Paying medical interns well is a good business

Dear Tingasiga:
 President Yoweri Tibuhaburwa Museveni’s fresh directive that a medical intern’s monthly salary should be increased to Shs2.5 million is a welcome measure.  

Whereas the new salary remains small relative to the critically important role of an intern in healthcare delivery,  it is a step in the right direction. Hopefully the President will continue to push his treasury to allocate more funds to the health workers of Uganda and achieve fair monetary compensation for this extremely essential group of professionals.  

The Ugandan medical intern’s current salary of Shs750,000 is utterly inadequate. Whereas I am not privy to the logic behind this low pay, the Ugandan medical intern is very undervalued by the government and, perhaps, even by the public. 

After five years of undergraduate medical education, the new doctor embarks on their internship loaded with the broadest knowledge that they will ever have in their professional career. The typical intern is young, energetic, and driven by a desire to master medical and surgical skills through practice. 

These skills are acquired at a very high cost of working very long hours, including night and weekend duty; taking frontline responsibility for the lives of some of the most critically ill patients; and exposure to potentially deadly infections as has been tragically demonstrated by the Covid-19 pandemic. 

Whether in Uganda or Canada, Lesotho or England, Kenya or the United States of America, the medical intern and junior resident (postgraduate specialty trainee) is one of the indispensable members of the healthcare team in a large training hospital. One cannot overstate the mental, emotional, and physical exhaustion that most medical interns endure for days on end, just to keep us healthy and safe.

To be sure, senior doctors are the first to tell you that their hospital-based work would be pure hell if they did not have junior colleagues to shoulder the very heavy load of providing care for the sick. The wise senior physician or surgeon treats and teaches the junior doctors with respect and collegiality that enhances teamwork and motivates them to give more of themselves.  

 Interns handle well over 80 per cent of the medical and surgical caseloads of most teaching hospitals. The figure may be higher in hospitals that have very limited numbers of senior medical officers and consultants. 
Whereas medical interns in countries like Australia, Canada, UK, and USA do not perform complex medical or surgical procedures, their counterparts in Uganda and similar countries deliver babies and perform many procedures that are exclusively reserved for specialists in the developed countries. 

So, the medical interns’ demand for better pay is very reasonable. Frankly, offering them a pay increase and other incentives and benefits should not be viewed as doing them a favour. 

It is a necessary investment in a critically essential service whose monetary value is multiple times higher than the cost to the treasury. 

It bears repeating that our country should be embarrassed by doctors’ salaries compared to those of its Members of Parliament.  

With a basic monthly salary of Shs 11 million, plus multiple allowances that bring the total monthly package to as much as Shs30 million, a Ugandan MP is extremely well paid for work that is far less risky, less exhausting, and less essential than that of a medical intern. 

 The academic requirement to become a Member of Parliament is an Advanced Level Certificate or equivalent qualification. To become a medical intern, one must successfully complete five  years of rigorous education in an accredited medical school. To earn one’s salary as an MP, all one needs to do is to show up in Parliament. Whereas most MPs actively participate in legislative proceedings and other parliamentary work, they are not required to speak to earn their hefty salaries.    Parliament’s 529 members can take a six-month vacation together without affecting the health of the country.  

The President and his government can keep the country going without a Parliament. On the other hand, the unscheduled absence from duty of even one medical intern can have fatal consequences for citizens who present to the hospital. 

To test my argument, we should arrange a six-month strike of all 529 MPs. Let them not show up for work both in their constituencies and Parliament and we measure the impact of their action. 

Then let the country’s 1,500 interns go on a one-month strike. We can all make an accurate guess about the outcomes of those actions.

In recent years, President Museveni’s government has made reasonable offers of better salaries for doctors. However, these remain far below what these highly educated, critically needed professionals ought to be paid. 

Furthermore, doctors do not work in isolation. They are members of multidisciplinary teams that include nurses, laboratory technologists, diagnostic imaging technologists, pharmacists, physiotherapists, and other specialized professionals. 

A comprehensive review of the healthcare professionals’ working conditions, salaries and benefits is urgently required.  

Our priorities appear to be rather skewed, evidenced by the example of huge salaries for MPs compared to those of senior doctors and other high-skilled professionals.  

President Museveni should cap his long tenure at the helm with turning this skewed tradition on its head.