Doctors’ emigration crisis and the government’s shortsighted vision

Kareem Raafat
June 11, 2019

On June 3, Prime Minister Mostafa Madbouly held an important governmental meeting to discuss the country’s shortage of doctors and the means of solving it.

Madbouly gave his recommendations to examine the exceptional graduation from medical schools and increasing the numbers of students admitted. He also urged to arrange agreements with private universities concerning access to public hospitals and to allow the training of its students at these hospitals, taking advantage of the resources and infrastructure of the Ministry of Health. This is in addition to facilitating the establishment of medical schools and providing university hospitals to these universities.

Khaled Abdel Ghaffar from the Ministry of Higher Education and Scientific Research said that the plan of developing the medical sector is based on several elements. Foremost is the expansion in constructing new medical schools, whether public, private or national, in addition to rising the numbers of students accepted in public and private universities for ten years at least.

The PM emphasised the importance of executing the government plan of developing the health sector, including an integrated system to improve the situation of sector members in terms of numbers, skills, finances and improving the work environment. These factors come under the government’s program for Egypt 2030 that aims to invest in the Egyptian human factor.

A Huge Crisis

The number of registered medical doctors with professional licenses – not including pensioners – is around 213,000. The ratio of doctors to people in Egypt, 21.3 doctors per 10,000 inhabitants, is very close to the world average which is 23 doctors per 10,000.

However, the number of actual working doctors currently in the entire governmental health sector (including the Ministry of Health and its affiliated bodies, universities and the hospitals of al-Azhar University) is 82,000 doctors – only 38 percent of doctors registered. This means that about 62 percent of Egyptian doctors are either working abroad (there are 65,000 doctors working in a single Arab country according to Speaker of the Parliament Ali Abdel Aal); or they have resigned from government work (about 6,000 doctors resigned over the last three years alone); or they have taken unpaid leave to work in the private sector.

Egypt has 8.2 doctors per 10,000 inhabitants compared to the world average of 23 doctors per 10,000. Indeed, the shortage of doctors extends across the 25 governorates, which means the entire country is suffering from the shortage of doctors.

For many reasons, doctors are forced to leave government work. Most notable are the extremely bad working conditions, with junior doctors forced to work long hours without breaks as a result of the lack of doctors. Current working doctors are subjected to frequent complaints, and even physical offences, by patients and their relatives. In 2017, there were 16 cases of offense against doctors. These offenses are committed for reasons that are outside the doctor’s capacity, such as the lack of beds, medication or medical devices, yet they are not afforded any security protection.

In addition to the difficult working conditions, doctors are poorly paid in the governmental sector with the salary of a junior doctor – who bears the entire burden of public hospital work – is around 1,800 EGP only (approximately $100). Meanwhile, the salary of his equivalent in other countries is tens-folds. Moreover, the infection allowance received by doctors in Egypt is only 19 EGP, while the infection allowance received by judges is around 3,000 EGP.

Dose the government strategy work?

The government said that its plan includes improving the financial situation of the sector’s members and improving the work environment. Whilst this is idealistic, what measures are actually taken?

The same government appealed a court order to raise infection allowance of doctors to 1,000 EGP. The same government also refused to provide sufficient allocations to the Ministry of Health in the general budget to apply the new health insurance law. As for the rest of the government strategy elements, they are not expected to yield results, according to the Egyptian Medical Syndicate, as they do not address the core problem.

Doctor Ehab el-Taher, a council member of the syndicate, said that talking about a “graduation of exceptional classes is bullshit! There can be no exceptional classes in the study of Medicine that requires a specific manner. It takes 15 years for student to become a specialist.”

Taher adds that “increasing the number of admitted students is not a solution as long as the work environment remains the same. The emigration of doctors will continue whatever the number. We just cannot bury our heads in the sands with these kinds of problems that challenges the profession. The solution is to confront the problems that are facing the profession and doctors – with the infection allowance, salaries, offenses, deliberate media distortion being at the top of the list, as well as other problems that plagues the profession.”

Doctor Mona Mina from the medical syndicate board warned that: “increasing admitted students to medical schools without improving the capabilities of these schools would only have one result – the weakness of graduate level.” Regarding increasing medical schools and training students from private universities in public hospitals affiliated with the Ministry of Health Mina considered “an attempt to drop the requirement of having a university hospital in the Faculty of Medicine, as a condition for the establishment of the hospital. This is very dangerous because of the deplorable conditions of government hospitals which would need significant development to be able to provide the space for adequate education and training for students as with university hospitals at state medical schools. In the case of private medical schools where students pay tens and hundreds of thousands every year in attendance fees, their schools must provide them with their own university hospitals for studying in such schools. It is not right to use government hospitals, built by the simple taxpaying citizen, to serve private medical schools, whose owners [if they don’t provide their own private university hospital] would earn millions and billions [from student fees].”

Mina adds that “The attempt to drop the requirement of a medical school owning a university hospital – which is considered the spirit and foundation of every Faculty of Medicine – is an attempt to launch the establishment of new private medical schools without any regularities. This would mean a sharp increase in the number of private medical schools and the number of graduates, with a detrimental fall in the quality of the graduate and the level of health service.”