to do the needful to alleviate the sufferings being faced by fresh medical graduates in searching placements in institutions.
He said they needed a document to prove that they have undergone the programme in their respective profession and become qualified professionals.

“If you go to any hospital or health facility looking for a space for your housemanship, all you will hear is that there is no space or the hospital has no money to pay,’’ Onwe said.
But Dr Ayoade Adedokun, the Chairman, Medical Advisory Committee of LASUTH, said there was need to increase the number of hospitals that would absorb house officers.
“I do not believe we have enough institutions to take them on as interns and house officers.
“Some of the reasons are that we need certain calibre of senior doctors to oversee the work of these officers; unfortunately, we don’t have enough of those doctors.

“We must pay the house officers some allowance, because it is a tedious period for them; it is also a problem as not many hospitals are ready to pay them,’’ he said.
He disclosed that LASUTH was in the process of interviewing about 300 house officers of which the institution planned to absorb about 80 of them.

He said: “Again, there is an accreditation to be done by the MDCN because no hospital can take more than what is allowed by the council.
“MDCN does the accreditation periodically and assesses the calibre of doctors that are available.’’


This story was published in Newswatch Times on January 9, 2016.

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