Should the number of doctors be restricted?
— SR BALGOPAL
According to press reports, the Medical Council of Mauritius would have brought to the attention of the Ministry of Health and Quality of Life its concern regarding the fact that there is an increasing number of doctors who are requesting pre-registration to the extent that the supply of doctors in Mauritius far outstrips the demand.
To buttress its claim, the Medical Council has highlighted that in 2011, there have been 154 pre-registration trainees as opposed to a mere 23 in 2003. From what we have gleaned in the press, it would appear that the Medical Council has requested the Ministry of Health to take the cue from the Law Practitioners Act so that the number of doctors who are admitted to practise in Mauritius is limited.
If the press reports on this issue are correct, this calls for an observation as in Mauritius, the number of barristers and attorneys who can practise in their liberal professions is not limited by law. The profession of notaries is limited in terms of the maximum number of notaries who are entitled to practise here but this is in line with international practise in so far as the notarial profession is concerned. This profession is in a category of its own and it has to be recognised that “numerus clausus”, that is a limit on the number of notaries practicing in a given jurisdiction is one of the prime conditions precedent that ensures that the work of our notaries is internationally recognised.
In addition to the views expressed by Dr Deepchand, Registrar of the Medical Council on this matter, we also came across those of Dr Wasseem Ballam, the president of the Medical Health Officers Association. Surely, when it comes to a liberal profession such as medicine, quality matters more than numbers and it would be unfair to bar access to the medical profession to a student who has graduated from Oxford, Cambridge or the University of London (or from recognized medical institutions in India, South Africa, Australia, etc.,) just because Mauritius has too many doctors according to the conservative views prevalent in some quarters. Limiting access to the medical profession such that some of our potentially best brains will be excluded from it a few years down the line is not a viable and acceptable option in our view.
Section 12 of the Medical Council Act sets out the functions of the Medical Council Act and provides as follows:
12 Functions of the Council
The Council shall –
(a) exercise and maintain discipline in the practice of medicine with the assistance and support of its Disciplinary Tribunal –
(i) in relation to public officers, in respect of whom it holds a delegated power, to the extent and within the limits of that delegation of power; and
(ii) in relation to any other registered medical practitioner, in accordance with this Act;
(b) advise the Minister on any matter governed by this Act or any matter connected with, or incidental to, it;
(c) establish a Code of Practice for the medical profession on standards of professional conduct and medical ethics and monitor compliance with such a code;
(d) promote the education and training of medical practitioners generally;
(e) keep a record of all its proceedings and decisions;
(f) publish the annual list.
Presumably when writing to the Ministry of Health and Quality of Life, the Registrar of the Council purported to act under section 12(b) of the Medical Council Act as set out above. However, it is debatable whether the Medical Council, which is a body created by statute is mandated thereby to give advice to the Ministry of Health and Quality of Life as to the necessity to restrict access to the medical profession or to erect barriers to entry into the profession. A number of issues have to be addressed:
(a) Is the Medical Council travelling outside its mandate by asking the Ministry of Health and Quality of Life to take measures to restrict the number of doctors who can practise in Mauritius?
In our view, the Medical Council was wrong to advise the Minister in the way it did as it is the Council’s business to regulate the profession in as much as discipline is concerned but it is surely not the Council’s business to turn the medical profession into a private club where members already admitted will guard access to the profession, resulting into a monopolistic business sector where existing members would have a field day for charging high fees. In fact, the Council should strive to maintain standards in the medical profession and prescribe minimum entry requirements for whoever wishes to practise medicine. Is it not unheard of that some have qualified as doctors despite having consistently academically underperformed right from School Certificate. It would be interesting if consideration were given in future for prospective medical graduates to meet a minimum standard of achievement at A-Levels as a pre-requisite for undertaking study in medicine. A measure of this nature, rather than acting to limit the numbers just because there is a so-called “saturation”, would serve to raise the standard of the practice in the country.
(b) Is the Ministry of Health and Quality of Life allowed to restrict the number of persons who are entitled to practise medicine in Mauritius?
It would be difficult, if not impossible for the Ministry of Health and Quality of Life to legislate to restrict the number of persons entitled to practise medicine in Mauritius.
(c) Is it not the case that every Mauritian citizen is entitled to pursue whatever studies he wishes?
In our view, every Mauritian citizen is entitled to pursue the studies of his choice. The problem that arises is that Government has limited funds and if the only set-up in which a person who has studied medicine happens to be a Government hospital, it follows that Government is not duty-bound to provide pre-registration trainee seats to every qualified student.
(d) Is the Ministry of Health and Quality of Life not faced with the financial burden of paying the salary of pre-registration trainee doctors so that it cannot sustain the growing number of pre-registration trainees?
From the Pay Research Bureau Report 2008 (PRB 2008) we read, in relation to pre-registration trainees, that:
30.84 – We recommend that the all inclusive allowance paid to doctors during their pre-registration training be revised to Rs 24000 monthly.”
From the above, it can be safely assumed that the funds in relation to the number of pre-registration trainees who are enrolled by the Ministry of Health have to be limited as the Ministry functions, as is the case with any other Ministry, within the constraints of a given budget. In view of the budgetary limitations, is it not time to review the policy that pre-registration training can only be done in Government hospitals? Rather than limiting the number of doctors who can practise in Mauritius, the limited number of seats for pre-registration training should be increased by allowing the duly recognised private sector medical institutions to step in where the resources of government are limited.
(e) Is the fact that a pre-registration trainee can only do pre-registration training in a Government hospital not part and parcel of the issue of “overcrowding” in the medical profession?
From what we have stated at paragraph (d) above, the real issue seems to be that Government hospitals cannot, for budgetary reasons and also supervision of pre-registration trainees by senior doctors and consultants, enroll all the pre-registration trainees who come on the market every year.
It is beyond doubt that there are many doctors in Mauritius who are practising but who happen to have sub-standard HSC results and who unfortunately are allowed to practise, as the universities from which they obtained their degrees happen to be recognised medical institutions. Whilst it is difficult to investigate those practicing medicine with sub-standard qualifications, it is possible to set out minimum entry requirements to be eligible to practise medicine.
Further, in view of the fact that the medical profession is a liberal one, pre-registration trainees should be allowed to do their pre-registration in the private sector, provided that they are given sufficient exposure to all fields of medicine. As matters stand, this would appear to be a major stumbling block, as private clinics do not offer all fields in medicine. It would be appropriate for the new Minister of Health and Quality of Life to bring a breath of fresh air to the medical profession by paving the way for much needed reform.