The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

A WEEK after junior doctors complained of their substandard terms of service in the public healthcare system, senior doctors did the same yesterday, focusing their ire on Health Minister Dr Duane Sands and his recent talk of “non-performing clinicians”.

The Elizabeth MP has said “time is up” for a “small but visible minority” of clinicians who work “as little as five hours a week or less” yet complain about their annual $60,000 salary. 

However, Dr Locksley Munroe, head of the Consultant Physician Staff Association (CPSA), a union representing 130 senior doctors, rejected the idea that doctors work so few hours.

He portrayed Dr Sands’ comments as the latest indignity suffered by doctors who work amid crumbling infrastructure in an underfunded system and who are absent from key discussions about how to improve healthcare in the country.  

It is “not the case at all” some consultants work five hours a week, he told reporters at a press conference.

Patient

“You would have to show me somebody who is working less than five hours. Unless you are going to show me real evidence that persons are making that input I would totally disbelieve that. If you are speaking of coming in here, checking a patient, taking blood and setting up an IV-line, that is not the job of the consultant. The job of the consultant is to guide and direct the care of the patients.

“My phone has been going off the entire morning advising my junior staff which patient to take to the operating theatre; advising somebody about their cat scan and results of their cat scan. The fact that I am not here visible for 20 hours does not mean I am not having an impact on healthcare delivery in the institution.”

“To become a consultant in this institution is not based on non-performance,” he said, emphasising the considerable academic performance and medical training necessary to reach such a level. “The Bahamian physician is excited to return home, but sadly in many instances they return to a broken system.” 

Dr Munroe called Dr Sands’ comments, which were made in the House of Assembly, a “slap in the face,” saying he did not address the issue with senior doctors before speaking about it publicly. A speech Dr Sands gave the association last year at the Public Hospital Authority’s (PHA) corporate office contradicts this, however. Dr Munroe did not attend the event, but Dr Sands said yesterday all members were invited to attend the meeting and the speech was put in a CPSA chat group.

Dr Sands told doctors quality of care problems in the public system are compounded by a “vexing and chronic problem of under-productivity by a visible and morale-killing minority of our engaged senior staff…some of whom believe that two or four hours a week is acceptable for the ‘pittance paid.’ Some of these persons may have contributed mightily in the past––but cannot find the public wards in our hospitals.”

“...If you are paid to spend twenty hours per week and on call, we expect twenty hours per week and on call. If you are paid for an additional ten hours of administrative time as a division or department head, we expect that additional time.”  

“While I commit to reviewing and embracing the principles and improved remuneration as outlined (in a proposed CPSA industrial agreement), I have no plan to reinforce the lame professional behaviour of a visible minority. If your practice is so entrenched that you cannot immediately and consistently adjust to provide the services that you have agreed you will provide, then simply say so and we will arrange for early retirement or a downgrade of your benefits to reflect your working reality. There are no sacred cows.” 

Problem

“Solving the problem for the majority will have to include correcting the long-neglected problem of the minority who have poisoned public and administrative perception of physicians.” 

Nonetheless, Dr Munroe yesterday said Dr Sands has not lived up to their expectations, a view he said was unsurprising. 

“...When you transition out of being a physician to becoming a politician, your focus is now on everybody,” he said. “You’ve lost contact with the problems that we face as physicians. He is not unique in that manner. We’ve had many physicians as ministers of health and the habits haven’t really changed. You’ve gone from being a doctor looking after a single patient to being a politician that now has the whole system to deal with. But they do not seem to have the capacity, the competency to truly address the system at all levels.” 

Junior doctors in the Bahamas Doctors Union (BDU) complained last week about caring for private patients without pay when the consultants paid to care for those patients fail to show up. 

“That is a reflection of current attitude and practices,” Dr Munroe said in response, adding the practice is what traditionally happens in medicine. “When I was a junior in this hospital in 1982 if Dr Sherman or Dr Nottage or Dr Farrington asked you to do something on their patient, that is actually what you did, you honour your seniors,” he said.

“You may ask (junior doctors) to do something that they might not like and yes there are times when you have to ask them to do things on your patient. How you resolve that issue, that’s a different story. You may honour them by taking them to dinner, giving them some kind of funds or simply telling them thank you for what you are doing. Are you going to say I’m a non-performer if the junior chose to say he’s not here he’s late? No.

“I have something to do. As a senior person, why would I after 30 plus years be doing the same thing that I did when I was a junior?”

In response to the CPSA yesterday, Dr Sands said: “All Bahamians and particularly people who can least afford it are entitled to good care. While my responsibility is for every singe person in this country who requires medical attention, I am particularly concerned about those people who have limited options and I want to make sure that person, the uninsured whose only option is the public sector gets healthcare in an environment that is dignified, clean and safe and they are cared for no differently than the very wealthy in this country.

“That’s where we need to take healthcare in this country.”