The medical profession neglects the needy - Nimal

  • 27 Mar 2006 22:47:50 GMT

    Gaja,

    `This shows a `narrow` outlook by the Minister. Medical students and Graduates bring their own skills into the profession and even if they go overseas their achievements help motivate those at home.`

    Its not the case here, those who learn from the tax payers leaving the country, which tends to lag the service of quality doctors at home. Nobody is arguing on docs going out & getting further training but do they return? That needs channeling.

  • 28 Mar 2006 00:08:38 GMT

    Thank you DrAkai,

    The investment in the doctors does return one way or the other - often through the family system. It ought to be extended to the national level. The Minister is talking about direct barter system. We need to take a global approach and identify with the credentials these doctors earn for Sri Lanka - wherever they go. Towards this I state that my highest educational qualification is Sri Lankan Chartered Accountancy. Our minds must stay connected. If the graduates don`t do it - the government and the profession must - like parents keeping themselves connected to their children.

    The Minister seems `attached` to the physical outcomes. He needs to raise himself to the higher level and recognize the higher level benefits. These graduates who went overseas are a big part of the reason why Sri Lanka is comfortable with International activities.

    love

    gaja

  • 28 Mar 2006 01:34:10 GMT

    ((Its not the case here, those who learn from the tax payers leaving the country, which tends to lag the service of quality doctors at home. Nobody is arguing on docs going out & getting further training but do they return? That needs channeling.))

    This is a two way street. There is a shortage of doctors in the developed countries, for them it is a big expense of tax-payer money to train a doctor, hence the number of places in medical schools are limited, and the competition for entry is as keen or even greater than in SL, there are so many hurdles to jump before one gains entry. To keep their costs at manageable levels, most western countries have a policy of encouraging docs from developing countries to come-over, this is done in a sort of an underhand way. If I am not mistaken, at one time the SL government was trying to negotiate agreements with countries they sent their doctors for post-graduate training to send them back once finished; I know at one time anyone who went out on a Fulbright had to return for at least two years; a similar thing. I think nothing came out of it.

    But there might be a welcome change, some of the western-trained children of SL born parents have ideas of going to work in SL at least for a few months of the year. I guess, there was an influx after the Tsunami, might have some long-term effect, but doubt it`ll have much effect on alleviating the shortage.

    My recent experience with the SL medical system, even places like Apollo, less said the better, lest I offend some of the docs on the forum, who I hope are different.

  • 28 Mar 2006 02:23:43 GMT

    This issue has two sides.

    First, in Sri Lanka medical students do not have to pay for their education. (Sometimes even at the post graduate level) If they had to pay for their education 90% of our doctors would not have been their in the first place. It is the general public of this country who paid for their education. As we all know it takes a significant amount to produce a doctor. SO THE DOCTORS COMING OUT OF OUR EDUCATION SYSTEM HAS AN OBLIGATION TO SERVE THE PEOPLE WHO HAVE PAID FOR THEIR EDUCATION.

    Doctors are also more privileged than other public servants because other public servants cannot do any other work outside their job. Doctors are the only category that can legally work outside their job.

    The other side is most of the doctors, specially the young doctors, live a difficult life. The interns are supposed to work round the clock with no leave. Even afterwards the young doctors struggle a lot to earn their living. Their job is not an 8-5 hour job and they of course do a great service to the society.

    I think we have to strike the balance somewhere. I fully agree the Doctors should be given a decent package, but they too should not ignore their duty towards society.

  • 28 Mar 2006 03:52:54 GMT

    Even the politicians neglect the needy! The politicians ride to power after hoodwinking the needy (who are the majority in the country) and then completely neglect them.

  • 28 Mar 2006 04:22:19 GMT

    Sri Lanka had a system where a medical graduate from Sri Lankan medical schools had to sign a bond that they serve the government sector for certain period of time. In 1977 JRJ abolished it . As a result of that those who signed the bond and had been in oversees on postgraduate studies and even on paid leave did not return back.

    Many doctors went to UK for post graduate education because, prior to 1983 Medical council of UK recognized the commonwealth countries degrees to work in UK without any entrance exams. After 1983 they introduced the exam called PLAB to any doctor wanting to work in UK. This was applicable to every body other than from European countries, USA, Australia, NZ and South Africa. The PLAB examination was tough. Furthermore UK had introduced a mandatory senior registrar positions prior to becoming a consultant and stopped giving senior registrar jobs to foreigners. This had an impact on the Sri Lankan doctors too who were going to UK on their own for postgraduate studies.

    In 1976, the Institute of Postgraduate Medicine (IPM) came into being under the Directorship of Professor K. N. Seneviratne. However, the functioning of the IPM was seriously hampered by a lack of resources and appropriate infrastructure, and because of the fact that the postgraduate diplomas of the Royal Colleges in the UK continued to be recognized by the government as an appropriate qualification for award of consultant posts in the Department of Health Services. With the departure of its first Director to accept a position in the WHO the Institute`s progress suffered a further setback. In 1980, the Institute re-named as the Postgraduate Institute of Medicine (PGIM) was established under the provisions of the Universities Act No. 16 of 1978, with Dr. S. A. Cabraal as its Director. The PGIM Act No. 1 of 1980 came into force in April 1980. The government decided to grant exclusive recognition to the local postgraduate degrees for the award of consultant posts. This was the turning point after which postgraduate medical education flourished in Sri Lanka albeit with some initial resistance from some quarters.

    As a result of establishing PGIM most of the Sri Lankan doctors now first obtain their post graduate training in Sri Lanka and then go to UK or Australia for foreign training. Most of the doctors who obtained their post graduate qualifications locally through PGIM and had foreign training returned back to Sri Lanka since they were guaranteed a consultant position in the government sector which they did not get in UK. Those doctors who did not obtain postgraduate training at PGIM but went on their own to UK and had the training never returned to Sri Lanka , and took staff grade positions in UK hospitals and rarely were able to become consultants. One reason they did not come back to SL was that their training and qualification were not accepted for a consultant post in the Government sector without passing the post graduate exams conducted by PGIM.

    Interestingly things started to change in UK in late 90?s. 35-45% of consultants working in UK were Asians who were retiring. There was a vacuum for those positions which could not be filled by the British trained doctors. The Asian doctors including Sri Lankans and well qualified now were able to get in to Senior Registrar jobs and then become consultants. Now even those who go after PGIM training can find consultant jobs if they can get in to a senior registrar job first. This is bad for countries like Sri Lanka because there is no obligation for them to return.

  • 28 Mar 2006 04:31:04 GMT

    Naleen,

    It is not totally true that first year interns have to work round the clock without leave. They have now better on call schedules and at least once a month a full week end off. other week ends, if their consultant is not taking admissions for that week end, after morning Ward rounds they stay in their quarters only attending to an emergency in the ward.

  • 28 Mar 2006 04:47:51 GMT

    Magha,

    I personally know how interns struggle. (some in very remote areas) The situations have not improved.

    I have a friend who is an intern in a very remote area. He usually accompanies patients in the ambulance when they are being carried in between hospitals. In every one of these journeys he has to spend from his own pocket to provide food for the drivers and other medical staff travelling with him. He is being paid Rs. 12,000 per month.

  • 28 Mar 2006 04:48:24 GMT

    Hellow Mr. Minister!

    BAN PRIVATE PRACTICE!!

    These money hungry idiots who are educated under FREE EDUCATION is an INSULT to the fore farthers of FREE EDUCATION as they do not respect the ETHICS OF MEDICAL PROFFESSION IN SRI LANKA.

    SO BAN PRIVATE PRACTICE BY GOSL (CON)DOCTORS who do not deserved to be called Doctors!

  • 28 Mar 2006 05:04:46 GMT

    Thanks magha, for taking the time to write that elaboration.

    ((The other side is most of the doctors, specially the young doctors, live a difficult life. The interns are supposed to work round the clock with no leave. Even afterwards the young doctors struggle a lot to earn their living. ))

    ((It is not totally true that first year interns have to work round the clock without leave. They have now better on call schedules and at least once a month a full week end off.))

    In most cases, these young junior doctors get paid for a scheduled number of hours, although they put in far more real hours, in some cases double. This is one method, governments keep public health costs down. This non-paid work put in, can be recouped later on, if they go into a speciality or onto private practice. I don`t know what the monetary rewards are in SL.