The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

HUNDREDS of qualified doctors in Trinidad & Tobago face unemployment in what Health Minister Dr Duane Sands says is a case of “piss-poor planning” - the kind The Bahamas has also been guilty of over the years.

A Saturday report by the Trinidad & Tobago Guardian revealed many recently registered doctors are unemployed even as T&T’s government has spent $150m over a five-year period on the tuition of recent graduates of the University of the West Indies.

Without course correction, Dr Sands said The Bahamas could similarly find itself spending a fortune on the education of people who could also end up unemployed. The country already spends millions per year on tuition for medical students.

“There has been an exponential increase in the number of students training per year,” he said.

“Those students would have trained with scholarships from the Bahamian people. But those scholarships carried an expectation or a commitment to provide training opportunities and for some people, the expectation that they will have a job. That expectation was probably not unreasonable when the numbers were manageable and the economic headroom and wherewithal was there.”

In the House of Assembly last month, Dr Sands said the government will limit the number of medical school graduates granted internship slots at local public hospitals moving forward, reversing the practice whereby every Bahamian medical school graduate – outside those from programmes The Bahamas does not recognise – has been accommodated. The policy shift creates uncertainty for some graduates, with Dr Sands saying it is increasingly difficult finding space for people in other countries.

“Historically our graduates would have gone to the USA, Canada or Great Britain,” he said. “Now some still manage to get training posts in those countries but you now have people travelling to South Africa or Australia and the challenges of getting post-graduate specialty training slots is stiffening as the number of persons increase.”

No dramatic shift in the country’s scholarship policy appears imminent, but Dr Sands said there will be greater collaboration between the Ministry of Education and the Ministry of Health going forward.

“It’s a case of the right hand and the left hand talking to each other,” he said.

“For scholarships granted by the Ministry of Education, we’ve agreed to discuss the manpower needs and the implications for future training. If I know six years down the road this person and his cohort are going to require a certain level of training, we have to make sure that will be in place. The chickens have come home to roost.”

Dr Sands said it must be clear to aspiring doctors what specialty areas the country is most in need of.

Otherwise, he said training opportunities at local hospitals must be enhanced. Providing patients with healthcare services is important, he said, but so too is training the next generation of doctors.

“The truth is our hospitals are not primarily training facilities,” he said. “Let’s say I have a young surgical trainee and I want as a consultant surgeon to teach him or her to do a minor case. That training is going to add a certain amount of time to the execution of that case. As a manager with limited access to the operating room, I now have competing concerns. If I let that trainee do that case, which I have to, then it means one less or two less patients that get operated on that day.

“Do you choose to see to it that Dr Rashad gets trained or Mrs Smith gets her surgery that day and doesn’t get cancelled? When we build capacity, it’s not just to build capacity to provide services but to teach nurses and doctors, to build capacity for tomorrow.”

One way the Ministry of Health is addressing its human resources problem is by establishing the Office of Medical Staff Development that focuses on the development of doctors. Through that department, over 200 senior house officers have recently been enrolled in a residency programme within a medical department.

“That then starts the clock but it still doesn’t change the path to registration or licensure,” Dr Sands said. “All of these individuals now still have to have a personal plan as to how they are going to move along.”

Although the programmes could last as much as seven years, Dr Sands said the doctors will generally be expected to become registrars within three years. Ultimately, he hopes the number of senior house officers in the public system will gradually reduce, allowing hospitals to accommodate more medical school graduates seeking internships.