Oman


Govt hospitals face severe staff crunch, growing patient inflow



Muscat: Despite millions of rials being pumped into health care services every year, the government hospitals are still severely understaffed, leading to frequently noticed shortage of experienced and senior medical practitioners. 

The Ministry of Health needs to respond to the changing world and an expanding population. Oman is no longer a backward country with villages dominating social life, as was the scenario at one point of time. The rapid expansion of sprawling towns and cities has led to an increased demand for quality health care. A patient used to walk in and see a specialist within an hour but now it takes months.

A major operation would take up to two years. Yet, these are the same hospitals that used to receive 7,000 patients a day 10 years ago and now receive 20,000 across the country. Muscat being the capital city is the hardest hit.

The heath centres struggle to cope and most of them have only two doctors at a time. The major hospitals in Muscat, the Royal Hospital, Al Nahdha and Khoula, don't have enough beds, neither are there enough medical practitioners. The shortage of beds is directly connected to fewer hospitals against an expanding population.

Low salaries

However, the problem of fewer doctors and nurses is different. A principal of a medical college in Oman says that youngsters do not find medicine attractive enough. Why? Because doctors and nurses in the civil service are not paid as well as graduates who find jobs in areas such as business and Information Technology.   

It makes sense. There are no statistics available but the same principal estimates that a quarter of all government doctors have two jobs. They work in the morning in state hospitals and in the afternoon in the private medical institutions. It is obvious that they would not be able to make both ends meet if they solely depended on the wages they were paid by the civil service.

'Renegades'
And the number of 'renegades,' as they are called by medical insiders, is increasing every year. This practice compounds the woes of our medical sector. When you have the loyalty of doctors divided, they start losing their credibility as professionals.

Since medicine in Oman is a growing but unsatisfying profession, these doctors now treat it as any commodity sold in the market against their ethical training.

A doctor who was in the night shift in a private hospital gets only four hours to sleep to find time for his other job in the government hospital where he has to reach by 7:30 in the morning. He rushes through every patient so that he can go home and catch up on his sleep. He is probably getting more money at the private hospital. Why should he pay more attention at the Royal Hospital or at Al Nahdha? His patients in the government hospital suffer from a decision that allowed him to work for two employers at the same time.It goes further.

The root of many difficulties in the government hospitals is their inability to offer round the clock services. Conditions on weekends and official holidays are even worse. But to work at full stretch seven days a week requires that we recruit more doctors and nurses. We also need more full time consultants, not the ones who hold two jobs. The government cannot share its doctors with the private sector.

Experience
Recruiting experienced staff in the government hospitals is another factor that needs closer engagement. It seems that trainees are outnumbering the experienced doctors by a much bigger percentage than the international norms. Many patients complain that they are examined by young doctors who have only a couple of years of experience. To be examined by an experienced doctor is now a rarity in the government hospitals and that's why many patients go out of the country when they have major illnesses. But what about those who cannot afford to undergo treatment abroad? 

Obviously, reforms are needed urgently, especially now that we know that the consequences can be serious. Increasing the number of beds by building more hospitals and recruiting more experienced doctors are two of the most important priorities.

A junior doctor can take care of common cold but cannot cope with a painful slipped disc. A patient needing an urgent heart bypass cannot wait two years either. Somebody needs to do a study on how many people die every year unnecessarily because of lack of timely treatment.

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It is clear fact that Omans Healthcare industry is still growing and requires a lot of attention immediately specially in the government sector. Without clear statistical data it would be hard to comment on the output and efficiency levels achieved.

However it is understood that recruiting or appointing in-experienced medicos will only increase costs and reduce efficiency as compared to appointment of a few capable and really experienced surgeons.

The need of the hour is not infrastructure development in healthcare but retainer ship. The qualified and experienced doctors are offered higher packages either abroad or in private sector. Even citizens of Oman are of perception that a heart surgery or kidney transplant performed outside Oman specially in India, USA or UK is much safer than in their home country.

The decline in quality doctors at governmental level has allowed a strong private lobby in this industry. The level of proficiency of these medical professors are much higher than those in government sector.

Commentators often argue that the answer to the problem is to refocus the healthcare system from delivering activity to delivering value; simply spending more money does not translate to better outcomes. So what is value in healthcare?

It may be patient outcomes or results achieved for every penny spent; this is hard to visualise so it may be better to say that value equals solving health problems for patients to leave them in a better position than when they approached the service, and at a cost which is more efficient than paying for the long-term consequences of the presenting problem.

The particular pressures that health services face are the difference between solving a problem and responding to an illness, and the difference between taking the long term or short term view.

Recently the Gujarat Govt. in India proposed to increase the retirement age from 58 to 62 of teachers and doctors serving in the government-run medical and dental colleges and hospitals across the state. With the new doctors needing more support, it is essential to idealize investments in setting up training institutions for the freshers apart from on-job training they are currently provided.

Medical today is a mere monetary profession unlike old days. Hence it is necessary to transform the know-how in an efficient manner. Another option could be bringing together platform of major surgeons to tie up with various hospitals apart from their private sector jobs.

How these question will be answered remains the BIG QUESTION? Can a sustainable model be developed? If so how soon? A lot of things remain unanswered and need to be attended soon.





This is a very good article and should open the eyes of those who are at the helm of affairs. I have served MOH for 21 years and I agree that the patients are suffering really. they are not getting that care in some overcrowded places what they should supposed to be.

One of the reasons among others , is that the experienced physicians are being kicked out of the service with probably no solid reason. In one region only within last 2 years around 50 senior physicians were terminated . A physician by the time and experience learns and develops professional skills and knowledge which is highly useful and applicable to his patients.

moreover a patient-physican bond is developed by the time. there is no alternative what you learn by experience. considering simple and minor financial reasons as excuses to end the jobs of senior physicians and deprive the patients of their skillful services do not seem to me more logical.

More patients now who can afford or manage to afford the expenses of the private hospitals, visit private hospitals because private hospitals are now receiving the cream by employing the experienced physicians and medics retired from other services.





Because of the issues mentioned in this article, the Omani public has little confidence in our healthcare system and they always look abroad for medical treatment. The system needs to be responsive to the needs of our population, so that people can be confident that the treatment they are being offered in Oman is genuinely world-class. We have the infrastructure, now we need trained personnel. It is imperative that good quality medical staff is recruited and then retained by attractive benefits.




Another important fact is the mandatory retirement age is 60 years of age. If there is such a shortage, why should the seasoned doctors made to take up involuntary retirement at age 60. As all of the senior doctors can and are willing to work upto the age of 65.


NOT 60 OR 65 . SOME EXPERINCED PHYSICIANS AFTER GETTING PROFESSIONAL KNOWLEDGE , SKILLS , CERTIFICATES , COURSES , DIPLOMAS IN THEIR RELATIVE FIELD WHEN THEY ARE ABLE TO SERVE MUCH BETTER THAN BEFORE GET INVOLUNTRY RETIREMENT AT AGE OF 50 , 51 ETC.



This situation is very alarming for a progressive country like Oman when its people finds it very hard to be sick. This country should not be comparable to 3rd world countries wherein its people are not allowed to be sick.