What is Housmanship?
Housemanship is the compulsory first year post graduation medical programme where a doctor is to work under the supervision of senior colleagues in accredited hospitals. It is also called internship and the doctors are called house officers/interns.
What happens in this period is that the newly graduated doctor works with a provisional practicing license to practice all what he/she has learnt in medical school with further guidance by a senior colleague. Afterwards, the doctor is then given a full registration to practice medicine in Nigeria and onwards into the National Youth Service Corp.
During housemanship, the doctor passes through the following departments: medicine, surgery, paediatrics and obstetrics and gynaecology; spending at least three months in each posting. For a centre to be accredited for housemanship, all the aforementioned departments must be available and also have a consultant whom the doctor reports to.
As a house officer, the young doctor is expected to do the following:
- Be the first point of contact of a patient, obtain history and perform physical examination on the patient.
- Take blood samples from a patient
- Send patient for relevant radiological investigation.
- Follow up on the care and investigation results of patients
- Administer certain drugs to patients
- Inform senior colleagues about patients
- Take part in departmental meetings/learning sessions
- Prepare patients who are booked for surgery
Problem of Housemanship in Nigeria
It is always a joyful moment when a successful final year medical student takes the Hippocratic Oath signalling the end of undergraduate medical education and the beginning of a career as a medical doctor.
However, the journey is hardly ever smooth in Nigeria as this first year comes with its ups and downs. Some of the challenges that emerge include:
- Failure to get an accredited centre to practice
- Too much workload
- Intimidation by senior colleagues
- Poor remuneration
- Incessant strikes
A newly graduated medical doctor is expected to get placement in an accredited centre for housemanship within two years of graduation otherwise such a person would be required to re-write a qualifying exam to get another provisional license to practice medicine. This is a dreaded process. This problem results from a paucity of accredited centres for housemanship. Since independence, the population of Nigeria has increased. However, there has not been an exponential rise in the number of care facilities or even health centres that are accredited for housemanship.
There has also been a slow pace in upward review of the number of house officers in each accredited centre.
There is also the problem of corruption in the Nigerian system where merit is put aside and letters of introduction from highly placed officers are used in awarding placement. This has greatly affected average fresh doctors from getting placement in accredited centres because some of their colleagues exploit the system by doing housemanship twice within two years, as such depriving others from getting placement.
With an increase in the nation’s population, there has not been a compensatory increase in the number of house officers who are usually the first to attend to patients when they arrive in the hospital. This leads to attendant stress of having to attend to the needs of so many patients leading to frequent physician burnout.
Intimidation from senior colleagues is another problem being faced by house officers at work. Shouting down at house officers in front of patients is a very common practice in Nigeria. This has a very negative effect of negatively affecting the self-esteem of the doctor in question and hence the patient and their relatives would not cooperate respectively with the doctor. In the end, the doctor does not learn all he/she is expected to learn during that period.
Furthermore, there is also the problem of poor remuneration. House officers perform various roles in the hospital and most times even work overtime in the process, thus, they deserve to be paid for the effort given at the end of the month. The pay of house officers differ in the various accredited centres for various reasons and this in the end makes individuals to gravitate towards centres with better pay. There is also this wrong notion that house officers are doctors in training and therefore should not be paid a salary on that account. This is not only unfair but also exploitative. The last strike by the National Association of Resident Doctors (NARD) resulted in part from the non-payment of house officers.
Finally, incessant strikes have the negative effect of prolonging the stay of the house officers in the system. Most centres have it programmed that a house officer is to receive pay for 12-13 months. However, when there are strikes, there is no work and obviously nothing to supervise. Therefore, the young doctor cannot be signed off on account that that he/she has not been found adequate to manage patients under that department. This interrupts their time tables which implies that they have to work for more months without pay and miss going for national youth service when due.
Possible Solutions to the Problems of Housemanship in Nigeria
Nigeria is in need of more health centres to meet up with its growing population. This is not only the function of the government and its agencies in the health sector but also the private sector. The sooner accredited health centres are made available, the quicker the problem of non-placement of house officers will be a thing of the past.
With more centres and more house officers being recruited, the doctor-patient ratio would be in tandem with the required ratio stipulated by the World Health organization as well as reduce physician burnout in the process.
The Medical and Dental Council of Nigeria (MDCN) has also come up with an ingenious way of posting house officers to various accredited centres thereby preventing an individual from performing housemanship twice in two different centres within the stipulated time-frame. All what a potential house officer is to do is to go to the MDCN website and fill all the necessary information and then choose the centres they want to be posted to.
There should be a collaboration between the relevant ministries and departments like the Medical and Dental Council of Nigeria (MDCN), Nigerian Medical Association (NMA), National Association of Resident Doctors (NARD) and the accredited hospitals when it comes to designing the central portal for posting of house officers and, if possible, their payment. Otherwise, payments should be left to the discretion of the individual accredited centres in the various states of the country.
The problem of incessant strikes should as a matter of urgency be looked into by the Nigerian government.
House officers are meant to work under the supervision of a senior colleague and not be demeaned by them especially before patients who they come in contact with. Junior medical doctors need to be groomed to be confident in the face of any medical condition they come across and have a sense of high self-esteem when they are attending to patients and their relatives.
Nigeria has some of the best medical training schools in the world despite the dearth of infrastructural facilities. Every year, the nation produces numerous medical doctors and groom foreign trained doctors on the Nigerian way with the aim of providing the best treatment to patients in Nigeria.
Junior medical doctors, the house officers, need to be protected and welcomed by all so that they can grow and get better in future for the benefit of Nigeria as a country and Nigerians as a people.