Head of the Association of Government Medical Consultants (AGMC) Dr Konrad Lawson says that the complement of overworked and underpaid doctors in the island’s public hospitals is attributable to the Government’s refusal to get rid of an outdated job post system.

In an interview with the Jamaica Observer, Dr Lawson said that the current complement of posts in the public health system dates back to the 1970s and is now holding back scores of young medical professionals who are often hired on contract.

“What has been done is that, instead of creating the posts that have to be funded into pension, they put the doctors into contract positions for two or three years and renew that contract religiously for 20 to 25 years every two to three years. This is for the consultants at level four down to the grades three to one,” said Dr Lawson.

His comments came on the heels of a series of articles published in the Jamaica Observer last month highlighting the plight of doctors who complained about having to work long hours with little supervision, shoddy equipment, among other things, in an overburdened free health care system.

Dr Lawson highlighted the fact that with ‘contract work’, doctors are given allowances that far exceed their basic pay and are not pensionable.

“When the time comes for the contract to be ended and not be renewed, usually at the time when the doctor has gone on to something else or they have come to the retirement age, there is no pension to pay because they have got their pension as gratuity over the years. This is what has been used to put doctors into positions instead of updating the cadre of posts for the last 50 years,” said Dr Lawson.

His concerns were echoed by president of the Jamaica Medical Doctors’ Association (JMDA) Dr Elon Thompson, who told the Observer that currently at Kingston Public Hospital (KPH) there are several specialist doctors who qualify for consultant positions, but who are languishing in level three positions.

“We have MO3s (level 3 doctors) who are specialists, a multiple of persons who should be promoted to the level of a consultant, but what we are hearing is that there is no MO4 (level 4) position vacant. Many persons have questioned why, because I am in a senior role at KPH, because I am a specialist, but I am also required to perform pretty much the same functions as a consultant by virtue of being a specialist.

“Many persons would question why am I the JMDA president if I am a consultant in the private setting, but then in the public setting I am a level three. But that is by virtue of how the system is set up. There are flaws within the system that do not allow for a promotion when that should be done. Many persons who are at the same level as I am, who are qualified and have applied, but have been refused the MO4 because they say there are no vacancies,” said Dr Thompson.

Dr Lawson further noted: “It’s not so much that there is no vacancy, but there is no vacant post. My understanding is that the cadre/post system we are working with is coming from the 1970s. The administration does not create and look at the cadre of posts at all levels,” said Dr Lawson.

He also said that this is something the AGMC has argued over the years, and admonished the Government to develop a new establishment of posts for the doctors based on the need that exists.

Meanwhile, the orthopaedic surgeon pointed to the remuneration of doctors in public health care, especially in health centres, as another area that the Government needs to address.

“The doctors that work in the health centres, their pay is almost confined to a basic salary and a few allowances. The doctors that work in the hospitals get their basic salary, a number of different allowances, and for members of the JMDA they get something called a rostered duty allowance or overtime.

“From 4 o’clock in the afternoon until 8 o’clock the next morning, Monday to Friday, doctors are working outside of the normal working hours. But the hospitals have to be manned and services have to continue. And so the doctors from grades one to three get paid this rostered duty allowance and the consultants, based on our responsibilities. We negotiate for on-call allowance which doesn’t change,” Dr Lawson said.

However, he noted again that these allowances, although they add up, do not go toward a pension for doctors.

“These allowances make up the lion’s share of our pay; three quarters for many, and down to two thirds for those who get a bigger basic salary, like the grades seven and eight doctors. But for the average grade four doctor and below working in the hospital, it is almost three-quartets of their pay. And when you retire, your pension is calculated on a quarter of your basic pay.”

Dr Lawson said the AGMC is in discussion with the Ministry of Health and Wellness and the Ministry of Finance on how doctors’ allowances should be treated.

“It is something that we are working on. The Government is in the process of looking at what to do with all of these allowances, and we are waiting to hear from them what it is they are going to do with these allowances. We are in the process of discussing and talking to the Ministry of Finance as to how we think these various allowances should go.

“But this is the reason why many of the consultants cannot retire because there is no significant pension benefit. It is egregious when 70 per cent of your take-home pay that doesn’t change with working conditions; in other words it is part of your basic pay, and when that is 100 per cent discarded when time come for pension, too many of our members have retired and are in dire straits and have to continue working in private practice because the pension alone, based on how it is calculated is insufficient for them,” said Dr Lawson.