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Hundreds of graduating doctors can’t find workShattered dreams

Published: 
Saturday, July 21, 2018
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Ministry of Health Chief Medical Officer Dr Roshan Parasram.

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Attaining a medical degree after five years of hard work was supposed to bring financial rewards. However, this is not the case for hundreds of newly-qualified doctors in T&T who are now battling unemployment, exploitation and hopelessness.

A three-week investigation by the T&T Guardian revealed that an estimated 680 qualified young doctors have been facing unemployment and underemployment since 2014 after graduating from the University of the West Indies.

Many of the unemployed doctors, having acquired registration from the Medical Board of T&T, are now seeking employment abroad in countries like Canada, United Kingdom, United States and Australia, although an estimated $150 million of taxpayers’ funds were spent on tuition fees over a five-year period for the recent batch of 2017 graduates.

With no work available, some of the qualified doctors are even working for free at private hospitals in the hope of acquiring medical experience.

“It is pure exploitation and nobody is doing anything about it,” one medical student, who did not want to the identified for fear of victimisation, said.

A qualified doctor who has been awaiting placement as a house officer said he has even been working part-time in a pharmacy.

“Some people are still being supported by their parents, so taking up a job in a private hospital with no pay is not a problem. I cannot do this because I have a loan to pay,” he said.

“Some of my friends say I should be doing better for myself after six years of study. There is always the option of taking up a post abroad but I have my mother to care for and I cannot leave her.”

He explained that as a child he noticed how their village doctor always commanded respect and admiration and this was what led him to pursue medical studies.

“I wanted to be in a position to help others but after working so hard, there is no job for me at the hospital.”

Another doctor who requested anonymity said the medical field has become so saturated that prior to 2017, there were even problems finding placements for interns who were completing their final year of medical school. But this has since been rectified with an additional 75 intern placements becoming available.

It takes between five to six years to complete medical studies, depending on specialties. After medical school, students are mandated to do a one-year internship at a public institution. They are hired by the Ministry of Health as an intern and during this time they are given a temporary license to practice medicine in public institutions under the guidance of fully licensed medical practitioners.

After completing the internship and rotations, the medical student gets certification by the Chief Medical Officer of Health and the Dean of the Faculty of Medicine. This certificate is then taken to the Medical Board of T&T to get full registration to practice medicine.

Under the Government Assistance for Tuition Expenses (GATE), the Government pays $1 million in tuition fees for T&T nationals studying medicine at the University of the West Indies’ Mona campus over a five-year period and a subsidised fee of approximately $500,000 per student studying at St Augustine over the same period. This means a total of $150 million was paid to educate doctors in 2017, half of whom are likely to migrate because there are not enough jobs for them in T&T.

320 doctors graduate every year

When the T&T Guardian contacted the University of the West Indies, Dean of the Faculty of Medicine, Professor Terrence Seemungal, estimated that 320 doctors graduate every year.

Data obtained from UWI’s Marketing and Communications assistant Deena Daniel revealed that each year across its four campuses UWI graduates approximately 280 doctors who are T&T nationals; 200 from the St Augustine campus, 50 from Mona and approximately 30 from Cave Hill, Barbados.

“If we add these to the 40 who graduate from St Georges College we have approximately 320 new doctors for whom internships must be found annually,” Daniel revealed.

Asked how many were absorbed into the RHAs as interns, Daniel said there were about 360 internship posts across the regional authorities.

Asked whether there was also a delay in placing medical students as interns in the public hospitals, Daniel said, “There may be a delay due to a gap between the graduation dates and when intern posts become available in January and June annually. The wait, however, is usually no longer than six months.”

She said recommendations were made and internship posts were increased about one year ago.

Asked whether UWI was aware doctors who complete their one-year internships were forced to stay at home for a year and more as they await placement, Daniel said, “The UWI is not responsible for the placement of doctors. We acknowledge that the post-internship placement system is not without challenges and with only 150 House Officer positions available each year we all need to be thinking about alternatives; prospective students, graduates and policy influences alike.”

As to what alternatives the students had, Daniel, said, “There is a huge training demand from persons wishing to pursue medical careers in Trinidad and Tobago but the public health system can only absorb a percentage of graduates into permanent positions post-internship. We need to decide as a people if we want to satisfy the demand for medical training, which is high, or the demand for work placement which is smaller.”

With regard to migration, Daniel said, “Understandably, some of our qualified doctors do emigrate post-internship but their training is an investment the country has made so this also needs to be a part of the wider conversation.”

Ministry responds

Health Minister Terrence Deyalsingh, when asked about the mass unemployment in the medical fraternity, referred questions to his team.

A meeting was set up for the T&T Guardian to direct questions to acting permanent secretary Asif Ali, Chief Medical Officer of Health Dr Roshan Parasram, deputy permanent secretary Charmaine Jennings, health sector advisor Brenda Jeffers, Northwest Regional Health Authority CEO Wendy Ali, North Central Regional Health Authority CEO Davlin Thomas and Southwest Regional Health Authority CEO Dr Albert Persaud.

Ali said the intake of medical students at The UWI had increased by 300 per cent between 2001-2002 to 2015 while the number of vacancies remained the same.

“The intake has tripled at UWI,” Ali said, adding that more positions will be made available when the Point Fortin and Arima hospitals come on stream.

Asked how many doctors will be employed, Ali said he did not know because they were still finalising the manpower plan for the two hospitals, which are to be completed by June next year.

Asked why training was being offered for a surplus of students when there were only vacancies for 150 house officers, Parasram said this question should be addressed by the Ministry of Education. He added that the Ministry of Health was trying to accommodate the young doctors by sending off contracted house officers with accumulated leave and allowing house doctors a one, two or six-month contract. He also said qualified doctors can open up private practice once they are fully registered.

“When you get your full medical certificate it means that you can practice as an independent medical practitioner and it means there is no supervision and you can work privately or work in the public sector,” Parasram explained.

Asked why the MoH was hiring foreign doctors when there was a surplus of qualified local doctors waiting to be hired, Parasram said this stopped in 2017. He said the foreigners were being hired only if there were no locals to fill the posts. Once the various regional authorities advertised the posts and no locals applied, the ministry then sources foreign doctors, Parasram explained. He noted that there were some specialist fields in need of staff but first preference was being given to locals.

“Some of the specialties are retinol surgeons, which we have not been able to fill for a number of years, plastic surgeons and maxillofacial surgeons,” Parasram said.

Maxillofacial specialists treat many diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is an internationally recognised surgical specialty and Parasram said paying these specialists is a problem.

“It is difficult to compensate these specialties,” he explained.

Asked why there was no training locally in these specialties, Parasram said most specialists are trained in the UK and US and few ever come back home to work because of a range of issues, including compensation. He also said it was not true that newly minted doctors get a stain in their career because of unemployment.

“Remember you have finished your internship and you are now taking a few months off, perhaps before you decide to go abroad because you are fully registered. We have collaborated with the UWI and the TTMA in the past to find solutions for the pool of unemployed doctors, so we are still actively working with them to fill positions,” he said.

However, some of the doctors who commented on Parasram’s statements said their license to practice medicine is not valid in other countries and they have to go back through the entire medical process once abroad. With regard to opening up private practice, the doctors said this was unheard of because someone with only a year of experience is not qualified to work independently.

“Thirty years ago, probably that was acceptable but nobody opens up a private practice after completing your studies with one year of experience. With medicine you learn from other doctors. You usually have to do a post-graduate programme like family medicine before opening up your practice. If you get a job at a private hospital they refuse to pay you, so many of us chose to work voluntarily by shadowing experienced doctors at our expense,” the medical source said.

In 2017, a total of 145 house officers were hired by the MoH, 17 in the Eastern Regional Health Authority, 60 in North Central Regional Health Authority, 21 in the Southwest Regional Health Authority and 47 in the Northwest Regional Health Authority. This means 175 doctors ready to enter the field locally last year are still waiting for jobs.

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