Pursue a Fellowship or PhD or perish: the fall and fall of medical practice in Ghana

What is the future of medical practice in Ghana? Once again, I am tempted to be a ‘prophet of doom.’ Academia and medical doctors themselves have come up with the rules:

1. Without a PhD, one cannot become a (Senior) Lecturer nor hold a major position in the university. It is interesting how this same debate has been going on in Nigeria:

Medical fellowship can’t substitute PhD as qualification for VC – Prof Osodeke, ASUU president

https://punchng.com/medical-fellowship-cant-substitute-phd-as-qualification-for-vc-prof-osodeke-asuu-president/

2. Without pursuing a Fellowship programme (in Obstetrics and Gynaecology) a Specialist will not be promoted to the Senior Specialist position.

What are the implications of the above two positions for medical practice in Ghana? Most people are thinking about Fellowship programmes and PhDs which will not necessarily improve clinical skills in Ghana. Considering the fact that few centres are accredited to be training centres for the Fellowship programme in many of the faculties, many medical doctors (specialists) are moving from the districts to Accra and Kumasi (and the few other training centres for the Fellowship programmes).

What are we going to see:

1. In the districts/rural communities, Physician Assistants, nurses and midwives are going to do many of the ‘medical procedures’ and are going to push to do even more.
Already midwives are certified to perform Manual Vacuum Aspiration (MVA) or to evacuate the uterus for incomplete abortions. In cervical cancer prevention, nurses are treating more precancerous lesions of the cervix with (thermal coagulation and cryotherapy) than doctors are doing. In the absence of experienced medical doctors in rural communities in Ghana, Physician Assistants (and midwives) are asking to be licensed to perform caesarean sections to save lives…
Most anaesthesia in Ghana for surgeries are given by non-Physicians who now have the masses to ‘dictate’ the direction of anaesthesia in Ghana.

2. The skill of medical doctors in many disciplines will drop drastically. Let’s remember that someone cannot teach another person what he himself doesn’t know. I wrote elsewhere that we are going to see Professors in Obstetrics and Gynaecology with PhDs who cannot perform caesarean sections.
Yes, we are going to see very theoretical medical doctors with fellowships and PhDs who do not have a lot of practical skills to teach the next generation of doctors.

Medical doctors are losing ground as leaders in the health profession by our decisions. We can decide to use ‘semantics’ to protect our egos and profession but we cannot hide from the truth.

I wrote this a couple of years ago:

What is in a name?

“When a midwife conducts a breech delivery, she is practising midwifery. When a medical doctor does the same thing (even with less skill), it is obstetrics.
When a medical doctor looks at the cervix under magnification with a (mobile) colposcope, it is called colposcopy. When a nurse does the same (even more skillfully), some people want it to be called ‘Enhanced Visual Inspection with Acetic acid’ (not colposcopy), because to them, nurses are not supposed to perform colposcopy.”

– Dr. Kofi Effah.

“What’s in a name? That which we call a rose by any other name would smell as sweet.”

– William Shakespeare.