Editorial

Editorial

The coat and the cloth

We ran a report last Sunday quoting the secretary of the Government Medical Officers Association (GMOA) predicting an exodus of doctors out of the country because he says that doctors are not paid enough. His complaint is that doctors salaries have not been increased since 1994 and that the salaries paid here to government doctors, averaging around Rs. 17,000 a month, are low compared to what obtains elsewhere in the SAARC region.

We do not know whether the GMOA secretary is right about salaries paid to doctors in other SAARC countries. He says that these are in the range of about Rs. 50,000 a month. He may be right if he has employed a conversion rate relative to the par value of the much devalued Sri Lanka rupee. But rupee for rupee, we do not think doctors in India, Pakistan and Bangladesh get paid an average of as much as Rs. 50,000 a month working for the governments of those countries except at a very senior level. Of course, if you convert the currency, Indian Rs. 25,000 will be Rs. 50,000 here.

It is useless converting salaries paid to doctors or any other professional abroad into Sri Lanka rupees at the current exchange rate and then arguing that the scales that apply here do not bear comparison. The GMOA official had talked of a talented neuro-surgeon who had recently left for a job in the USA and was now earning the equivalent of Rs. 300,000 a month. At almost Rs. 90 to the dollar, this would be a salary of less than US dollars 4,000 a month which would not be inordinately high in that country considering the earnings of medical professionals in the USA.

But Americans who go through college and medical school earn their professional qualifications through a tertiary educational system which works on a cost recovery basis. That is not the case here. University education is free and all the people of this country contribute in taxes to give our doctors their medical education. The rates of pay that prevail in any country must bear a relationship to its economy, its ability to meet the wages and pension bills of its public servants and a variety of other factors including the relationship between the salary scales of different professions and other sectors in government service. In such a situation, doctors can only feel as underpaid as engineers, state counsel, judges or whoever.

All public servants and not only doctors are convinced that they are insufficiently paid by the government. Doctors are at least fortunate that they enjoy the right of private practice even in that they are salary earning, pensionable government servants. The GMOA official was quoted saying that about 40% of its membership engage in private practice earning Rs. 15,000 to 20,000 over and above their emoluments and that is what enable them to live well. To that extent, they are a highly privileged sector that has retained this privilege despite widespread criticism of conflicts of interest and abuse that has prevailed over the years on the private practice issue.

It may be worth remembering that the Shelton Wanasinghe Administrative Reforms Commission (ARC) recommended several years ago that doctors salaries be increased and their right to private practice be taken away. The ARC recommendation was that government doctors then in employment be allowed to retain their right to private practice and be ineligible for the recommended salary increases if they opted to do so. But new entrants be denied this privilege and be paid the higher emoluments recommended. The eventual outcome was that the doctors got the higher pay and also kept their right to private practice. In fact, the GMOA had in the old days campaigned for abolition of private practice and better pay and finally ended up having their bread buttered on both sides.

The GMOA is a powerful trade union which is not slow in protecting the interests of its membership even at the cost of withdrawing its services from the sick. Minister A. H. M. Fowzie who stood up to the government doctors did not retain his health portfolio for long. As it is, there is nothing to stop a doctor who thinks he is underpaid from seeking greener pastures outside our shores. There is no compulsory service enforced here on doctors, or for that matter any other professional, even though most of them are educated at public expense. The GMOA has enough muscle to ensure that those who have qualified abroad as doctors, whether on scholarship or at their own expense, are placed at the bottom of the list for purposes of postings and most of them must serve their internships in war-torn or other difficult areas.

Time was when the Americans held their ECFMG (Educational Council for Foreign Medical Graduates) examination here and many of our doctors who passed it, went off to the USA where they repeated their internships and carved lucrative careers for themselves in that country. Particularly in the sixties, when all medical graduates qualifying here were not granted government employment, this proved a boon. We may well be approaching a time when this cash-strapped nation may not be able to employ all doctors passing out of our medical schools or, for that matter, offer a free medical education for the same numbers as today.

The clichŽ may be threadbare but its validity nevertheless remains: the coat must be cut according to the cloth that is available. There is no use converting their present salaries to U.S. dollars and arguing that they are underpaid. That holds good for everybody. The doctors must not forget they are a privileged group with guaranteed employment after qualification - though for how long we don’t know.

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