Holding back the doctors

Nigerian doctors take the Hippocratic Oath.

In April 2019, Nigeria’s labour and employment minister, Dr Chris Ngige, was asked about Nigeria losing healthcare professionals to economic migration that took them to better-paying jobs in other continents, and he brushed it aside, saying that Nigeria had a surplus that made the migration a non-issue.

A year before that, his colleague, the health minister at the time, Isaac Adewole, was asked what could be done to improve the post-residency situations of Nigerian doctors, many of whom go through a lot of frustration during and after their residency programmes. Dr Adewole’s flippant response was that such people did not have to be doctors and could choose to pursue careers as farmers and tailors.

These Cabinet members were unconcerned about the reports that many of Nigeria’s doctors and other healthcare professionals were seeking better pastures in other countries. This idea that Nigeria does not have enough doctors, nurses, and other forms of healthcare professionals get discussed regularly, and a comparison with some other locations might help us see if there is any truth to the claims, especially with how loudly the complaints get sometimes.

Nigeria currently has 24,000 licensed medical doctors serving a population of 200 million people. For comparison, California has the highest number of doctors in the US, with 118,151 physicians serving a population of 40 million Californians. New York has 98,821, and Texas has 69,676

If Nigeria were a state in the US, it would not be in the top 10 for the number of licensed doctors. You have to get to the 15th position to get an American state that Nigeria has more doctors than, and that is Washington which has 22,515 physicians looking after a population of 7.9 million, about the population of Bauchi State. Those complaining about Nigeria having a serious healthcare personnel problem have a point, so our legislators have decided to act.

The Nigerian House of Representatives has just had second reading on the Medical and Dental Practitioners Act (Amendment) Bill, 2022, which would make it compulsory for graduates of medical schools to work in the country for five years before being eligible to receive their full license. If passed, the law is meant to check the migration rate of medical professionals to other countries.

It looks like, after the initial bluster, the Nigerian Government has owned up to the existence of the problem but is, as usual, choosing to focus on a symptom instead of looking to understand and solve the true problem, and instead is looking to tackle the issue in a way that is more likely to hurt than help.

What we are seeing is nothing other than a demand and supply situation that should be handled accordingly. We have to take note of the demand situation outside of Nigeria. Despite all of its doctors, it is estimated that by 2025, the U.S. will be faced with a deficit of 446,000 home health aides, 95,000 nursing assistants, 98,700 medical and lab technologists and technicians, and more than 29,000 nurse practitioners, according to a 2021 report conducted by industry market analytic firm Mercer. The American Association of Medical Colleges (AAMC) also predicts that the US will have a deficit of 122,000 physicians by the year 2032, which would be partly caused by an expected 48% of the over-65 population due to people living longer.

In England, The NHS has 94,000 vacancies for healthcare professionals, with 9,691 of those openings being for doctors and 38,952 for nurses. So the demand is clearly there, and forcing products of Nigeria’s medical schools to stay home for five years after graduation will not solve the problem.

The Nigerian Medical Association (NMA) has 75,000 Nigerian doctors registered with it, and over 33,000 have left the country. Other than the demand in the West, you have a situation in the Middle East where countries like the Emirates, Oman, and Saudi Arabia have an 80% dependency on foreign-trained healthcare human resources, creating strong demand for African healthcare professionals. In Saudi Arabia, for example, only 3000 out of 33,800 doctors in the private sector are Saudis, while only 2700 out of 45,900 nurses in privately owned hospitals are Saudis.

Nigeria has fewer than 25 thousand doctors in the country and needs 363,000 more doctors to cater to its 200 million-strong population, but our university system produces 3,000 new medical and dental doctors every year. Nigeria would need a hundred years to satisfy its population at that rate, so there is a problem with increasing the supply of qualified medical personnel.

The healthcare brain drain is not a problem unique to Nigeria. Egypt’s medical association says that 50% of Egypt’s registered doctors have left the country, and over 10,000 doctors are reported to have emigrated between 2016 and 2019. A doctor who earns as little as $2,500 annually is always going to be keen on migrating to labour markets that pay as much as $220,196 annually, and in some US states, general surgeons tend to get more than $383,333 per year in a working environment that is much more conducive to personal development. When you pay people accordingly, you can hold them to the highest standards they have been equipped for. Keeping people alive is worth whatever the market says it costs. Nigeria’s government has also done nothing to maximise the reach of the extant quantity of medical personnel through telemedicine. As I mentioned, it is a supply and demand problem, and those with the means will always find ways to corner the supply.

Outside of learning how to heal people miraculously or telling them not to fall ill, there is nothing we can do to increase the demand for medical professionals either in Nigeria or abroad, and our skilled people will always move to where they feel adequately appreciated. So we have to increase the supply of healthcare professionals, which will not happen by forcing people to stay for five years. All that will do will be to ensure that all doctors who want to leave will be leaving with five years of experience, creating the weird situation where we will be enhancing the tide of migration of mid-level and senior medical professionals with more than ten years of experience. The very people who we would need to run our hospitals administratively. The kind of nonsense that is happening to our banks!

Finally, there is the issue of how difficult it is to come to the decision to migrate. Many people I know have left Nigeria in the last five years agonised extensively before making the final decision and did not come to that decision lightly. Have we interrogated why people decided to leave their comfort zones and start life anew in other, sometimes hostile, environments?

Most of Nigeria’s problems have come from trying to act in contempt of market signals. This attitude is guaranteed to keep the migratory tap flowing heavily. The most sensible approach would be to respect the market signals and pay doctors accordingly to discourage economic migration and increase the supply of labour in the field as people react to the reward system by investing in becoming qualified enough to earn them.

Before I drop my biro, it is important to note that I deliberately did not talk about our government officials going abroad to seek treatment from the same doctors they did not provide for back home. That is an entirely different wormhole to go down and would double the length of this piece…

Nwanze is a partner at SBM Intelligence