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Frustrating the practices of new specialist doctors?

Monday, April 6, 2015
Science and Society

At the meeting of Medical Board held on March 25, 2015, a new resolution was proposed by the Medical Council of T&T, for the registration of specialist doctors and their eligibility to practise privately. It claims to be “in keeping with good medical practice and maintaining international standards.”

In fact, this was discussed in a previous meeting of a specialist grouping with the meeting being adjourned in chaos. Subsequent to that meeting, in a letter addressed to the Minister of Health, the Permanent Secretary of the Ministry of Health and the Chairman of the Equal Opportunities Commission among others, the author refers to the move as one designed to frustrate the registration of ophthalmologists and indicates, “This of course would delay the production of specialists, thus protecting their private practices …”

The meeting of the March 25, 2015 was attended by a record number of doctors and, as expected, was punctuated with heated debates. It ended without resolution as young doctors felt that the proposed new rule for further certification, even after obtaining  higher qualifications, to be punitive and counterproductive. Especially so in light of the poor mentoring and lack of structured clinical training programmes for post graduate medical students.     

If this resolution is approved, then it is the citizens who would be denied the services of new specialist doctors. It clearly does not serve the best interests of the public. What then is the rationale for this new proposal?

It should be emphatically stated that the formalising of a specialist register is a progressive move. However, the proposed regulation for allowing the registered specialists to practise privately is oppressive, impractical and unnecessary. This lends credence to the above-mentioned letter to the Minister of Health.  

At present, after graduation with a medical degree, a doctor must obtain a higher qualification in order to be registered as a specialist. There are two routes normally taken by young doctors: the DM (the Doctor of Medicine, a postgraduate degree) offered by UWI; and the obtaining of a fellowship from one of the Royal Colleges of the UK. The standing practice is that either qualification allows one to be registered as a specialist immediately upon the award and to be able to go into private practice.

To register for the Royal College exams, one must be practising in the particular field for a specified number of years, deemed adequate by the relevant college. The award is only obtained by being successful in the several separate exams over many years and tests the knowledge, surgical and clinical skills of the candidates to ensure that they are competent to manage their patients independently in a safe and professional manner. 

The exams are very rigorous and are administered by a panel of international experts and the award is internationally recognised. Now for the UWI DM. Statistics indicate that the graduation rates from the various DM programmes, some of which are long standing, vary from non-existent to abysmally low. The principal and the dean of the Faculty of Medical Sciences of UWI, St Augustine, should make public the graduation data of the various DM programmes and the duration of their existence. 

Anecdotal evidence points to what seems like a dislike for structured training and mentoring of the postgraduate students. There is thus a clear and urgent need for an independent, professional and thorough academic review of these programmes and an even more expeditious implementation of procedures and processes for transparency and standards. 

This way young doctors can have a well-defined pathway and timeline for graduation. Until then, young doctors would clearly prefer the Royal College exams for though they are tough and long, if you are competent, you can graduate. But it should be noted that not all specialities have access to the Royal College exams and, therefore, it is an urgent imperative that the Faculty of Medicine, Medical Council and the Ministry of Health address this with the greatest urgency.

To be continued.


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