Dear Editor,
The public health system has been plagued with a plethora of problems, ranging from shortages of drugs and medical supplies to prolonged waiting times for patients at outpatient and even at emergency departments. Very often patients’ frustration, disappointment and anger are directed at the doctors and nursing staff, many of whom are not responsible for the mismanagement that occurs on a daily basis.
The doctors themselves are frustrated with the system, and while they have made known their concerns, about drugs shortages, equipment failure, inadequate and untimely laboratory results all of which have a severe impact on clinical management of patients many of these doctors feel that the administrators at these public institutions have done little or nothing to address these growing concerns. When they persist in complaining, they are harassed and threatened by the government officials. Many doctors feel that such an atmosphere of fear and intimidation is not conducive to the practice of proper medicine.
Also, these problems are further compounded, because doctors especially junior doctors are required to work long gruelling hours, for relatively small salaries and benefits.
Long hours of work
The International Labour Organization through its various conventions have recommended a shorter working week, anything exceeding 48 hours per week is considered long hours. Long hours of work can affect both doctors and their patients. This is well documented in the United States, in a case where an 18–year old patient Libby Zion died due to a prescribing error while under the care of doctors who were on a 36-hour shift. This death led to an investigation by the Bell Commission, which recommended that doctors must not work more than 80 hours per week, nor for more than 24 consecutive hours. Over the years, these hours of work have been reduced to address concerns for patient safety and to prevent physician burnout. The current European Standards is that physicians should not work more than 48 hours per week.
At the GPHC, in some departments, it is the norm for doctors to work 96 hours per week. This happens when doctors work “on call” every three days. In extreme instances, some departments require doctors to work from Saturday morning at 8 am to Monday at 4 pm, a total of 56 hours continuously in addition to the average work week. It should be noted that GPHC is regarded as the best staffed public hospital; one can only imagine how many more hours doctors have to work at the regional and district hospitals across Guyana.
Many of the doctors believe that they will be able to provide a better quality of service if the public health system adopts the European Standards of work for physicians in Guyana.
Inadequate accommodations for doctors on call
When physicians are “on call” they are required to be physically present in the hospital compound. This is to ensure that if needed that these doctors would be immediately available if an emergency arises. The public hospitals would usually designate an area, where these “on call” doctors, can be found if needed. The basic requirements are a secure room, with toilet and bath, a cot, table and chair. These basic
requirements are not met by most of the institutions, forcing doctors to sleep on the corridors or in their cars. At the GPHC for example, both male and female doctors are required to share the same room, with few beds and limited toilet amenities.
Doctors at the GPHC whether “on call” or performing their regular duties complained that they do not have designated canteen space. Many of them who bring their food to work have often had to resort to eating in the wards, or often standing at one of the corner shops around the hospital.
Most modern hospitals have a proper canteen service that caters to both patients and staff. If the hospital is unable to provide this service, then the least they should do is to make canteen space available where the staff of the hospital can dine with some dignity and comfort.
Salary and allowances
Many Government Medical Officers are unhappy with their wages, especially the younger doctors. A first-year GMO at GPHC receives a salary of $181, 808. A second year GMO at GPHC gets a salary of $218,169. A third-year GMO at GPHC gets a salary of $ 261,802. Many of these doctors have complained that this salary is wholly inadequate, especially with the increased cost of living.
The allowances that doctors receive across the public health system vary. The doctors at GPHC would get a monthly housing allowance of $20,000, but most of them complain that they are unable to rent a house in or around Georgetown for this sum of money. They also receive a meal allowance of $500 per call; this is far less than what an actual meal would cost. If a doctor decides to buy a real meal while “on call” s/he would often end up spending more than $1000.
Doctors are given a 3000 dollars per month cell phone allowance to be used when on call to get in contact with their registrars or consultants. Most young doctors complain that this sum is inadequate and are seeking an increase in this allowance.
Overtime rate versus “On Call” allowance.
Doctors are required to work ‘’on call”, that is for extended periods after their regular 8 hours shift. During the work week from 4 pm to 8 am Monday to Friday, and on weekends from 8 am to 8 am Saturday, Sunday and holidays. For each on-call session, the doctor is paid $2500 as an “On Call” allowance, which the PPP/C government had agreed would not be taxed.
The APNU+AFC has now imposed a tax on this “On Call” allowance. Many doctors believe that this is no longer an allowance and would like to be paid under the applicable laws of Guyana. That is they think that anything beyond their regular work time should be treated as overtime and that the applicable rates for overtime should be used. If this is not done urgently, then many are of the view that they will test the matter in a court of law.
Compensation for interns on call
Interns rotating in various departments of the Georgetown Public Hospital are required to work their regular work week, plus “On Call” sessions during the work week and on weekends. For these additional “On Call” sessions of work, they do not receive any compensation. In other jurisdictions, Interns are given adequate reimbursements for work done. This anomaly must be corrected immediately as it seems that this is in breach of our labour laws.
Meritocracy or party loyalty
Many doctors in the public health sector are alleging that the Granger administration is rewarding party loyalty over medical competence and meritocracy. Many young doctors are complaining that scholarships for further training have not been properly advertised, panels are not balanced, and results are often skewed. They feel efforts must be made to have an open and transparent system, where persons are promoted based on their assessed competence or sent for postgraduate training based on merit.
Conclusions
Our medical doctors deserve better, they should earn a better salary and allowances, reduced working hours to improved patient outcomes, better working conditions in the hospitals and a fair and equitable system that would allow for promotions based on merits rather than a party card.
As the government prepares to lay the next budget in parliament, I hope that the many concerns that doctors and other medical staff have raised about their salaries and emoluments would be considered. Many of the doctors have been quite patient and have raised these concerns with the relevant authorities in the hope of getting them resolved. Unfortunately, the Granger administration has been studiously ignoring them. If this attitude continues, then we all will reap the inevitable. Our doctors in the public service deserve better.
Yours faithfully,
Dr Frank Anthony
PPP/C MP
