Dr Duane Sands, Minister of Health. Photo: Shawn Hanna/Tribune staff
By RASHAD ROLLE
Tribune Staff Reporter
rrolle@tribunemedia.net
HEALTH officials are bracing for a potential nationwide demonstration involving frustrated junior doctors, according to Health Minister Dr Duane Sands.
The rumoured action comes after some nurses engaged in a “sick out” last week.
“I spoke to the Bahamas Doctors Union president who acknowledged that union membership is prepared and determined to take some type of action (today),” Dr Sands said yesterday. “The public’s safety is in jeopardy here. I’m not certain (it will happen) because I’m not a member of the union but we’ve had this information confirmed by the members.
“We’ve taken steps as we view this as a credible threat.”
Asked if junior doctors will take industrial action today, BDU President Dr Macumba Miller told The Tribune yesterday: “We are entertaining all options. The staff is up in arms but we haven’t taken a strike vote. We won’t do anything illegal. We always view our patients’ care as more important than anything else.”
The demonstration fears reflect junior doctors’ agitation over impending changes within the public healthcare system that will impact their future. This month, heads of medical departments will rank senior house officers – junior doctors who work under the supervision of consultants and registrars – based on their performance. Likewise, the SHOs will rank the various medical departments, such as paediatrics, internal medicine and surgery, based on their preference.
“Using an algorithm with appropriate oversight, people will be matched to a department,” Dr Sands said.
However, not everyone will make the cut. Dr Sands expects that about 100 SHOs will not be chosen to participate in a residency programme within one of the medical departments. Those who do not make the cut will be mandated to participate in a “foundation programme” geared towards preparing them for private practice. At the conclusion of the programme, they will be required to take a Special Purpose Examination (SPEX) to qualify as a private medical practitioner. Those who fail the programme or the exam will be forced to exit the medical profession.
Dr Sands said the changes have been planned for some time.
Standards
“Over a decade or more we’ve been gradually increasing the standards,” he said. “It used to be someone would get a private practice licence just after completing an internship but that doesn’t serve the public well. You cannot say ‘I’m a doctor’ but camp out in a place where you’re neither fish nor fowl. Nobody envisioned young physicians being essentially permanently in a position where they cannot practice independently. Without qualifying to take the SPEX and passing the exam, the Medical Council won’t give licences to practice independently. And there will be no more staying as a mid-level doctor in a public hospital for 20 years.”
Dr Sands said more than 200 SHOs have been trapped in the public system for years and must exit so newly-trained interns can be accommodated.
“If we don’t deal with this problem now what am I going to say to 48 young doctors who don’t have a job and we say we don’t have a job for you?” he asked. “We have not dealt with this because it was too much of a political football and the chickens have come home to roost. I didn’t get involved in politics to maintain the status quo. Our country is in great trouble in large part because we have not tackled the serious problems, whether in education, immigration, in crime or what have you and we have paid a horrible price because of this inaction. An aggressive reform agenda is not anymore a choice but a necessity.”
The number of SHOs – 261 at last count – is growing by about 15 per cent per year and the budget allocation for them siphons off money from other essential services, Dr Sands said.
But junior doctors, often stung by negative experiences with the Medical Council of the Bahamas and the University of the West Indies’ post-graduate healthcare programmes, do not trust that the foundation programme will function fairly and are protesting the ministry’s effort to make it mandatory.
Junior doctors view Dr Sands as an elitist who, having gained his medical certifications in the United States, is unfamiliar with the “inadequacy” of Caribbean post-graduate medical programmes for which claims of bias are rampant.
“All are concerned about this,” Dr Miller said yesterday. “Every single day I cannot walk the halls without getting questions about it. Some people are willing to join the foundational course but making it a requirement doesn’t make any sense.”
Dr Miller said Dr Sands should have concentrated on improving UWI’s post-graduate programmes where matriculation rates are low even as Bahamian doctors perform well in similar programmes in the United States or the United Kingdom. The impending foundation programme, Dr Miller says, mirrors negative characteristics of UWI’s post-grad programmes.
“Thus far we have not seen the list of lecturers or any curriculum for the foundation programme,” Dr Miller said.
“If Dr Sands was truly interested in a postgraduate and certification system, he would strengthen UWI’s post-graduate programmes. It was strengthened before with the family medicine component where the government funded the programme to increase the number of lecturers. It now has about an 80 per cent pass rate. If done with all departments we can see an increase in matriculation percentages out of UWI Bahamas.”
Dr Miller said Dr Sands told his group of doctors who can’t pass the SPEX exam at the end of the programme “should be taxi drivers or maids or wash dishes or become lab techs.”
“We found that very insulting,” he said.
Asked about this yesterday, Dr Sands said: “We practice a profession that has the power to result in life or death. If you cannot pass a certifying examination that says you are a fit and proper physician then you have to find another job. So, there is a possibility all people who don’t apply themselves and who are unprepared to safely practice medicine in The Bahamas will have to find work somewhere else. If it means you have to wait tables, that is not the function of an unkind Medical Council, that basically means you have not applied yourself. “That is the context in which those statements were made and I’m sorry if people are offended. We will do whatever we can to train somebody; we will give you opportunities for remedial study; we will provide you with mentorship but there must be personal responsibility. We’re talking about human lives here and when you’re talking about human lives, I, the minister, am sworn to protect the interests of the public.”
Dr Sands said a meeting with BDU is expected at 2pm today.
Comments
joeblow 5 years, 11 months ago
How would Dr Sands explain the doctors who pass the exam but are poor doctors? There are some so called specialists I never go to or send an enemy to. Obviously there has to be standards of care in all industries, but a way to assess pt outcomes based on decisions a Dr makes is a far better way to determine,their competence than some standardized test!
There are too many in medicine for reasons other than taking care of patients, that is the heart of the problem!
TheMadHatter 5 years, 11 months ago
Hi, I'm Dr. Johnson - may i take your order?
Chicken in the bag? Breast or thigh?
Breast? Ok, i will go perform a quick chicken mastectomy and be right back with your order.
joeblow 5 years, 11 months ago
If you really think about it its the gov't who puts the public at risk by not treating its employees fairly, poorly maintaining the needed infrastructure and work environment and wasting money while creating inefficiency in the system. Government shares some of the responsibility for making it more difficult for doctors and nurses to do their jobs properly!
TalRussell 5 years, 11 months ago
Ma Comrades, all doctors should come under BahamaCARE Also, place a cap on cost prescriptions must be a higher priority over the minister health in conjunction security minister dispatching hundreds corned beef policeman's to raid the poor and near peoples grocery cupboards.
sealice 5 years, 11 months ago
Well_mudda_take_sic 5 years, 11 months ago
Sands is absolutely right. If you cannot pass basic professional knowledge examinations as part of demonstrating your proficiency and entitlement to be certified as a medical doctor with a license to practice then you should not be allowed to practice medicine or refer to yourself as a medical doctor. Too many of our people are dying as a result of our government and the Bahamas Medical Association permitting unqualified individuals to hold themselves out as MDs. These individuals should not be employed as MDs within our public healthcare system nor should they be licensed as private practitioners. The situation Sands is confronted with should have been dealt with by Minnis when he was Minister of Health (MOH) under the last Ingraham administration. Minnis's failure to address these matters when he was MOH suggests that he might have been more adept at waiting on tables than practicing medicine as a UWI trained doctor.
sheeprunner12 5 years, 11 months ago
There is nothing wrong with re-certification programmes to get promoted ....... straight across ALL government Departments ...... clerks, teachers, nurses, policemen, accountants, doctors, lawyers etc, and do away with automatic ACR 3 ratings for annual increments ....... It makes civil servants LAZY and COMPLACENT.
bogart 5 years, 11 months ago
What slso needs to happen is that should be some agency that pore patients who have had problems wid substandard, inferior Doctors care can go to get justice!!!! Cannot ever recall any Doctor being sued for malpractice????
sheeprunner12 5 years, 11 months ago
Office of The Ombudsman ........ duhhhhh
UserOne 5 years, 11 months ago
I applaud Dr. Sands for taking an unpopular stand for the good of the people and the country. This is what we need in government.
ThisIsOurs 5 years, 11 months ago
"this month, heads of medical departments will rank senior house officers – junior doctors who work under the supervision of consultants and registrars – based on their performance. Likewise, the SHOs will rank the various medical departments, such as paediatrics, internal medicine and surgery, based on their preference.
doctors view Dr Sands as an elitist who, having gained his medical certifications in the United States, is unfamiliar with the “inadequacy” of Caribbean post-graduate medical programmes for which claims of bias are rampant.
This is absolutely LAUGHABLE, these people CANNOT be saying that UWI has a substandard medical program. And if by some stretch they're right, they shouldn't be practicing anyway, so they prove Dr Sands' point. The other day they were trying to convince someone that they could earn their entire PMH salary by making phone calls from their "other" job.
It is standard practice at hospitals worldwide for doctors to recertify. I agree 1000% with Dr Sands. There are doctors walking around in white coats who are dangers to their patients. Their colleagues know who they are. I am told that there is a culture of "social promotion" in the medical field. This is not restricted to the Bahamas. Teaching hospitals are reluctant to fail students because theyve put so much time into their studies. But some of them have to be failed, it's the life of your relative they playing with.
DEDDIE 5 years, 11 months ago
I don't see what the big deal is. 95 % percent of modern medicine evolves around several drugs, pain killer, antibiotics, blood pressure agents, blood sugar control agents and last but not least viagra (lol) . The other 5% you refer the patient to a consultant.
ThisIsOurs 5 years, 11 months ago
I disagree. And you would too if it's your baby or your parent that has to be diagnosed.the graveyard is littered with persons who were given a few tablets and sent home. You want to roll the dice with your child?
In order to prescribe anything you first have to diagnose. In my opinion (I could be wrong) the most important skills that a physician needs are analysis and diagnostic ability. The foundation to both I guess is a HUGE knowledge base, you need the know a vast amount of conditions and their causation and you need to know how they present. You need to have a very good understanding of the different body systems. You also need to know what treatments are available for various conditions. In our country you might have to be McGiver. A doctor who just walks around in a white coat and hands out pills as you describe isn't much of a doctor. and they definitely shouldnt have the title senior house officer.
Well_mudda_take_sic 5 years, 11 months ago
Just wait until you need a "real" medical doctor!
Jetflt 5 years, 11 months ago
Good for Dr. Sands! He is absolutely right! If you can’t pass a test, then you can’t be a MD. Go back to school or pursue a different career. In fact, one has to wonder, how did these so called MDs get to be MDs??
joeblow 5 years, 11 months ago
The demonstration fears reflect junior doctors’ agitation over impending changes within the public healthcare system that will impact their future. This month, heads of medical departments will rank senior house officers – junior doctors who work under the supervision of consultants and registrars – based on their performance. Likewise, the SHOs will rank the various medical departments, such as paediatrics, internal medicine and surgery, based on their preference. “Using an algorithm with appropriate oversight, people will be matched to a department,” Dr Sands said. However, not everyone will make the cut. Dr Sands expects that about 100 SHOs will not be chosen to participate in a residency programme within one of the medical departments. Those who do not make the cut will be mandated to participate in a “foundation programme” geared towards preparing them for private practice. At the conclusion of the programme, they will be required to take a Special Purpose Examination (SPEX) to qualify as a private medical practitioner. Those who fail the programme or the exam will be forced to exit the medical profession.
There are several different issues at play which have NOTHING to do with producing quality doctors. Firstly Sands is the one who complained about consultants not being in hospital long enough to earn their pay. What qualifies them, if that is true to assess their junior staff. In addition, a medical school decides who is fit to become a Dr, that is why they have rigorous exams etc.. The Bahamas Medical Council decides fitness to practice in the Bahamas based on criterion they have already determined (so a foreign Dr has to meet the qualifications of the BMC to work in the Bahamas). What Sands is proposing is limiting the number of Dr's allowed in the various departments at PMH through a certification process, those who fail that process have to take an exam to determine if they are fit for private practice. If they fail that exam then they cannot be a Dr. This is nonsense. What they should be doing is moving some of the dinosaur consultants who have been in the system for 30+ years and create room for Dr's to move up in the system. Next they should not allow foreign Dr's to work in the junior Dr posts and stop letting foreign Drs who marry Bahamians have the right to go into private practice since they are competing with Bahamian Drs in a limited market and for positions and lastly, the BMC and them alone gets to determine fitness to practice not the MOH. I understand that the BMC has a continuing education criterion for annual practice so this is enough.
I smell something more nefarious at work here that has NOTHING to do with the competence of Dr's
Well_mudda_take_sic 5 years, 11 months ago
You sound like one of those UWI trained MDs who should not be an MD or the parent or grand parent of such an MD!
joeblow 5 years, 11 months ago
Not at all just a person who can read and think at the same time! Consider if the AG made the same demands about lawyers etc. You graduate from law school, become registered at the bar and them have to take an exam to see if you can go into private practice? That is ridiculous!!! Meanwhile you can sell numbers illegally, make lots of money, influence politician to make it legal and do whatever you want. This is telling people education does not pay!
ThisIsOurs 5 years, 11 months ago
These guys afraid to take exams are NOT representative of UWI med school graduates. UWIs program is RIGIROUS. the program they have here under the banner of "UWI" is doing the students a disservice. I'd recommend they all hightail it to Jamaica if this is something they really want to do.
Justher 5 years, 11 months ago
IT IS ABOUT TIME!!!
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