Opinion: The problem with Nigeria’s medical internship system

by Obinna Nnewuihe


“Ah me I’m going to study Medicine oh- at least when I finish there will be no need to look for job. Who has time to be carrying brown envelope upandan?? Abeg o.”

So we thought when we first signed up to study medicine…  Guess who is carrying brown, white and transparent clear files now?

You see when they say life never goes the way you expect it to; men no be lie. Before my very eyes and in the space of fewer than 4 years I’ve watched as the famed hope of having jobs chase after you once you are done with medical school gradually fade away!

Let me break it down. You see, after spending 6+x years in medical school- “x” frankly dependent on how many years your university feels like dashing you (my friend don’t you know a doctor needs to be fully mature before coming out of school? And beards don’t grow overnight- or are you a learner?) As I was saying jare, after your 6+x years, you eventually get let out into the world to go and ‘save lives’. You then go on to complete a mandatory 1-year clinical internship before proceeding to the National Youth Service Corps (NYSC) programme.

This doesn’t hold only for medicine; in other health professions- Pharmacy, Physiotherapy, Radiography, Medical lab science etc, there is need to complete the one-year clinical internship before proceeding to the NYSC year and independent practice subsequently.

Now here lies the problem; over the past few years, it has become increasingly difficult to secure the internship position. Surprising huh? In a country like ours with one of the highest patient-doctor ratios in the world, one would assume that once clinicians are freshly minted by our medical schools they will be immediately absorbed to fill the huge gap that exists. But nope! They are not!

To further put the case in perspective- there is a limited time frame- usually 2 years to complete the internship year. Failure to complete it within this time means that one would have to repeat the final year exam- after 2 years of graduating! One would then pay the exam fee; even though you probably haven’t been earned a dime and have spent so much travelling the length and breadth of the country in search of the internship.

During exams for the internship position, there can be up to 500 people seeking jobs in a centre that can only take about 30.

So what is the way out? This present system is not sustainable and no longer working! Too many trained personnel with skills the country desperately needs do not have the opportunity to contribute to improving the health indices of their country while earning a decent pay for their years of training. Rather than sit back and complain- together we can think through what can be done differently.

I don’t think solving this internship issue is so much of an impossible task. First off- the regulating bodies- Medical and Dental Council and our other regulating agencies have the record of every individual that they license every year yes? The hospitals that are licensed to train interns and the number of interns they can take are known to regulators yes? The number of students who should graduate from our medical schools are also known to the regulators yes? So what then is the problem?

Couldn’t we have a system that pulls together the projected number of interns who will be graduating yearly from the different medical schools alongside foreign trained graduates who return to the country? This database can be used to match graduates of clinical disciplines to the different hospitals that should absorb them. If we have an NYSC scheme that posts all graduates to different parts of the country to carry out community service, why can’t we have a system that registers and posts trained personnel to the different hospitals nationwide who need their skills? There have been allegations that some hospitals taking in fewer interns than they have the capacity to absorb in a bid to reduce overhead. Centralising the internship application process and simplifying it with the use of technology that guarantees a unified database, could be a major step in curbing certain fraudulent practised that derail the country’s roadmap to providing quality affordable healthcare for all.

If the time for posting interns is relatively fixed and known to all, it could further have the effect of forcing medical schools into compliance with respect to adhering to the stipulated number of years for training. Furthermore, more medical centres need to be licensed for the training of interns in other to make the placements less tedious.

Our options as a country are clear! We can continue lamenting about the state of things and reminiscing the “good old days” or we can face the reality that confronts us head-on and devise ingenious ways to solve them. The relative simplicity with which the internship year went for most clinical graduates doesn’t exist anymore! The number of graduates seeking these entry level clinical roles continue to swell yearly. Uncertainty about the prospects of clinical training is one of the most potent driving factors for the mass exodus of Nigerians doctors, pharmacist and other medical professionals. If we think things are bad now, they definitely can get worse way quicker than we think.

The time to act was yesterday! Perhaps today may not be too late to start trying.

Op–ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija

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