The shortage of specialist doctors has reached alarming levels in the country, posing a significant threat to the healthcare system. The Association of Medical Specialists (AMS) has highlighted the pressing need for 4,000 specialist doctors across 62 specialties by 2025.
However, the current cadre of specialists stands at a mere 2,000, a significant decline from 2,300 in the past eight months alone. Migration accounts for approximately 95% of the reduction, exacerbating the brain drain of medical professionals. Amidst this crisis, the Government’s decision to lower the retirement age to 60 years has further exacerbated the shortage, prompting concerns from experts and medical associations.
“In the midst of this brain drain of medical specialists, the Government brought in a retirement age of 60 years. The change of retirement age frequently is also an issue for doctors leaving the State sector. This was done despite our advice to exclude specialist doctors from this retirement age requirement,” an AMS source told The Sunday Morning.
During the Court of Appeal hearing on Wednesday (28), the Attorney General shared that the health authorities had made a significant decision to increase the retirement age of consultant specialist doctors to 63 years.
Additional Solicitor General Nerin Pulle, PC, representing the Attorney General, informed the court that instructions had been received from the Secretary to the Ministry of Health regarding the retirement age adjustment. It was further stated that a Cabinet decision would be pursued to officially implement this change for the petitioners.
Drastic decrease in specialist cadre
According to the AMS, there are currently 750 specialist doctor vacancies nationwide. The recent change in retirement age has added another 300 vacancies this year alone. Around 250 doctors will have to retire at the age of 60, while an additional 50 doctors will face compulsory retirement as they exceed the previous retirement age of 63. Consequently, the specialist cadre is expected to dwindle from 2,000 to 1,700 in 2023, severely impacting healthcare services across the country.
Migration and decreased intake numbers
The declining number of specialist doctors can be attributed to the discouraging economic conditions and lack of opportunities within Sri Lanka’s healthcare system. Increasingly, undergraduate medical students opt to pursue postgraduate studies abroad instead of returning to the country. Previously, there was a balanced ratio of students going abroad for further studies and those returning to practise in Sri Lanka. However, this ratio has shifted to 4:1, resulting in fewer doctors coming back to serve their home country.
Retention strategies for healthcare professionals
Experts, including former President of the Sri Lanka Medical Association (SLMA) Prof. Indika Karunathilake, emphasised the urgent need for long-term measures to retain doctors, particularly specialists.
The World Health Organization (WHO) recommends a multifaceted approach that encompasses financial benefits, non-financial incentives, and legislative measures. Creating an environment that encourages doctors to stay and serve requires addressing macro-level factors such as the economic and political situation, safety, and security.
Moreover, non-financial benefits such as improved housing, adequate education facilities for their children, and better transportation options in remote areas should be provided. Legislative measures must also be implemented to ensure transparent and unbiased recruitment and deployment of doctors in the State sector.
“Non-financial benefits include things like housing. For example, if a doctor has to work in a remote area, like any other professional, the problems would be reasonable accommodation, schools for their children, and adequate transport facilities. These are all lacking in distant areas. These things can easily be developed.
“After an internship, an undergraduate has to work for one year before they can start a postgraduate programme. This generally ensures that there is an availability of doctors according to the needs of the country. These are legislative measures that can ensure that health professionals work in the needy areas in the country. The Government must establish a transparent system that is free from influence and manipulation for recruitment and deployment of doctors in the State sector. This is an example of a legislative measure,” Prof. Karunathilake told The Sunday Morning.
Financial considerations and tax implications
Salaries play a crucial role in retaining healthcare professionals. According to Prof. Karunathilake, while there is a misconception that doctors earn substantial incomes through private practice, the reality is that less than 30% engage in such activities and not all are financially successful. The recent tax reforms have further burdened doctors, exacerbating their financial difficulties. Addressing these financial challenges is imperative to attract and retain talented medical specialists, the former President of the SLMA said.
“Salaries are also important. The recent tax has affected doctors badly. Many believe that doctors are earning a lot through private practice, but less than 30% are engaged in private practice and not everyone is successful – a vast majority of doctors don’t do private practice so there are a lot of doctors facing financial difficulties,” noted Prof. Karunathilake.
Government response and future plans
Minister of Health Keheliya Rambukwella acknowledged the gravity of the situation and the need for immediate action. According to him, the Government has taken steps to increase the intake of doctors and plans to deploy approximately 1,500 doctors to peripheral areas from 27 July.
Furthermore, the retirement age for specialist doctors has been temporarily extended to 63 years, pending a Cabinet decision. The Minister assured that recruitment efforts would resume after September, following agreements with the International Monetary Fund (IMF). A comprehensive national policy would be formulated to address the acute shortage of healthcare professionals.
“We have also extended the retirement age to 63 years. The court asked us our views and we gave approval to extend the retirement age to 63 years for a temporary period. The court can’t overrule Cabinet decisions. The President has agreed to restart recruitment after September and after we have signed the agreements with the IMF. We have a shortage of 13,000 health professionals in the entire health sector. There will be a national policy formulated on measures to retain healthcare professionals,” Rambukwella told The Sunday Morning.
Sri Lanka’s healthcare system is currently grappling with a severe shortage of specialist doctors, threatening the quality and accessibility of healthcare services. The migration of medical professionals coupled with the Government’s decision to lower the retirement age has exacerbated the crisis. Urgent measures must be taken to retain doctors, including providing financial incentives, improving non-financial benefits, and implementing legislative reforms.
It is essential to create an environment where healthcare professionals feel valued and motivated to remain in the country and serve the needs of the population. Only through comprehensive and coordinated efforts can Sri Lanka address its critical shortage of specialist doctors and ensure the wellbeing of its citizens.