Patient, Doctors, nurses, pharmacists and other health professionals are increasingly locked in struggles over roles, recognition and leadership. No thanks to policy gaps, blurred job descriptions, and economic interests that push practitioners beyond their traditional training scopes. Although the rivalry is not new, its intensity and consequences have grown with time, creating confusion among patients, disrupting teamwork and weakening the sector’s capacity to deliver effective care, IJEOMA NWANOSIKE reports.

FOR decades, the rivalry among medical professionals has shaped both the working environment within hospitals and the quality of care delivered nationwide. Far from being superficial, the conflict is deeply ingrained in the system and has evolved in complexity over time. At its core are unclear role definitions, overlapping responsibilities, competition for status and economic benefits, all compounded by inconsistent and sometimes outdated policy frameworks.

This discord is most visible in public hospitals, where doctors have traditionally occupied top administrative positions such as chief medical directors and medical directors. The dominance of physicians in leadership is rooted in a hierarchical structure established by a 1985 military decree, a framework that many other healthcare professionals say has systematically excluded them from decision-making. Over time, this perceived marginalisation has fuelled resentment among nurses, pharmacists, physiotherapists, laboratory scientists and others, with the sense of exclusion passing from one generation of health workers to the next.

The University Teaching Hospitals (Reconstitution of Boards, etc.) Decree No. 10 of 1985, now Act Cap U15 LFN 2004, specifies that the chief medical director must be a “medically qualified” person who is registered and licensed to practice. The law also provides a uniform administrative structure for federally-controlled teaching hospitals. While originally intended to standardise hospital governance, the decree has increasingly become a focal point of controversy.

Over the years, critics have argued that the decree has contributed to the decline of the health sector by concentrating management authority in a single profession, often at the expense of administrative competence and multidisciplinary input. These concerns have driven repeated calls for legislative reform, particularly from non-physician professional groups.
One such effort came from the Nigerian Society of Physiotherapy, which pledged full support for an amendment bill sponsored by Bamidele Salam, representing Irepodun/Isin/Oke Ero/Ekiti Federal Constituency.

First read in the House of Representatives on March 30, 2020, and revisited in 2024, the bill seeks to reform governance structures in teaching hospitals to improve efficiency and healthcare outcomes. Similarly, in 2021, the Joint Health Sector Unions (JOHESU) and the Assembly of Healthcare Professional Associations (AHPA) strongly pushed for a repeal or amendment of the decree during a public hearing organised by the House Committee on Healthcare Services. At the hearing, they advocated comprehensive reforms to replace what they described as a long-criticised law.

Their position was echoed by pharmacists under the Pharmaceutical Society of Nigeria (PSN), Lagos branch, who used their 2021 Annual General Meeting to urge the National Assembly to strengthen provisions in the proposed Federal Medical Centre and Federal Teaching Hospital Bill. The pharmacists argued that federal hospitals required chief executives who were either health professionals with postgraduate management training or administrators with substantial hospital-based experience. They linked decades of physician-dominated leadership to persistent challenges such as rising maternal and infant mortality, decaying infrastructure and weak regulatory oversight.

The PSN further cited global trends highlighted by the International Pharmaceutical Federation, which show an expanding role for community pharmacists, and called on the Federal Government to reassess Nigeria’s operational health model. But despite all these interventions, the debate has continued. About a year ago, tensions resurfaced sharply over the issue of consultant cadres for pharmacists and nurses, drawing the Clinical Pharmacists Association of Nigeria (CPAN) into a fresh dispute with the Nigerian Association of Medical and Dental Academics (NAMDA). The clash followed a December 1, 2025, petition by NAMDA to the Head of Service of the Federation opposing the implementation of consultant status for the two professions.

In a firm response, CPAN accused academic doctors of misleading policymakers, recycling outdated arguments and resisting evidence-based reforms adopted in other countries. Led by its National Chairman, Dr Maureen Nwafor, the association noted that consultant pharmacists and consultant nurses have long been integrated into health systems in the United Kingdom, United States, Canada, Australia and South Africa. According to CPAN, Nigeria’s adoption of such cadres represents alignment with global best practices rather than innovation, and opposition to the move reflects outdated thinking rather than empirical evidence.

Beyond leadership and professional titles, remuneration and welfare disparities have further deepened inter-cadre tensions. Doctors operate under the Consolidated Medical Salary Structure (CONMESS), while other healthcare professionals are placed on the Consolidated Health Salary Structure (CONHESS). This long-standing disparity has remained a major source of grievance, with critics arguing that unequal pay scales and career incentives encourage role expansion beyond training and intensify competition within the workforce.

Compounding these challenges are poor job descriptions, role ambiguity and weak enforcement of professional guidelines. In such an environment, disputes over authority, patient management and decision-making are almost inevitable. These explain why experts warn that without clarity, professional boundaries will continue to blur, further undermining teamwork and patient safety.  Ultimately, observers say the rivalry reflects deeper struggles over professional identity, power, resources and recognition. Addressing it, they argue, will require clear policy directives, equitable opportunities across professions, strict adherence to scopes of practice and a renewed emphasis on interprofessional collaboration.

The World Health Organisation defines interprofessional collaboration as a process in which multiple health workers from different professional backgrounds work together with patients, caregivers, families and communities to deliver the highest quality of care. Such collaboration, the WHO notes, depends on complementary roles, shared responsibilities and collective decision-making in patient care.

Speaking to The Guardian, the President of the Nigerian Society of Physiotherapy, Dr Oyinlola Odusanya, said that the persistent rivalry in Nigeria’s health sector stems from long-standing structural imbalances that elevate one profession above others in administration and governance.
He argued that the tension is often mischaracterised as professional ego when, in reality, it reflects a system that concentrates authority in a single cadre despite the multidisciplinary nature of healthcare.

Addressing the controversy surrounding the 1985 decree, Odusanya said the problem lies not in the law itself, but in how “medically qualified” has been narrowly interpreted to mean only physicians. According to him, this interpretation excludes other trained health professionals and contradicts earlier British administrative models that allowed broader managerial inclusion. He attributed the persistence of the problem to a lack of sincerity in governance. Odusanya warned that the sector cannot progress without a deliberate rebalancing of stakeholder influence, noting that physicians dominate decision-making despite the essential roles played by other professionals. “The health sector is a chain system, and no profession can do it alone. Therefore, the system will continue to fail until we understand that everybody in that sector is important,” he said.

From a contrasting perspective, a past president of the Nigerian Association of Resident Doctors and consultant orthopaedic surgeon at the Federal Medical Centre, Umuahia, Dr Emeka Orji, said that unresolved rivalries have deepened because the government has failed to clearly define professional roles and boundaries. In an interview with The Guardian, he attributed much of the friction to weak policy direction and financial motivations that drive some practitioners to expand their scope of practice.

Orji said the resulting confusion has become widespread, with patients increasingly unable to distinguish between different health workers. On the issue of consultant status for pharmacists, he argued that the debate centres on responsibility. Medical consultants, he said, lead clinical units and assume full responsibility for patient management, roles for which pharmacists are not trained. Granting consultant titles without corresponding responsibilities, he warned, would disrupt care and compromise patient safety.

The surgeon rejected arguments that medical teams should operate without a clear leader, describing such proposals as impractical. He maintained that global practice recognises doctors as leaders of medical teams because of their broader and more holistic training. While acknowledging the right of nurses, pharmacists and others to demand improved welfare and representation, he insisted that leadership structures must align with existing laws and training standards.

He called on the government to urgently “set rules and boundaries” to minimise rivalry, noting that while tensions may not disappear entirely, they could be significantly reduced through clear and consistently enforced policies.
Adding another dimension to the debate, Consultant Clinical Pharmacist and public health expert, Dr Kingsley Chiedu Amibor, said the conflict among health workers has been reinforced across generations, shaping attitudes from undergraduate training and entrenching mistrust in a system that should prioritise teamwork.

Amibor identified remuneration as a key driver of rivalry, recalling a time when all health professionals operated under a unified salary structure. He said divisions emerged when physicians assumed hospital leadership and championed a separate pay scale that later evolved into CONMESS, leaving other professionals under CONHESS.
“Significant differences in salary structures, allowances, and welfare packages are a primary source of conflict. There was a time in the 1980s when all healthcare professionals were on a single salary structure. But all that changed when physicians took charge of hospitals as chief executive officers. That scenario marked the beginning of the prolonged and bitter rivalry in the healthcare sector,” he said.

He added that disputes over resource allocation, autonomy and limited interprofessional training opportunities continue to widen divisions, while government policies such as the exclusive sponsorship of residency training for physicians reinforce perceptions of institutional bias. Without deliberate reforms to restructure leadership, harmonise roles and foster mutual respect, Amibor warned, rivalry will remain a serious threat to Nigeria’s healthcare system.