The effect of the COVID-19 pandemic on career prospects for the Nigerian medical graduate

INTRODUCTION

Doctors are more important now than they have ever been before. The current unpredictability of disease-causing agents, exposure to unhealthy situations, the ever-increasing global population and the various consequences thereof are pointers to this fact. The medical profession grows more invaluable by the day, and this was proven last year, as the novel COVID-19 tore through nation after nation, forcing 90 countries and territories, and about half of the world’s population into some form of lockdown. It was up to doctors to secure the frontline, amidst the traumatic, unprecedented and unfamiliar coronavirus. Nigeria had her own fair share of the outbreak, recording over 170,000 cases so far, and over 2000 deaths. However, rather than tear down the insufficient Nigerian health sector, the pandemic could boost the prospects of its medical graduates, and improve the sector.

MAIN BODY

First, the COVID-19 pandemic could help aggrandise the most common career choice of the medical graduate: clinical practice. Since the establishment of University College Hospital in 1957, the medical education in the 38 medical schools of Nigeria has produced doctors, some of which are known all over the world. Unfortunately, however, Nigeria is an enormous source of medical human capital flight, with many Nigerian trained physicians leaving the country for better opportunities abroad. This is a recurring problem in Africa—a continent that experiences 25% of the global disease burden, but has only 1.3% of the world’s health workers—and it continues to stunt the growth of medical practice in the continent. For instance, of the 80,000 registered, Nigerian trained medical doctors, only about 35,000 practice in the country. In a country of approximately 200 million people, this means a ratio of one doctor to almost 6000 people, when the ideal ratio, according to the World Health Organisation, should be a doctor to 600 people. This deficiency problem, however, is not only faced by African countries. It is estimated that by 2030, Europe would be short of 600,000 doctors, and America would be short of 121,900 doctors by 2032.

The pandemic made things worse. The demand for healthcare givers (including primary care physicians and specialists) is much greater than the number available to fill the positions. The high rate of physician and nursing staff burnout, as well as the deaths of at least 115,000 health and care workers globally due to the COVID-19 battle has not helped either. It is also noteworthy that a tangible percentage of doctors are older. In the US for example, where the average retirement age for doctors is 66 years, the largest age group among doctors is the 55-65 age bracket. Burnout from the all-round stress of covid-19 even suggests earlier retirement. Clinicians are needed both home and abroad, and they can decide whether they want to go into private practice, or hospital-employed work. Nigeria especially is a fertile group for the establishment of practice, as excellent hospitals are few in the country, and the population is large. An increase in the number of active doctors would also improve the overall quality of healthcare in the nation, and tap into the 576 billion naira Nigeria loses to medical tourism yearly. Specifically, nephrology, oncology, cardiology, and orthopaedics make up 60% of the medical tourism cost, and so specialising in these areas could redirect the funds back into the country. Considering these, in the future post-COVID, clinicians can look forward to increased demand for their skills.

Second, the pandemic stressed the importance of pursuing academic career prospects in research work. Like the Ebola outbreak of 2014-2016, Africa was unprepared to face the coronavirus outbreak due to lack of adequate research facilities and personnel. Hence, Africa largely relied on first world nations like the United States or China for information. Inspite of the fact that Africa records high number cases of diseases like malaria (95% of all cases and deaths), HIV (25.7 million cases), tuberculosis, and cardiovascular disease (20 million cases), our research on health issues is just about 2.5% of global clinical trials. Africa is therefore a rich field of research subjects for medical graduates who want to become physician-scientists. These are doctors with or without other advanced postgraduate degrees pursuing a career path in clinically related, patient-oriented science research. Academic physicians play a vital role as they engage in both clinical practice and research. They work on how to use new knowledge to better the lives of patients and have more understanding of issues normal scientists might not put much thought into. The eradication of smallpox, development of the polio vaccine, procedures for the revitalisation of failing organs, and so on, came through physician-scientists. In fact, even though they make up less than 2% of doctors in the world, 50% of Nobel prizes in physiology and medicine were awarded to physician-scientists. From disease biology and mechanics to molecular medicine and biotechnology, research can bring breakthroughs in healthcare, especially in the fragile health sector of Africa.

The lack of clinical scientists has been to the disadvantage of the continent, as their shortage played a major role in disease progression and mortality for the indigenous Ebola virus. Africa lacks enough intellectual expertise to handle possible future disease outbreaks, which could be more deadly. The pandemic therefore serves as a wake-up call for the promotion of epidemiology research, clinical research, health services research and so on. Apart from the obvious advantages of discovery in research like credibility and accolades to the doctors, physician-scientists and their work contribute to the reputation and success of major academic medical centres. Breakthrough findings, or polishing of existing clinical practices with more effective alternatives could put Nigeria, and her academic medical centres, universities and research institutes in the spotlight. Indigenous doctors-in-research in Nigeria and Africa as a whole could also help to solve the many challenges in the management of some diseases that research inference from first world countries can not help with. Hence, medical graduates interested in research prospects can become the eyes and ears of the Nigerian health sector, providing better protection and knowledge to prevent future cluelessness in the face of continent-wide emergency.

Finally, the pandemic may pave the way for important business prospects. Because of safety restrictions, healthcare givers had to take care of patients without exposing them to the coronavirus. Examples include telemedicine, self-screening and outpatient surgeries and procedures. The COVID-19 pandemic also brought an underestimated but fundamental part of healthcare into the limelight: medical equipment, supplies and consumables. Monitoring devices, oxygen therapy equipment, airway management and incubation equipment, ventilators, to name a few, were put on the priority list by the WHO as part of necessary materials needed to handle the novel coronavirus. Many of the devices, however, were in limited amount in hospitals across the country, even before the pandemic. Into the pandemic, Nigeria suffered a shortage of ventilators, beds, and even oxygen tanks. The pandemic had affected manufacturing of medical equipment overseas, and our source countries also needed these equipments, hence a decrease in the supply and a consequent increase in the price. Without medical technology, devices, and products like IV start-up kits, gloves, gauzes and so on, it would be virtually impossible to practise medicine. Therefore, a career or investment in medical technology manufacturing, sales, and distribution could be a goldmine in a country where 64% of said devices are imported from China alone. As doctors, such a career path could affect thousands of patients nationwide through accessibility and affordability of essential supplies, even without having to see any of the patients. Furthermore, experts say the market entry into medical devices is promising; the market is expected to hit $201.8 million by 2023. Medical graduates can access this career path, and the various opportunities in it, and could help prepare for possible new waves or diseases in the future.

CONCLUSION

While the loses (time, money, human resources) due to the coronavirus outbreak of 2020 can not to regained, the pandemic has taught the world a lot of lessons. In a spontaneous time like now, it would therefore be wise as medical graduates to find sustainable s olutions to these problems, as doing so could help set them well in their different areas of practice, and the Nigerian health sector on a path to greatness. Besides, the medical profession itself is a problem solving profession. The COVID-19 pandemic created a void that needs to be filled, but has also shown how important it is to address the pre-existing shortcomings of the Nigerian health sector, and as important future stakeholders, medical graduates can make use of these opportunities to achieve heights in their individual careers.

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