Medical students and medical residents, also known as registrars, have recently faced significant fee increase, with postgraduate fees at the University of Nairobi going up threefold. This brings the average fee of a master of medicine programme to around Sh680,000 per year.
With the cost of living rising and inflation at 9.2 per cent, the highest since June 2017, it seems nearly impossible to afford.
Career progression in the medical field requires patience and perseverance. Obtaining an undergraduate degree in medicine takes a minimum of six years in an institute recognised by the Kenya Medical Practitioners and Dentists Council. After a few years in the medical field, one may choose to do their master’s, allowing them to specialise in a particular field.
During this training period, they are known as medical residents. After completion of their master's programme and thereafter working under supervision for three years, medical students qualify and attain the title of consultant.
Consultants are fundamental to the safe and effective practice of medicine. They are senior hospital-based physicians who provide guidance to junior doctors.
In Kenya, the average period of a master's of medicine programme is five years; ranging from psychiatry, which has a three-year minimum to neurosurgery, which has a six-year minimum period.
Each of these years requires Sh680,000 fee, with the final year's fees being Sh710,000. This means the average residency training cost is Sh3.4 million.
During this training period, the students provide their professional skills and labour to the hospital but are not paid.
In the Western healthcare system, take the UK, for instance; the students train as they work. They are regarded as working doctors and are paid throughout their training with no university fees paid, as no traditional universities are involved in the training.
In these systems, doctors are matched to various hospitals where they are employed, provide services, and receive training from consultant physicians. Adequate government investment in the healthcare sector and in related infrastructure has made this system possible.
A large number of junior doctors, therefore, have access to speciality training at no cost. This begs the question, we borrow so much from the West—language, religion, political structure and some integral parts of our societal norms—so, why doesn’t investing in healthcare, training medical doctors and the health of our future generation make the cut?
The debate on the training of medical professionals and their remuneration is nothing new. In 1999, medical residents, medical officers, medical officer interns and students went on strike, protesting poor working conditions and the lack of remuneration for their services.
The registrars were overworked and not paid, despite having fees to pay, their families and themselves to take care of. Their requests were met with threats, and the leaders of the strike were expelled from their various programmes.
Many years later the same problem, if not a bigger one, persists. The recent fee hike will affect all incoming students, and some departments are already experiencing an enrolment decline as high as 60 per cent.
If this persists, we will find ourselves with a shortage of medical specialists, a situation already present in some subspecialties, but far worse.
This is a major problem for all Kenyans. Medical research and disease management is becoming highly specialised. Gone are the days when one doctor could cure all. With our life expectancy increasing and science evolving at a mind-blowing rate, new drugs, new disease management protocols and surgical techniques are under constant development and implementation worldwide.
It is, therefore, an impossible task for one medical doctor to have the knowledge required to safely practice medicine at the consultant level in all the specialities and subspecialties, which is why specialists are essential. Qualified individuals with the latest evidence-based information are therefore an essential service to the people of Kenya.
Qualified personnel reduce healthcare-related costs through safe and efficient patient management, therefore, relieving the strain on public healthcare funding.
With such harsh conditions for doctors in training, from lack of infrastructure with willing and able trainers to the lack of compensation and exorbitant school fees, we must ask ourselves, how will the public health sector operate in the near future?
Will we overcome these challenges, or will our already strained system crumble?
