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Frustrating the practices of new specialist doctors?

Monday, April 13, 2015
Science and Society

Part 2

In last week’s column, the issue of the proposal for the imposition of a further bar to the eligibility of newly-qualified specialists to engage in private practice was raised. This move was vehemently opposed by most if not all of the doctors who are at present pursuing a higher qualification either through the DM or Royal College Fellowships. Why? 

Well, their arguments are quite reasonable, logical and straightforward. In the case of those pursuing the Royal College Fellowships, they are only certified after rigorous testing and examination by an international medical panel, as being fit to practice independently in a safe and professional manner. Now these are the doctors (House Officers and Registrars) who actually man the public health care facilities while pursuing their higher qualification. They are thus experienced and qualified. 

In light of this, the Medical Council must give compelling reasons for wanting to disregard or demean this internationally recognised award. In the case of the DM, the candidates, all practising House Officers and Registrars, need to spend a minimum of five to six years before graduating. During this time they are under the care and supervision of the very same senior doctors who would be required to sign off on them as being fit for private practice; a further two years after graduation. 

When one recognises that these self-same senior doctors do indeed have their own private practices, very interesting issues arise. If they cannot fully prepare their charges to practise safely and independently after graduation, then clearly it is eminently reasonable to arrive at the conclusion that they are abysmal failures as teachers and mentors. 

Or are they deliberately putting up road blocks so as to eliminate or severely limit competition in the private practice arena? Many young doctors who work at the public health facilities complain that the mentorship and training provided by many consultants are virtually non-existent. It fact many believe that the consultants deliberately deny them the opportunity to develop requisite specialist medical skills. If this is the case, it is at odds with their oaths as doctors and norms of postgraduate training. 

Thus again, this column is renewing and intensifying the call for the Minister of Health to investigate these issues as they impact on the welfare of the citizens and also for the Principal of UWI to conduct a thorough review of the post graduate programmes at its Faculty of Medical Sciences.

As an entering doctoral candidate at UWI’s Faculty of Engineering some 39 years ago, I was made aware of the alleged past incident of a postgraduate student chasing his supervisor around the building with a cutlass in order to have his examination completed. Such was the power that supervisors had over their students. Mercifully, in engineering and elsewhere, the processes were streamlined so as to remove the “I hold the power over your career” complex of those in charge of postgraduate students. 

One gets the impression that this “God complex” might still be rampant with medical consultants and professors, as manifested by their non-structured approach to postgraduate training and the resulting catastrophic results. The Faculty of Medical Sciences must conform to the approved university processes for postgraduate programmes and Dean and Principal must be held accountable for the existing deplorable state of affairs. 

Further the Ministry of Health, through the various RHAs, must hold consultants to the terms of their contracts. They must engage in training and mentoring House Officers and Registrars and must be subjected to evaluation by not only their peers but by those whom they are being paid to mentor and train. How else can they be evaluated for renewal?

So, why the move to have doctors with internationally-recognised specialist qualifications be subjected to this new proposal? It really reeks of something less noble than the aim of good practise, more so since those so moving are guilty of poor mentorship and academic stewardship.


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