• NARD insists upgrades could fuel patient mismanagement, quackery
• Upgrade aligns with global academic standards, say pharmacists
• ‘Multiple ‘doctors’ may blur leadership in patient care’

A controversy is brewing in Nigeria’s health sector following a policy change by the National Universities Commission (NUC) to upgrade the academic degrees of pharmacists, physiotherapists, and optometrists from bachelor’s to doctoral status.

This latest development has ignited broader conversations about hierarchy, recognition, and the future of inter-professional collaboration in Nigeria’s healthcare landscape as resident doctors expressed serious concern about the policy change, warning that it could lead to confusion among patients, heightened professional rivalry, and quackery within the already fragile health system.

In a statement signed by the Executive Council of the Nigerian Association of Resident Doctors (NARD), the association expressed dismay over what it described as a potentially destabilising move by the NUC. The doctors’ group warned that granting the “Doctor” title to multiple health professional groups could sow confusion among patients.

NARD maintained that while it supports improved welfare for all health workers and a more robust health system, it believes that this reclassification prioritises title competition over genuine systemic reform. “Over the past two decades, agitations by other health worker groups have increasingly focused on competing with medical doctors, rather than driving systemic improvements,” NARD noted.

The doctors emphasised that globally, public institutions do not place pharmacists, physiotherapists, or optometrists above physicians in terms of clinical leadership or earnings. “Patients typically seek doctors for diagnosis and treatment decisions, a fact reflected in salary structures and clinical governance worldwide.”

NARD also contested the rationale of “global best practices” cited by the NUC, arguing that countries like the United Kingdom and Germany maintain clear professional boundaries without granting the “Doctor” title to non-physician healthcare professionals unless earned through a PhD.

The group urged the NUC to reconsider the policy, warning that the changes could erode teamwork, clarity, and trust in Nigeria’s fragile healthcare system.

NARD President, Dr Zenith Osundara, told The Guardian that while NARD is not opposed to professional advancement or salary improvements for other health professionals, allowing multiple professions to adopt the title “Doctor” without adequate regulation opens the door for quackery and increases the risk of mismanagement.

He argued that assigning the title “consultant” to non-physicians, such as pharmacists who specialise in diabetes care, was problematic, as they often manage only a narrow aspect of a disease, whereas medical doctors, such as endocrinologists, are trained to treat the condition in its entirety, including associated co-morbidities.

“If you say a pharmacist is a consultant in diabetic care, that doesn’t compare with what an endocrinologist does,” he explained.
“We treat the patient, not just the diabetes. There are usually broader issues involved.”

He accused some stakeholders of copying foreign models without considering the peculiarities of Nigeria’s healthcare environment, noting that such “copy and paste” reforms often lack the necessary regulatory and educational frameworks.

Osundara warned that these changes might be politically motivated rather than driven by sound medical principles. “People want to be politically correct but are not focused on what is medically right and suitable for our system.”

NARD president dismissed suggestions that upgrading degrees or titles would help stem the tide of emigration among doctors. He attributed the mass exodus of healthcare workers to poor welfare, unattractive incentives, and inadequate government support.

He said, “Changing titles won’t stop brain drain. The core issue is that healthcare professionals, including doctors, are not being treated with the dignity and support they deserve. If inflation hits, we are affected just like everyone else, sometimes even more, because people assume doctors have money and inflate prices when dealing with us.”

On the salary disparity between doctors and other health professionals, Osundara emphasised that NARD is not against any group agitating for better pay.

He further warned that if such trends are not checked, they could encourage other cadres, including technicians and sub-professional groups, to seek academic upgrades without merit, further complicating the already strained healthcare structure.

“Today, it’s pharmacy and physiotherapy, tomorrow pharmacy technicians or nursing assistants will begin demanding doctorate-level recognition, and we’ll lose the ability to differentiate roles and responsibilities,” he cautioned.

The President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Prof. Aminu Mohammad, warned that such a trend could cause serious confusion in Nigeria’s healthcare system and compromise patient safety.

He stressed that with the current use of the doctor title, there are already instances of impersonation, which have led to cases of patients being mishandled or misdirected. “So, what if everybody is called a doctor? Patients will go into the wrong hands,” he warned.

Mohammed warned that without a clear system of leadership in the clinical setting, patient care would be compromised. “There is usually no system without a leader. In hospitals, all patients are admitted under a consultant; if everyone calls themselves a doctor, who then leads in managing patient care?” he questioned.

The MDCAN president also pointed to international examples, noting that Ghana, after experiencing similar confusion, resolved the issue by designating all first degrees as bachelor’s degrees, regardless of discipline. According to him, the authority to be called a doctor in clinical settings is not granted by a university degree, but rather through registration with the Medical and Dental Council of Nigeria (MDCN).

However, in a swift and scathing response, the General Secretary of the Young Pharmacists Group, Enugu Chapter, King-David Ahuchaogu, dismissed NARD’s concerns as misleading, elitist, and out of touch with contemporary professional standards.

Ahuchaogu argued that the title “Doctor” is not the exclusive preserve of physicians, noting its origins in academia and its application across various fields. He also challenged the idea that calls to adjust the Consolidated Health Salary Structure (CONHESS) to mirror the Consolidated Medical Salary Structure (CONMESS).

Rather, he insisted these are legitimate demands rooted in equity and fairness, as outlined in a 2009 Memorandum of Understanding between the Joint Health Sector Unions (JOHESU) and the Federal Ministry of Health.

On the issue of inter-professional roles, he dismissed NARD’s claims that patients only seek physicians, calling such assertions “vague and deceptive.” He argued that no doctor can work in isolation, emphasising the indispensable roles of laboratory scientists, pharmacists, physiotherapists, and other professionals in the care continuum.

Defending the NUC’s decision, he called on the Commission to stand firm and avoid being swayed by detractors. “Nigeria is not an island,” he said, adding that the policy shift aligns with global trends and promotes interprofessional respect and collaboration.

Also, the President of the Pharmaceutical Society of Nigeria (PSN), Ayuba Tanko, criticised the Nigerian Medical Association (NMA) for what he described as their constant opposition to collaborative progress in the health sector, stating that their stance is detrimental to healthcare teamwork and patient outcomes.

Tanko expressed his frustration with the NMA’s approach to inter-professional relations in the healthcare system. According to him, the NMA’s resistance is not just disruptive but also harmful to efforts aimed at improving the country’s healthcare delivery.

“The way NMA is going about it… We can’t reply to everything they decide to talk about. Everything—they are opposed to everything. They are opposed to everybody getting progress in this profession. It doesn’t work out for our teamwork.”

When asked about possible steps towards harmony and improved healthcare delivery, the PSN president asserted that the NMA does not appear to be interested in collaboration. “They don’t want harmony because they don’t believe healthcare is teamwork.”

Tanko also criticised the influence NMA wields over government decisions, stating that the association often resorts to threats of industrial action.