The recent release by the Nigerian Association of Resident Doctors (NARD) against other health professions, particularly Pharmacy, Physiotherapy and Optometry, raises serious concerns on whether the NARD is truly in touch with reality or simply chooses to be mischievous. There is thus a need for clarification to be made.

The prefix Dr Is not the personal property of any profession. Tracing history, the Dr title is from the Latin word _docere_, which is reserved for scholars. Specifically, it is linked more to PhD holders and not 1st degree holders like MBBS, who now imagine they have the exclusive privilege to the Dr title. Thus, the title Dr can be used by anyone who earns it, whether by an academic degree, a professional degree or on an honorary basis, or even as a courtesy title (as seen with physicians with only an MBBS degree, which is not a doctorate but a Bachelor’s degree). Hence, the genuine quest for the Dr Title cannot be seen as competing with physicians as claimed by NARD. The title can be earned by the above-mentioned health professionals just as physicians earn theirs, too.

It is also not out of place to seek better remuneration or better working conditions. Health workers on the CONHESS have a right to demand a reward for their labour. The clamour for adjustment of CONHESS, as was done for CONMESS, is based on a 2009 MoU signed between the JOHESU and FMOH, which unambiguously says that once you adjust any of the 2 salary scales in the health sector, the other must be adjusted by a commensurate percentage.

The thought of physicians thinking the goal is to match the CONMESS salary structure is rather an illusion and deceptive. Pharmacists and physicians used to enjoy the same entry levels, which were GL 08 during internship and GL 09 after youth service.

The difference was a two-step advantage in favour of physicians up to 1991 when the discriminatory MSS was introduced by the then Olikoye Ransome Kuti-led FMOH. Today, physicians start their full time job on GL 13 after their youth service with 100% call duty allowance using higher COMESS scale while other health professionals (including pharmacists who, hitherto enjoyed same entry points as physicians) start their full time job on GL 10 with 50% call duty allowance using relatively lower CONHESS salary scale. Pharmacists with Pharm. D and optometrists ( Opt. D) now have enabling circulars to start full-time jobs on GL 12 after completing their NYSC still using the CONHESS salary scale that is relatively lower. This still gives the physicians the relatively higher GL advantage as they still enjoy the higher entry point with the higher pay scale of CONMESS.

This implies that adjusting CONHESS does not translate into earning the same salaries as the physicians who are already on a higher pay scale of CONMESS and a higher Grade Level, but just to maintain the RELATIVITY and EQUITY between the two salary scales in the event of amendments contrary to the propaganda of NARD.

Furthermore, for clarity purposes, the process of getting a Pharm.D ( Doctor of Pharmacy) degree is not a walk in the park. It requires the same minimum of six(6) solid years with rigorous input and workload.

Medicine and surgery, just like other professions, are a choice; hence, while a physician chooses to study Medicine and Surgery, a pharmacist chooses to study Pharmacy, and the same applies to other professions.

The choice of profession is guided by passion amongst other factors, hence one cannot go to study Medicine and Surgery simply because of the title, and individual choices must be respected.

Interestingly, there is no course in any university known as Doctor or Doctoring. And globally, there are different types of doctors in healthcare. In neighbouring Uganda here to Nigeria, all graduate pharmacists are addressed with Dr title. NARD can choose to learn that the Kenyan Doctors Union ( also known as KMPDU ) is made up of pharmacists, physicians and dentists.

Health disciplines’ professional doctorates are a global thing and not a Nigerian creation. Our physicians here in Nigeria cannot claim to be unaware of the fact that the only professional degree of all pharmacists trained in the USA is the PharmD (Doctor of Pharmacy,) and the holders are addressed as Doctors.

Yes, in the UK, pharmacists and dentists may not be addressed as doctors or with the Dr title because they do not graduate with professional doctorates from school. However, the SURGEONS in the UK are also not addressed with Dr title and they don’t use it. If one may ask, why do Nigerian surgeons use the Dr title? It is, therefore, worrisome how some Nigerian physicians have abandoned their work and are using titles.

NARD claims that patients seek physicians for diagnosis and treatment decisions, but this claim is rather vague and deceptive, and it negates the place of interprofessional collaboration or teamwork. Healthcare professionals are also referred to as the healthcare team. A team is not a one-man or one healthcare professional show. Hence, the claims of physicians that patients come to hospitals to see only their brethren is a ruse. Many clients patronise public facilities because of the hands-on experience of the array of professionals.

Can the medical doctor diagnose alone without the aid of a medical laboratory scientist? Can the medical doctor treat alone without the assistance of the pharmacist, physiotherapist and other healthcare professionals?

A surgeon, for instance, cannot perform surgery without the input of the pharmacy professional, because sutures and other surgical dressings are all manufactured by pharmacists.

Even the drugs which a physician can prescribe are manufactured by no other health professionals apart from pharmacists, and pharmacists clinically assure the safety of medications.

The physicians must hence recognise and respect the place of other healthcare professionals, and stop making deceptive public statements aimed at confusing the lay public.

The title Doctor does not in any way negate the place of clear roles and trust. The NARD has no moral justification to even raise the concept of clear roles and trust when it is obvious the physicians have left their roles and path and are rather much more interested in other professional roles.

It is also insulting to use the term “quackery” on their fellow healthcare professionals who are qualified and certified by accredited institutions like NUC & the respective professional councils. Speaking of quackery, one may wonder about the profession that is notorious for having private practice where they divert patients, give certification to ‘self-trained’ auxiliary nurses, drug dispensers and other types of quack practitioners.

To enhance clarity, pharmacists put PharmD after their names, which makes it clear.

The use of the title Dr. Will boosts patient confidence, acceptance and adherence. If people with only an MBBS degree who have no doctoral degrees but a Bachelor’s degree can use the title Dr, how much more the fact that a qualified pharmacist or optometrist with PharmD or OD ( Doctor of optometry )?

If NARD members who are still students under training are finding it difficult to understand the use of nomenclature within the healthcare system, they should say so. We assure them that there are many qualified academics, including those in diaspora, who can help tutor them.

The NARD is, henceforth, advised to face their duties as physicians and pursue growth in their professional career while leaving other careers, especially other healthcare professions. They should rather stick to their path and roles.

NARD members who are all just students undergoing training should please focus on their studies & training and desist from making provocative and embarrassing statements which can further tear apart the seriously ailing Nigerian health system. NARD should be very grateful to the Nigerian government for sponsoring them financially, unlike what their equivalent colleagues go through in other climes.

The NUC is also hailed for its decisions and is encouraged not to yield to distractions by detractors who have refused to think globally while working locally. Nigeria is not an Island. Furthermore, policies that will increase professionalism, career growth and interprofessional collaboration should be encouraged.

Pharm. King-David Ahuchaogu

Residency Student of the West African Postgraduate College of Pharmacists