Doctors Propose Residency Program

Jigme Dorji Wangchuck National Referral Hospital

Given the shortage of specialists, and the increasing need for their services in the country today, doctors have proposed that it would be “wise” for Bhutan to start off with a post-graduate program, instead of an MBBS one.

Submitted some time last week to the medical university’s board, the proposal stated that starting with a PG program would “train our own specialists and have sufficient national specialists in various medical disciplines in the referral and district hospitals; improve tertiary healthcare services; create an academic environment at JDWNRH to promote the practice of evidence-based medicine in the country, and reduce the referral cost of treatment outside the country.”

That a PG program is more doable to meet the shortage of specialists in the country is the “agreed feeling” among most doctors, said health officials. “Starting with a PG program first is better because it can be done with the existing manpower,” a specialist said.

A curriculum and a pedagogy training for specialists is what is needed to take off with the PG program, said another doctor.

Starting with a PG program means Bhutanese doctors, who are abroad for their MBBS program, can come home and do their residency here. “It means there would be doctors around the clock at the hospital, because PG program isn’t conducted in a class,” a former doctor said. “So, patients would benefit more, because, today, except in the casualty, you can’t find a doctor at the hospital after 3pm.”

Although “a lot” still needs to be done, but if Bhutan is able to start off with the MBBS course, as planned by July next year, it would be getting its first batch of 35 doctors five years later.

However, in the next five years, about 248 doctors, who are studying MBBS on government scholarship, would be returning home, a number, which is more than 50 percent of the existing pool of doctors.

Having a program for these doctors to do their residency in the field of their choice at home would make the services of these doctors available at home sooner, because most PG courses are for a long duration, between three to five years.

“This is valuable service lost to the country, which could be made available here by the proposed residency training program,” the proposal stated.

One of the most important points doctors raised is that starting a PG residency program would be “cost effective”, and not as “cost intensive” as starting a MBBS course, and allow the government to continue sending the same number of students, 35, abroad for MBBS.

If the proposal comes through, and the requirement of resident doctors any indictor of the shortage of specialists in the country, then doctors have agreed to start residency for 14 doctors in its eight of the 17 departments. They have agreed to have two resident doctors each in the department of surgery, obstetrics and gynaecology, orthopaedics, paediatrics, medicine and ophthalmology, while psychiatry and anaesthesia have said they could start with a doctor each.

While the proposal at least in writing may be coming now, talks about starting it came a “long time” ago, said doctors. “In fact, a proposal was also submitted to the ministry, but it was ‘shot down’, because it wasn’t in line with the government’s manifesto,” said officials.

But with the “memorandum of understanding” with India, on which most requirements to start off the MBBS course hinge on, revised for the 11th time, and yet to be signed, health professionals have become more skeptical, said officials.

“The ministry is very certain to start off with MBBS, but we have to look at the demands and the requirement from the departments, because there is also an urgent requirement for specialists” the medical college’s project manager Jamtsho said.

Jamtsho said some exercises have been done for PG program, and they have a concept but need to work on the details such as the curriculum, if the academic board and the governing council approve the proposal. “It’s still under discussion,” he said.

Observers said they are waiting to see if the government this time would push for its political promise or go with the requirement that its people have been asking for.

Doctors however said that agreeing to start off with a residency program doesn’t mean that they are opposed to start- ing MBBS course. “If we can start MBBS, there’s nothing like it, but when can we start is the issue,” a doctor said. “We’re doing it now because we are asked to do it.”





This story from Sonam Pem

Sonam Pem has the distinction of being our very first author on Bhutanomics.