There’s a long-running dilemma being faced by medical doctors trying to find employment within the health care sector here in Jamaica. Just recently several hospitals across the island went into emergency mode as a great number of doctors called in sick. This was due to discontentment with the Government’s handling of a dispute over contract terms for some 143 doctors whose contracts expired on July 1, 2021.

But this incident is just the surface expression of a deep-seated issue that has been growing for some time now, yet has been ignored by the powers that be. This issue is that the main supplier of doctors for the country — the Faculty of Medical Sciences at The University of the West Indies (UWI) has consistently increased its intake of students for a number of years, despite there being little to no provisions made for their subsequent employment in the health care sector.

What is the reason for this? As with many issues plaguing our society, the answer is money.

But, to understand where this money problem arose, we have to look back into the pages of history.

A November 2012 article by the Jamaica Observer, entitled ‘UWI’s new $3.5-billion state-of-the-art medical school’, has the following information about medical student enrolment at The UWI:

“[Deputy Principal of The UWI and former Dean of the Faculty of Medical Sciences Professor Archibald McDonald] said the enrolment at the university was increased from 100 students in 2004, to the current 350, in order to secure funding to build the new facility. With foreign students having to pay the full US$28,000 per year for tuition, more of these students were enrolled gradually over the last four years. The fees from these students, in addition to a loan secured by the [Mona] campus, were used to finance the construction.”

So what does this tell us? The number of students taken in was more than doubled to provide more funding for a new building.

Later, in a 2018 The Gleaner article, entitled ‘Stop quoting tuition in US dollars — Outgoing UWI principal’, then principal for The UWI, Professor McDonald, detailed a “robin-hood policy”. The simple explanation of this policy is that the funds brought in to the university by self-funded/full-fee paying programmes such as MBBS (Bachelor of Medicine, Bachelor of Surgery) are used to cover the other expenses of the university, and so reduce costs that would otherwise be spread across the general university programme.

Why was this necessary? Normally, the Government subsidises the costs of tuition for university students by about 80 per cent. This is true across the region. However, in 2007, then Prime Minister Bruce Golding reduced the funding from the Government to The UWI by about $1 billion. Hence, The UWI has taken drastic measures to recover its funding, including the introduction of these self-funded programmes. This is detailed in a 2021 Observer op-ed by Dr Canute Thompson, entitled ‘Put money where your mouth is, Holness!’

Now where do we stand? For the better part of the last decade or so The UWI has been taking in over 300 medical students, despite there not being a subsequent increase in positions for medical doctors to occupy. Of course, not all of these students are Jamaican and intend to work in Jamaica; a decent portion of them will be returning to their home countries — however, our sister islands in the Caribbean have also been facing their own troubles with unemployment of doctors. One such example is Trinidad and Tobago, who recently had a case of over 600 doctors out of work.

In 2016, the Faculty of Medical Sciences capped the class size for its MBBS programme at 280 students and it has remained there since. But even if, for example, only 200 of those students continue the five years to graduate from the programme, there are not 200 spaces every year to accommodate new doctors in our health care system. Even if we make the gracious assumption that half of these doctors were international students who will return to their home countries, there are still not 100 new positions being created every year.

On top of that, we have not had the kind of governance that is forward-thinking enough to invest adequately in the health care sector for the good of all Jamaicans. This is the cause of the wound that has been festering for quite some time with little care or attention being paid to it. Even now, our hospitals and health care centres across the island are understaffed. We are short of doctors, nurses, and other medical professionals.

This is not the message that is passed on to students from as early as their high school years. Many think job security is a guarantee in medicine, and that because the country desperately needs more doctors, once you can get into the programme and finish it, you must be employed.

Picture now students from all across the island studying their hardest to be chosen for a place in the MBBS programme out of thousands of yearly applicants. The Government, under the direction of Ruel Reid, former minister of education, youth and information, cuts the number of sponsored spaces offered to prospective medical students repeatedly, until it finally reached 55 spaces in 2018, where it currently remains. The readers will remember the outcry from advanced level school leavers in 2019 when they discovered that no sponsored spaces had been left after they had received their examination results in August.

So many medical students have had to make do with high loans from the Students’ Loan Bureau, and other sources, in order to fund the cost of their US$28,000 tuition (over $4 million annually at present exchange rates), in pursuit of a dream of making a difference in the lives of those suffering from ailments of all kinds. Or so they thought.

Imagine, then, finally persevering through the great mental and emotional turmoil of the five-year programme, studying away the best years of their youth, and graduating successfully, only to discover that the one thing they were most sure of — employment — is not so sure after all. It is only expected, then, that doctors would cry out. They have essentially been sold a lie.

For those who do get employed, they are overworked and quickly burn out in a system that is still severely understaffed. The wages are set up in such a way that you must work overtime if you wish to pay your bills, much less have a decent standard of living.

Last year, widely publicised interviews had doctors telling of the sleep deprivation that made them a danger to themselves. Yet, they must also contend with limited progression through the ranks, late wages, non-payment of wages owed for overtime work, no health insurance, no pensions (and non-payment of the gratuity that is given in place of a pension), among other benefits that would be given to any duly employed public sector worker were they not given the short end of the stick with term contracts.

And still we cannot quantify or adequately measure the mental health impact on doctors from working in the Jamaican health care system. We know, though, that they were once bright-eyed and bushy-tailed medical students, who genuinely wanted to devote their lives to caring for the sick.

Where do we go from here?

Even if the Government is able to negotiate with the current set of doctors who are officially out of work, what will it do when the next 200 or so doctors graduate in a few weeks’ time? Will they also have to battle with the Government for employment? How will they pay their bills? What of the next batch of doctors coming in 2022? And 2023? And so on, and so on.

From where I sit, I see that we are left with but a few viable options:

1) The Government has to put a halt to its reckless spending, prioritise the health of its people, and provide more positions for doctors in a system that is crying out for help.

2) The doctors who are here now need to prepare themselves to migrate and seek employment elsewhere. Not just because of the horrible working conditions in Jamaica, but because the bottleneck will become even more severe, and the new doctors coming in will have nowhere to go.

Arguments about patriotism have no weight here. If the doctors do not leave their future colleagues do not have a place to go.

3) The UWI, in conjunction with the medical faculty, need to set out to reduce the number of students being taken in to more feasible levels. In the pre-clinical years, the classrooms are overcrowded. In the clinical years, even the senior doctors themselves lament that the student-patient ratio is much greater than it was in their time to the detriment of the students.

In that same vein, we as a society ought to rethink our traditional views. Every ‘bright’ child does not need to study medicine. Medicine, law and engineering are not the only valuable profession. Prospective medical students should take a serious look into the current situation in Jamaica and contemplate whether it is still worth it to pursue a career in medicine in Jamaica.

In the meantime, while the Jamaica Medical Doctors Association (JMDA) negotiates with the Government — and the South East Regional Health Authority — for morsels of bread that were agreed upon, doctors should take the cue of the nurses and rescue themselves from a health care system that has repeatedly shown it does not care about them. Fly the gate, it’s time to migrate.

blackhawkstriker72@gmail.com