Of VCs, CMDs, dying patients, physician conspiracy

NOT many people may have heard of Miriam Olusanya. But Ms. Olusanya is currently Managing Director of GT Bank, a company with a market capitalization in excess of a trillion Naira and well over three thousand permanent employees. GT Bank generated a profit slightly in excess of a trillion Naira in the first half of 2024. Ms. Olusanya originally trained as a pharmacist. Were she to have pursued a career in pharmacy and chosen to work in a hospital, she would never have been privileged to lead any public hospital whatsoever. Indeed, she would never have risen above the role of Director of Pharmaceutical Services, which is where pharmacists tend to be capped in the hospital environment. This is the paradox of Nigeria’s health institutions: Chief Medical Directors, as managing directors of hospitals are known, must be medical doctors, according to a decree that was engineered by Prof. Ransome-Kuti, health minister in the Babangida years. Even though it is irrational and illegal, being discriminatory against other health practitioners, that decree has since become entrenched in our statute books.

Managing an enterprise, as the world has long come to realise, is not necessarily a function of professional training. You do not necessarily need to have trained as a banker to run a bank successfully, as Olusanya and many others have proven. Nor do you need to be a trained physician to successfully run a hospital. In fact, in the United States, less than five percent of hospitals are led by medical doctors. Managing a thriving hospital as the US has long realised, is a function of how skillfully a leader synergistically aligns all the critical elements such as planning, organising, staffing, controlling and leading. While a medical doctor may indeed possess all of these qualities in addition to his skills as a physician, those traits are not exclusive to medical doctors and may also dwell in the sundry other professionals who provide service in the hospital environment: pharmacists, nurses, medical laboratory scientists, accountants, physiotherapists, psychologists, health economists, administrators, and many more. Unfortunately, doctors, aided by Ransome-Kuti’s decree, have continued to feed Nigerians with the wrong impression that only doctors can run hospitals. In the process, the dragnet for the selection of Chief Medical Directors of hospitals in Nigeria, is deliberately constricted, being restricted to doctors. These critical public institutions are therefore denied the potential leadership that may have been provided by hordes of talented professionals in disciplines other than medicine.

The situation is not different in Nigeria’s medical or health universities. While Nigeria’s first specialized university is the Tai Solarin University of Education in Ijebu-Ode, medical universities have over the years, gradually sprung up across the country. These universities train doctors and in addition, pharmacists, nurses and other medical specialties. They are staffed by medical doctors as well as teachers from other disciplines including the medical sciences. It doesn’t take rocket science to know that medical or health universities are not fundamentally different from other universities. They are only different in that they are limited to teaching courses in the medical and health fields. Managing these universities, therefore, is no different from managing any other university in Nigeria. Curiously, however, only medical doctors can aspire to become Vice Chancellors of Nigeria’s medical and health universities as any advert for that position will confirm. The current VC of Lagos State University is a physiologist – Physiology is one of the medical sciences. Were the College of Medical Sciences of Lagos State University to be upgraded to a full-fledged medical university today, LASU’s VC would not qualify to be its VC. A few months ago, the Nnamdi Azikiwe University, Awka threw up a case that presents a perfect opportunity for medical doctors to hold a mirror to themselves for a thorough examination. Seeking a new VC to replace the outgone one whose tenure had expired, the university advertised the vacant VC position. Any aspiring VC it stipulated, in keeping with a key requirement by the National Universities Commission, must possess a PhD. Hell was let loose as the same doctors who have for decades been beneficiaries of the discriminatory Ransome-Kuti decree which makes the CMD position exclusive to them, who have been discriminatory of other professions with regard to VCship of medical universities, cried blue murder. The university, they complained, was being “discriminatory” against medical doctors. In their reckoning which they presume is superior to the NUC’s prescription, the clinical training which a medical doctor undergoes in the quest to become a specialist or consultant, is “equivalent to a PhD.”

Interestingly, quite a number of medical doctors possess both the clinical qualifications as well as PhDs which suggests that the PhD is not quite the superfluous degree they would want the world to believe. The medical consultants went further. In typical fashion, they went on strike. They abandoned the sick and dying to their fate, in order to justify a claim that is at best questionable, and at worst an attempt to deceive the public. Which brings us to the question: Why do Nigerian doctors go on strike at the drop of a hat? Medical consultants are the top doctors in Nigeria – the most experienced and perhaps the most skilled. In downing tools over an unproven assertion that claims parity between clinical fellowships and PhDs, abandoning the same sick and dying patients whom they swore to protect and save, what manner of example do they leave their younger colleagues? University College Hospital, UCH, Ibadan has been in the news for all manner of reasons lately. The hospital has defaulted serially in paying its energy bills and its current circumstances are deplorable. Could leadership be its problem? Is it not plausible that opening the CMD position to sundry professions and in so doing broadening the pool from which the best leaders can be selected, could help redress the hospital’s pathetic situation?

The current system that imposes the doctor as the compulsory head of all health institutions, including medical universities, is anachronistic and has no place in the present day where all the health professionals are equally well-educated. Nigeria needs to jettison this ancient practice and allow the country to benefit from the value potentially derivable from selecting leaders of Nigeria’s healthcare institutions from a diverse pool of professionals. This will also help to considerably curtail the disharmony that exists in the health sector.

It is unfortunate, however, that other health professionals have over the years tended to accept with equanimity, a situation where they are perpetually subjugated in hospital settings and now, in medical university settings. Why have they been unable to challenge prevailing laws which are discriminatory even when Nigeria’s constitution explicitly states that citizens must not be discriminated against, under any guise? They need to borrow a leaf from the pragmatism of their doctor colleagues who typically waste no time in agitating vehemently, whenever they imagine they are oppressed. George Bernard Shaw was spot on when he asserted that every profession is a conspiracy against the laity. Apparently, no profession anywhere in the world typifies this assertion better than Nigeria’s medical doctors whose conspiracy of deceit has often left Nigeria with the short end of the stick. Do medical doctors play an incredibly vital role in our lives? Without question. That role, however, should embody honesty, honour, humility and responsibility. Doctors need to temper their sense of self-importance with a recognition of the sanctity of the lofty oaths they have taken to save lives. Governments on the other hand, must also learn not to become slaves to the demands of doctors, however irrational. And other health professionals must eschew complacency and fight for their rightful place in Nigeria’s healthcare settings, currently monopolized by their doctor colleagues.

• Okoruwa, a fellow of the Nigeria Academy of Pharmacy, is CEO of the communications consultancy, XLR8

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