The Good, The Bad and The Ugly

An air of prestige has accompanied a career in medicine for centuries. Once upon a time, being a health care professional commanded a great deal of respect and admiration from members of the society so much so that parents encouraged (or forced) their children to go into the once noble profession. Professor Umaru Shehu once […]

An air of prestige has accompanied a career in medicine for centuries. Once upon a time, being a health care professional commanded a great deal of respect and admiration from members of the society so much so that parents encouraged (or forced) their children to go into the once noble profession. Professor Umaru Shehu once told our class that the day he qualified as a doctor was the happiest day of his life. I can understand his joy, after all, medicine catapulted him from being a young anonymous boy in Borno to becoming one of the greatest emeritus professors in Nigeria.

Those were the days when medicine had prestige. The days when one would raise his head high when referred to as a “Doctor”. The days when just qualifying as a doctor opened doors. The good days.

Those days are long gone. These days when the flight cabin crew asks, ‘Is there a doctor on board?’, we turn our face in another direction. The zeal to save lives has since landed doctors in medicolegal turmoil, sometimes even jail. We no do again.

Perhaps our problem started from the word ‘prestige’. Prestige is strictly related to material status, education and qualifications, power and position as well as authority. An essential criterion of prestige is also social utility, validity, independence, responsibility and dedication. I suppose the profession of medicine started to lose its prestige when these factors began to decline. As our numbers grew, our relevance declined. Bad eggs emerged among us. Our responsibility and dedication diminished. Inflation made a mockery of our salaries and doctors became beggars. Society became capitalist. Prestige gradually became associated with only material gain. During a secondary school career talk, I asked the  students how many of them wanted to be doctors. Only four girls in a class of twenty-six students, raised their hands. When I asked the others why they did not want to pursue medicine as a career, one child looked me in the eye and said: ‘because doctors don’t have money’. I covered my face in shame.

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Prestige has left the group chat.

Worldwide, one in five physicians say it is likely they will leave their current practice within two years. A report published by Definitive Healthcare found that nearly 334,000 health care providers working in the US —including 117,000 physicians—left the workforce in 2021, with many citing burnout, medico legal issues, poor renumeration and bullying as their reasons. Another survey in 2022 reported that 62% of 847 clinicians had personal knowledge of other primary care clinicians who retired early or quit during the pandemic and 29% knew of practices that had closed up shop. That’s on top of a preexisting shortage of general and family medicine physicians.

In the UK, worsening staffing issues are now the biggest stressor for clinicians. Health care worker shortages, especially in rural and otherwise underserved areas of the country, have reached critical and unsustainable levels, according to the National Institute for Occupational Safety and Health (NIOSH).

In the west, more and more doctors are choosing not to follow the typical physician career path. Alternative career paths for physicians could look like a doctor completing residency in a clinical specialty and moving abroad to practice with an NGO. Or a physician leaving medicine to work for a pharmaceutical company. Or leaving clinical practice to go into research full-time. Or a female doctor leaving medicine to start a family and rejoining practice on a part-time basis as a writer and telemedicine consultant. Or ditching clinical medicine for public health.

Coming home, the figures in Nigeria are more frightening. Apart from the Japa movement that is continuing to claim many health care professionals, an increasing number of doctors are choosing to ditch medical practice for safer and more lucrative jobs.

The non-clinical careers for physicians’ conference is an annual conference for physicians looking to switch careers. Sponsored by SEAK (Skills, Education, Achievement, Knowledge), this lawyer-bred organization helps providers get the process of career change moving. While it’s somewhat focused on the intersection of medicine and law, there are also resources for more general non-clinical career pursuits. Why suffer burnout and poor pay when one can have an equally rewarding pay.

But have we thought about the repercussions?

What will the health care system do with so many physicians leaving medicine? Will the physicians left behind be asked to work harder without greater compensation? Will physicians be entirely replaced by physician assistants and nurse practitioners? Who will take care of our parents, grandparents and other relatives?

In order to address this catastrophe- we must look into the root cause: Why are doctors leaving medicine? For the purpose of this article, I will list only three.

The first one is a no brainer; burnout. Hospitals are understaffed and doctors are overworked. When I asked a young doctor who was seeking employment to apply to a certain government hospital, he declined, somewhat rudely. ‘What? That hospital that kills people with work? Ah! I would rather continue my website designing and poultry business.’

The younger generation prioritizes flexibility and work-life balance. Even with fantastic renumeration, they value their time and mental health above all else. No more long hours in the operating theatre. No more 24-hour calls. No more weekend calls. They will simply not turn up for work. They even have a term for it: ‘quiet quitting’. No resignation letter, no notification, no nothing.

The second reason is of course poor renumeration. As doctors, we are constantly comparing payslips with our colleagues around the world. What specialty pays best? Which countries pay better? Clinical medicine versus Non-clinical medicine? These answers influence a lot of our decisions. To Japa or not? To practice or not? Is it worth it?

However, for me, the most important reason why doctors are leaving clinical practice, has to be insecurity and violence in the workplace. Some doctors report being bullied, harassed, threatened or beaten up when they interact with patients. A professor at Duke University School of Medicine, often speaks to doctors about career options. He says a physician recently confided that the verbal abuse he’d been receiving from patients had him contemplating quitting medicine. “When patients seem to turn on their doctors and accuse them of not operating in their best interest, that’s a strong motivating force for leaving clinical practice altogether. For unhappy physicians already on the fence, that is the final straw.”

Three weeks ago, a doctor was physically assaulted by patient relatives in University of Ilorin,  Teaching Hospital, Kwara, which led to the Association of Resident Doctors (ARD) to go on a five day strike. Attacks on medical doctors and other healthcare service providers by relatives of patients who die in hospitals have become prevalent. So far, the worst has been the killingof Dr Uyi Iluobe, by relatives of his patient at a hospital in Oghara, Delta State, on New Year’s Eve. Dr Iluobe was shot dead allegedly by the relatives of a patient who died of a gunshot wound in the hospital.

So, in addition to back breaking labour and meagre pay, doctors have to contend with patient wrath and violence as well? Lack of prestige and now physical assault.

It is an open secret that the practice of medicine has become very unsatisfying. Government needs to sit up and find ways to address these factors so that we do not find ourselves in a vacuum that we cannot climb out of.

The ugly has come.