On doctors day, medical school graduates are not happy

On Egypt’s national doctors day, young graduating doctors are among those at the forefront of discontent in the health sector, apart from the doctors protesting police violence in hospitals that have grabbed headlines over the past month.

Coinciding with the date of the establishment of Cairo University’s Qasr al-Aini medical school, which was founded in the 1800s, doctors day is held under the auspices of the Doctors Syndicate.

Graduates from public universities engage in protest actions once or twice a year, objecting to the mechanism of their assignment to public health facilities following their graduation, which usually lasts one or two years as part of their training.

This year’s round of protests took place on March 9, when graduating doctors protested in front of the Doctors Syndicate, to demand additional bonuses for serving in health facilities that are in remote locations, as well as transportation cover. They called for a bonus for overtime, according to Aswat Masreya news website, which covered the protest. 

The protesters also demanded transparency in the way graduates are assigned to health facilities, which is a longstanding controversy.

A ministerial committee is responsible for overseeing the assignment process, which takes place twice a year. The assignment is dependent on grades, whereby the graduates with the highest cumulative grades get assigned to the most popular health facilities. Graduating doctors are usually assigned to health units affiliated to the Ministry of Health across the country, as well as universities, police and military hospitals, among other hospitals that fall outside the scope of the Ministry of Heath’s direct management.

Graduates assigned to hospitals as opposed to health units are usually seen as more privileged, since they are able to work in a specialization as opposed to being general practitioners. However, according to Amr al-Shora, a member of the board of the Doctors Syndicate, assignment to hospitals not under the auspices of the ministry, as opposed to health units, is usually governed more by informal relations and connections than the rules of the selection process and grading system. Moreover, doctors assigned to health units are expected to manage the units themselves with little or no training, he says.

“Besides being doctors, they have to manage and act as security. The medical part of the job became the least important,” says Taher Eid, a doctor who graduated in 2013.

Eid was assigned to a hospital in the southern city of Shalateen, but finding that he was confined to the emergency room, was stifled by the lack of learning and decided to drop the assignment. After five months of trying to relocate his assignment, he was assigned to a health unit in Safaga.

“The whole assignment period is a waste of time, as you don’t even have the time to study for your graduate studies,” he says.

Eid’s account echoes Shora’s comments about informal relations governing the assignments. “Only some of the posts available are publicized. The rest are kept un-announced and reserved for doctors who have connections,” he says.

Mohamed Zaki, a representative of Cairo University's Medical School's graduating class from last year, says that in this round of protests by graduates, they have been putting pressure on the ministry to list more facilities than the size of the graduating class in order for there to be more freedom of choice for the young doctors. 

Shora, who has been a part of the group Doctors without Rights since 2007, also says that the assignments are not preceded by a survey of needs in health units and hospitals, which means some health units end up with too many doctors, while others remain messy.

Doctors serving their assignments in health units in areas remote from cities have also reported poor living conditions. In these places, they are usually required to work long hours due to the lack of resources without additional bonuses, Shora says.

That the country sees repeated protests staged by graduating doctors is largely due to the absence of a law governing the assignment process, Shora explains, alongside the fact that grievances are not taken into consideration and are carried over from year to year. A draft law was submitted to parliament in 2012 but did not see the light.

When a delegation of young doctors and representatives from the syndicate went to meet with the deputy minister of health overlooking doctors' assignments following the protest, he pledged to ask governors of remote areas to set aside a budget that would attract doctors, including transportation and accommodation budgets, and to better secure hospitals, the privately-owned Al-Shorouk reported.

The system of assignment, in the meantime, remains unresolved, as well as the broader issue of medical training that Eid refers to.  

“There is no training program for us, even in the biggest facilities,” he says. “No one cares about the doctors’ training.”

Zaki says that the doctors this year have staged a strike, manifested in refraining from registering their assignment preferences on the portal that the Health Ministry has availed for this purpose. “Out of 7200 graduates this year across the country, only 500 have registered,” he says, adding that this puts pressure on the ministry to make some changes to the system. Zaki says this strike has been happening for a few years.