Times of Oman
Aug 30, 2015 LAST UPDATED AT 12:31 AM GMT
Oman healthcare sector facing crunch of medics
August 28, 2014 | 12:00 AM
Every private polyclinic and hospital faces a huge rush for varied specialised treatment everyday and patients have to wait for hours for their turn in the absence of adequate specialists in every department. - Photos - Jun Estrada, O.K. Mohammed Ali

With the healthcare sector booming in Oman, there has also been an upswing in the quality of treatment, in view of growing competition.

However, all polyclinics and hospitals face a common problem: shortage of specialists. Apart from the well-equipped multi-specialty government hospitals, around seven private hospital chains with state-of-the-art equipment have been complimenting the efforts in tackling the healthcare needs of people across the length and breadth of Oman.

The shortage of specialist doctors, however, has begun becoming a grave concern for most hospitals which are slowly but surely losing their patients who opt for treatment abroad to avoid the waiting periods.

"We have the most advanced technology and equipment available, but we are short of able doctors. This has resulted in losses for the hospitals, as well as rendered availing treatment an expensive affair for patients," says Dr Mohammad Al-Obeid, Medical Director, Muscat Private Hospital.

India has been the most sought after destination for sourcing doctors in the Gulf region including Oman. However, in the recent past, there has been a steep decline in the influx of doctors from the country which has majorly contributed to the shortage of specialist doctors in Oman. According to industry experts, one of the foremost reasons for the situation is the comparatively lower pay structure for medical personnel in Oman.

"Around 10 years ago we used to have a lot of highly qualified specialist doctors from India, almost 90%. But nowadays, we find it very difficult. Nobody is willing to come. In India, the salaries and incentives have increased substantially. So, those willing to come want at least double the salaries than what they earn in their home-country," noted Dr K. P. Raman, Chairman, Al Hayat Hospital.

Dr Raman added that the pay scale was not even on par with some of the neighbouring countries like UAE, Qatar, and Kuwait, so even those who opt to work in the gulf end up choosing those countries, rather than Oman.

According to Seeniya Biju, Chief Operating Officer, Aster Al Raffah Hospital, currently doctors from India and the West were mostly refraining from practising in Oman. "In the recent past the majority of expatriate doctors coming to the country were from countries like Bangladesh, Pakistan, and Sri Lanka. There is a cluster of reasons for this including the lengthy recruitment and licensing process, strict regulations and, of course, the comparatively lower wage scale."

Dr Rajagopal, Orthopedician and Medical Director, Atlas Hospital, however, pointed out that the number of doctors required in the highly paying countries, especially the UAE, was very less, as the population was very low, and hence they could manage to pay them highly. Also, the cost of living was quite high in those countries, compared to Oman. He also stressed that the recruitment rules need to be relaxed.

Ease it up a little bit
According to Dr Obeid, there is a two-phase exam followed by a lengthy verification process for recruiting the doctors in Oman. Once the candidate clears the exams, their papers are to be sent to the Ministry of Health for acquiring a visa. "The ordeal does not end here. Again we have to go through a lot of hassles to get their practicing license, which takes another one month," revealed Obeid, adding that the whole procedure takes about four to six months, in some cases, even nine months.

Obeid further said even though the ministry was taking initiatives to ease up the process, like the latest move to replace the 'theory test' with a 'pro-metric exam' (enabling the candidate to appear for the test in their own country), a lot was still required to be done towards easing the selection and licensing process.

Stressing upon the need to ease the selection process, Obeid said at least consultants and senior consultants should be excused from the test procedure, as their reputation is already established. "I don't see the reason why established and prominent doctors need to sit through an exam. They are well known for their skills, and their experience speaks enough about their reliability. We need to identify the doctors who are good in their own countries, and ease their recruitment process. The lengthy procedure unnecessarily makes life difficult for them."

Also, if at the end of 4-5 months, the doctor is disqualified, the establishment has to go through the entire process again, which proves to be too burdensome for the hospital management, Seniya added.

Another negative outcome of the lengthy selection process, according to Obeid was losing doctors to other countries. "Most of the GCC countries hire doctors from common placement consultancies. The hiring officials from other countries, like Saudi Arabia, check with the consultancy which candidates have been shortlisted by Oman, and offer those doctors visas instantly. Thus, after all the hard work of short-listing the candidate, we end up losing them to other countries in most cases."

Due to the time-consuming obligations, the doctor seeking to practice in Oman, often gets an offer from some other country and ends up landing in that job, added Seniya.

The confusion revolving around the new ruling regarding visa restrictions (2 year-ban for return, etc.) also deters doctors from coming to the country, said Dr. Rajagopal.

"Even we ourselves are not clear of the situation right now. We don't know what the actual ruling is, or if it has been modified.  There is a lot of ambiguity over the issue, and many doctors prefer not to come to Oman due to this uncertainty. Clear cut instructions need to be issued in this regard," pointed Dr Rajagopal, adding that an exception should be made in the case of doctors, with regard to the two-year entry ban, to encourage them to come to the country.

Catch 22
While in some specialty branches the hospitals cannot afford to lose doctors, in others, the hospitals can't afford to keep any. In branches, like cardiology, gastroenterology, gynecology etc. where the influx of patients is quite high, the hospitals are having difficulty in finding the right candidates to recruit, while in others like oncology, hematology etc. where the visiting patient numbers are quite less, the hospitals are unwilling to hire any specialists at all, as that would translate into loss of revenue.

"The problem is both ways. For the highly demanding specialty branches, the doctors are not willing to come, as they have high expectations, and ample opportunities. The lesser needed branches cannot afford to have specialists, as it would translate into a loss statement, said Dr. Raman who admitted that he has been unsuccessfully looking for an experienced gynaecologist and other specialists for the last two 2 years.

Not only for the hospital, hiring a specialist for the lesser needed specialties was also frustrating for the practitioner himself/herself, as they are not able to effectively utilise and hone their skills, said K.O. Devassy, Group Marketing Manager, Badr Al Samaa chain of Hospitals.

"A doctor is a professional, and he wants keep up his skills by studying more and more patients, which he is unable to do here. So, in such a scenario where but the employer and employee are frustrated, it definitely comes to an end, and hence many of the branches do not have specialists."

Dr. Raman suggested that if specialists were allowed to practice at more than one hospital, then the hospitals could collectively afford to pay them the desired package, and the doctor could get access to enough patients as well.

"Currently a specialist could only work for the sponsoring hospital. They are not even allowed to practice at the hospital's affiliated branches. The doctors which are recruited by us for Muscat, cannot practice at our branch in Sohar, as the region is different. The rules, therefore, need to be a bit more relaxed," noted Dr Raman, adding at least for rare specialists, the authorities should consider and allow working at more than one facility or as a consultant.

He further said, "The remunerations for consultants in all the branches are the same, both at private as well as government institutions. A pathologist and a gynaecologist are get the same package. Certain specialties are more in demand and, so, the specialists in those branches need to be paid more. The uniform structure might not work to the advantage of attracting doctors to Oman."

Saif Mohamed Al-Nabhani
Advisor & Supervisor of D G of Private Health Establishments
"The ministry of health has laid certain guidelines and set of rules to effectively hire qualified and efficient medical personnel.

We have to ensure the medicos hired are highly qualified and best in their respective fields to ensure quality treatment to the people.

"The ministry has constantly been putting efforts towards easing the selection process. The Initial theory test, in which candidates were earlier required to come to Oman, to appear in person, has now been upgraded to a pro-metric test. The candidates now give the test sitting in their home-country. The entire selection process takes a maximum of only a month now. The duration is extended in some cases, only if the documents are not proper and in place.

"The ministry has a fair and transparent, common selection procedure for both, the government and private hospitals. The panel of examiners consists of highly recommended experts from the particular fields, for a non-partial and bias free recruitment. We cannot rely merely on the credentials for the reliability of the shortlisted candidates.

"The pay packages for the doctors were also revised recently by the ministry and are on par with international standards. The ministry is committed towards providing world class treatment facilities to the people, and at the same time safeguarding the interests of the doctors as well."

To get in touch with the reporter  — faisal@hioman.com

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