- Researchers speak to doctors who previously practised medicine in public health facilities to try and understand why exactly they quit their job. The reasons leave a lot to be desired.
Dar es Salaam. You feel sick and you say to yourself, “Oh my gosh! It’s time to go to the nearby public hospital and talk to that competent and compassionate doctor I know well and appreciate.”
But on arrival at the hospital, as fate would have it, you are informed that the doctor who had previously treated you with all the compassion, empathy and commitment; has quit the practice of medicine for a health-related job at a Non-Government Organization somewhere in Dar es Salaam.
You are left wondering why, so suddenly, the doctor you thought he loved his job and appeared so committed; had to leave medical practice for something else?
Researchers say the trend of doctors abandoning clinical practice for other jobs is on the rise, leading to human resource gaps across many hospitals in the country. This is, despite the fact that in Tanzania, one doctor carters for a population between 20,000 and 50,000 people.
In order to meet at least 80 per cent of the basic health needs of the population, the World Health Organization (WHO) recommends a minimum threshold of 1:10,000 doctor to patient ratio. But this hasn’t been met yet, and the doctors in most facilities around the country are increasingly refusing to practice.
In a new study, titled: Exodus of Clinicians from Public Sector to Non-Clinical Practice in Private Sector in Dar es Salaam Tanzania; Exploring the Drivers, the researchers have interviewed doctors working in the private sector-who once worked in public health facilities.
And, the reasons they gave for leaving their jobs speak volumes of the human resource gaps in the country’s health sector.
The lead author, Nathanael Sirili, a Lecturer at Muhimbili University of Health and Allied Sciences (Muhas), says the research team carried out the study after witnessing a number of young doctors quitting clinical practice; from the years 2009 to 2015.
“In public hospitals, the shortage of doctors in practice has remained persistent problem, despite ongoing efforts by the government to train more and employ more,’’ says Dr Sirili, adding: “This has prompted us to find out what’s happening on the ground, by carrying out this study.”
“But also, times have changed. A young doctor is posted to work in a public hospital somewhere but each time he watches TV, he comes across an advert encouraging young people to go for self-employment. When he looks around, he realizes that he has loan obligations to meet after school and the current job cannot help him settle the challenges, he decides to leave,” explains the researcher.
Dr Sirili says previous studies done about doctors leaving clinical practice did not explore the reasons behind. “If we get to know why, it’s then possible to intervene appropriately,’’ he explains during an interview with Your Health.
The study, published in Tanzania Medical Journal (TMJ), recommends, “…nurturing junior doctors to be enthusiastic and adapting to cultural shocks can partly help to address the individual and external drivers.”
The doctors interviewed were based in Dar es Salaam because of its cosmopolitan nature and because most non-governmental organizations in the country are based in the city.
Unfriendly work environment
Some doctors said that there is more creativity in the private sector and a more friendly working environment than the public sector where they had been practicing.
One of the doctors said, “In the private sector if you see something that needs to be fixed today you have to do it on the same day. This is not the case in the public sector. A good example is ordering medicine/supplies from the [relevant authorities] sometimes they will tell you they are out of stock. You have to wait, you do not have an option; therefore, you may find that you treat the patient with something that is not [up to standards] for the sake of saving the present condition.”
Another doctor said, “You attend many patients in a day and this does not motivate you. For example, per day one doctor can serve over 50 patients in the outpatient department hence this leads to exhaustion of mind and reduced efficiency. As time progresses many doctors suffer burnout, as they are overworked and being paid the same salary. This frustration grows and they decide to search for a better option hence ending up leaving their job and join the private sector.”
Public sector underfunded
During the interview, some doctors said chronically underfunded health sector was the root cause of their migration. The lack of equipment, medicine and supplies was a secondary problem due to lack of funds in the health sector.
“In the private sector, I am very innovative than before. When you bring ideas people sit down and discuss how to fund it…subsequently, it is funded, but in the government, it’s very rare due to the normal cry from everyone, shortage of fund...,” one of them said.
Some doctors told researchers that they felt highly concerned when seeing patients experiencing great pains amidst inadequate drugs and medical equipment that would not allow them to be treated effectively.
One of them said, “It was a hard time for me to see the patients failing to pay for services and leave them there without treatment. I felt very bad. It reached a time I was giving them money from my pocket so that they can pay for treatment. As far as moral values are concerned, you cannot let the patient die because one does not have money to pay for services. Ethically, and as far as my morals are concerned, it is intolerable to work in this kind of working environment.”
Expecting to see impact
Some felt that going to the non-clinical practice would make them do things that have more impact. One of them argued that most of the patients suffer from preventable conditions and hence targeting the prevention in communities would bring more impact than continuing to be in clinical practice.
“… My happiness is to help people who are in need. If a person is sick she/he should be treated ... I worked at one of the referral hospitals for some time…, I realized that most of the patients come from low-income families and most of the diseases they were suffering from are preventable. This pushed me to go for preventive service than curative services.”
MAT speaks out
The General Secretary of the Medical Association of Tanzania (MAT), Dr Lilian Mnabwiru says there is a pressing need to incentivize the public sector in order to retain more practicing doctors.
“I know many doctors who were really committed and loved practice, but they ended up quitting to other sectors, some that are not even health-related,’’ she said, adding: “They will tell you they loved practice but unfortunately that could not help them take care of their families.”
A previous study warned that more than 50 per cent of all medical students enrolled in Tanzania between 2011 and 2020 would not be practicing medicine by the year 2025 and won’t be captured anywhere as medical doctors in the public medical institutions.
Researchers from US-based California University San Francisco and Muhimbili University of Health and Allied Sciences (Muhas), tracked down the medical students from the year 1990 using a mathematical tracking system, known as the Markov Process.
The researchers traced the movement of 25,000 medical students from various medical universities in Tanzania and physicians from medical training and employment channels, later revealing that most of them were gradually quitting medical practice.
Findings in the study predicted massive losses of doctors leaving clinical practice to secure employment opportunities elsewhere or migrating to other countries in pursuit of greener pastures.
“Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized,’’ warned part the study report titled: Modeling solutions to Tanzania’s physician workforce challenge.
The cost of training one medical doctor is estimated to be USD 25,000(Sh55million) for an entire five year course.
This study, published in Global Health Action—a California University—Muhas collaboration, largely confirmed a reality that was experienced by newly licensed doctors who completed their medical internship in the country and had been securing government employment but in vain since the year 2014.
It suggested “In light of these findings, Tanzanian policy makers would be well served to increase the health system’s capacity to absorb additional graduating students and improve physician working conditions, especially in rural areas.