Medical students reject lawmakers’ five-year licensing plan

To check the mass exodus of Nigerian medical doctors abroad, lawmakers are proposing a law that will make it compulsory for medical or dental practitioners trained in Nigeria to practise for at least five years before they are granted a full licence.

The lawmakers are concerned about the brain drain as many doctors leave to seek greener pastures abroad. Moreover, the government heavily subsidises medical training, which it does not ultimately benefit from when students leave the country to practise medicine elsewhere in the world.

A bill for an act to Amend the Medical and Dental Practitioners Act, Cap. M379, Laws of the Federation of Nigeria, 2004 has passed a second reading.

There are two more stages before the bill will become a law. Firstly, it will be referred to the relevant standing committee, which may hold public hearings to engage stakeholders. The last stage is the third reading when members can vote on it.

Presently, Nigeria has the third-highest number of foreign doctors working in the United Kingdom after India and Pakistan.

Data from the UK medical council shows that there are 9,976 Nigerian doctors in the country.

Nigeria currently has only 24,000 licensed medical doctors of its own for a population of over 200 million. Only one doctor is available to treat 30,000 patients in some southern states, while in the northern part of the country, it is one to 45,000 patients.

The World Health Organization’s prescribed ratio is 2.5 medical workers (physicians, nurses and midwives) per 1,000 individuals.

Degree cost

The average cost of medical education to students in Nigeria is low, due to state subsidisation, compared to what students pay in other countries.

While UK citizens pay about US$74,700 in tuition with an additional $286,347 borne by taxpayers for medical education, University World News’ findings reveal that many Nigerian medical students pay less than US$500.

The average cost of a medical school degree in the United States is US$230,296. Canadian students spend about US$100,000 to obtain their degrees.

In Nigeria, the cost of a medical degree varies, depending on whether the university is federal, state or private. Students in federal universities pay between NGN60,000 (about US$130) and NGN70,000 (US$152). At the University of Lagos College of Medicine students pay between NGN69,500 (US$151) and NGN21,500 (less than US$46).

Students at state-owned universities pay about NGN200,000-NGN400,000 (about US$434-$869). At the College of Medicine, Lagos State University, a state-administered university, medical students pay NGN115,750 (about US$251) per annum.

Private universities, however, charge between NGN3 million (US$6,516) and NGN5 million (US$10,860) per session or year.

Medical students reject bill

Nigerian medical students have kicked against the proposed legislation. Grace Majebi, a student currently studying at Lagos University Teaching Hospital, said: “You can’t bully people into doing what you want.” To her, the only solution to the massive brain drain is for the government to channel funds where necessary.

“People are leaving because they can’t afford to live on their current salaries, after going to school for all those years and working hard. It’s highway robbery. They haven’t increased the salaries even with inflation over the years, while the doctors are working themselves to death on peanuts,” she said.

Majebi, however, conceded that the cost of training healthcare professionals in Nigerian public schools is “next to nothing”.

“I agree (the school fees) are next to nothing, but it’s their choice. We don’t owe them anything because they choose to ‘subsidise’ it. I put ‘subsidise’ in quotes because we’re made to pay for every little thing; it’s always one thing or another,” she said.

Ejim Egba Clement, a sixth-year medical student at the University of Jos, and current president of the Nigeria Medical Students’ Association, or NiMSA, sees the bill as modern-day slavery.

“An average medical student spends at least eight years in school, after which they earn a paltry NGN180,000 (about US$391) or NGN200,000 (about US$434), which is nothing compared to what our counterparts in other countries earn after staying barely four years in medical school.

“You can’t address brain drain by forcing fresh medical graduates to stay back. This bill would further compound the problem of the medical sector,” he said.

Another sixth-year medical student at Bowen, a private university, Mercy Asekhauno, pays over NGN3.5million (about US$7,602) in tuition per annum. “This whole thing does not make sense to me,” she said. “They would push people to start writing US Medical Licensing Assessments while in medical school. So, this five-year thing won’t work.”

Mariam Anifowose is also a sixth-year student of medicine and surgery at Bowen University. “It is unfair; the government is not sponsoring our education. I also hope they realise that if you don’t have a full licence as a doctor and you make mistakes at work, the court can’t hold you liable.”

Ijoma Chidimma, a pre-clinical medical student at the University of Ibadan, says the bill seems like a lousy attempt at doing what it’s intended to prevent. “And the bill does not address any of the factors causing it. The health sector of the country is in shambles. The solutions are quite straightforward,” she said.

Legal perspective

A medical doctor and the chairman of the Senate Committee on Health, Senator Ibrahim Oloriegbe, says the proposed legislation cannot work in Nigeria.

According to him, the bill violates the constitutional rights to the freedom of movement and the right to freedom from discrimination. He explained that singling out medical and dental doctors to serve the country for five years before they could be licensed would amount to discriminating against them since the law does not apply to other graduates that enjoy the government’s free university education.

Similarly, Bola Asein, a legal practitioner, said the bill is dead on arrival as the Nigerian constitution guarantees freedom of movement.

Since the government is subsidising education for all Nigerians, it cannot place a ban on medical doctors alone, she said.