In the second part of the article, we examined the postgraduate medical training and how it differs from the traditional postgraduate degrees. This part will discuss academic qualifications and roles of two major groups of health care professionals.
The other two major groups and most closest to Doctors are pharmacists and nurses. The pharmacists trained for 5 years (actually 10 semesters of 3½ months each) and equally serve 1 year internship and they are the closer of the two in terms of professionalism and not necessarily based on the years spent in training or physical closeness. However as far as Nigeria is concern, traditional nurses have far superior clinical knowledge and exposure than the pharmacists. Most people thought the only jobs for pharmacists are drug dispensing and possibly compounding in addition to sales representatives of drug companies. Of course, pharmacy is a very wide course comprising many sub or super speciality. During their training, they learn skills in pharmaceutical chemistry, pharmaceutical microbiology, pharmacology and pharmacognosy etc. In all these, a pharmacy student has no contact with patients except during their pharmacology postings in which they are allowed to attend Consultant ward rounds along with medical students.
The role of a pharmacist in the hospital setting is therefore, that of receiving, keeping and dispensing drugs. However, many with advance degrees like MSc and PhD can work in several other places like pharmaceutical industries where they play a critical role in pre-clinical drug design and formulation (remember, drug development has both pre-clinical and clinical components!). Theirs is a modified credit unit system, as it is also a non classified degree, with a pass mark of ≥40%, however they enter probation with a CGPA of <2.40. Most of their postgraduate degrees are Master and PhD, but they equally have Doctor of Pharmacy (PharmD) that emphasizes on clinical aspects in addition to research. PharmD can be an undergraduate 6 year degree programme in some countries like Nigeria that is distinct from the postgraduate PharmD. It is those with Graduate PharmD or PhD with extensive clinical knowledge that can be considered Consultants in the medical sense, but they are restricted to mainly elderly homes or elderly patients reviewing prescriptions, drugs and their adverse effects.
On the whole, there is consultant pharmacy that is attained by rigorous academic research and clinical knowledge that have specific roles limited to drugs. “Consultant pharmacist is a pharmacist who is paid to provide expert advice on the use of medications by individuals or within institutions, or on the provision of pharmacy services to institutions.” https://www.ascp.com/articles/what-consultant-pharmacist. Consultant pharmacist earns an average salary of $107,689 and £50,000 (pharmacists as a whole reach a maximum salary of £39,239 to £67,805) in the USA and UK respectively http://www.payscale.com/research/US/Job=Consultant_Pharmacist/Salary,http://www.nhscareers.nhs.uk/explore-by-career/pharmacy/pay-for-pharmacy-staff/. Compare this with a Consultant Physician average of £75,249 to £101,451 http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/. I am not talking of the 6 months online training program Nigerian pharmacists undergo and brandish as Fellowship. Pharmacists are assisted by pharmacy technologists/technicians who in other countries can actually attain the status of pharmacy technician specialists who amazingly earn the same as pharmacists at band 6 in UHS system http://www.nhscareers.nhs.uk/explore-by-career/pharmacy/pay-for-pharmacy-staff/. May be one day in Nigeria the latter will agitate to head Pharmacy department or Pharmaceutical industries, you never know. Who then is a pharmacist?
: a person whose job is to prepare and sell the drugs and medicines that a doctor prescribes for patients.
Job Description for Consultant Pharmacist
- Educate patient on medication use, storage and side effects.
- Solicit information from patients regarding past and current medication to prevent drug interactions.
- May collaborate with other health care professionals to plan, monitor, review and evaluate patient effectiveness.
- Analyze prescribing trends to monitor patient compliance and to prevent excessive usage or harmful interactions.
- Dispense and review prescriptions to ensure accuracy, and compliance with professional, state and federal regulatory requirements.
There are basically two types of nurses in Nigeria; those with Bachelor of Nursing Science (BNSc) degree and the traditional/generalist Registered Nurses. The latter are the ones we are most conversant with and they are the majority. They are the ones in the clinics, open wards, Accident and Emergency units, High Dependency Units, Intensive Care Units, theaters, dialysis units, delivery suites etc. They receive 3 year training in school of Nursing or Midwifery and graduated with specialized certificate or diploma akin to National Certificate of Education (NCE). They receive training in general patient care and some basic medical procedures.
There after some go for post basic 1-2 year training in various nursing fields. The BNSc Nurses receive university degree in a 5 year semester based training (10 academic semester) with a similar pass mark and postgraduate degrees as pharmacists, but <1.0 is their undergraduate cut-off for probation. By default, they are scientists/teachers/researchers but have very limited contact with patients or clinical experience in Nigeria.
It is this group of nurses in other countries that undergo extensive clinical postgraduate training and productive research (MSc, Doctor of Nursing Practice or PhD.) to independently see and treat limited medical conditions, within the scope of their training, mostly in the PHCs or GHs, but hardly in the tertiary health centres if at all. Thus, they are called Nurse Practitioners or Advanced Practice Registered Nurses and such measures are taken to bridge paucity of Doctors and most importantly to reduce cost of medical services since they are paid less; average of $89,960 http://money.usnews.com/careers/best-jobs/nurse-practitioner/salary as against a Physician’s average of $191,520 http://money.usnews.com/careers/best-jobs/physician/salary. There are in addition Clinical Nurse Specialists and Consultant Nurses (not to be confused with nurse consultant even though they are often use interchangeably http://www.rcn.org.uk/__data/assets/pdf_file/0005/444299/003574.pdf). They are all advance clinical nursing degrees that one earns by diligent intellectual work albeit with a limited medical scope and not by the ritualistic public service promotion. In the UK, the highest rank a nurse can reach is the Consultant Nurse from band 8a through a maximum of band 8c with salary equivalents of £39,239 and £67,805 respectively http://www.nhscareers.nhs.uk/explore-by-career/nursing/pay-for-nurses/.
Advanced Registered Nurse Practitioner (ARNP) Tasks
- Prescribe therapy or medication with physician approval.
- Order and interpret test results and recommend treatment of patients.
- Provide physicians with assistance during surgery or complicated medical procedures.
- Administer therapeutic procedures.
- Conduct complete physicals, provide treatment, and counsel patients.
The remaining ones are psychologists, radiographers, optometrists, physiotherapists and other non-drug therapists, dietitians etc that mostly follow conventional university degrees etc.
While we don’t have NPs or consultant pharmacists in Nigeria, kindly visit our PHCs, GHs, nursing homes, drug stores, private laboratories and see for yourself. Over there everybody consults, prescribes and even admit patients right under the Nigeria’s compromised laws. Delicate cases are being seen like Stroke, complicated Hypertension and Diabetes Mellitus, Heart failure, Chronic Airway diseases, decompensated liver diseases, Pregnancy related complications, surgeries (yes surgical operation, recall the recent case of bilateral nephrectomy in Bauchi State http://www.thisdaylive.com/articles/stolen-kidneys-citizen-abubakar-cry-for-help/126661/), Hepatitis, severe Malaria etc.
That is where blood is transfused to patients as frequently as intravenous fluids. They only refer the patients when unacceptable disease progression and or complications arise or the patient has started gasping for his/her last earthly breath. The only time a patient is referred early is when s/he or his/her relatives are well informed or the patient present with a bizarre medical condition. These more than contribute to the 24 hour mortality rates of tertiary centres. Is it any wonder then why ordinary people have morbid fear of admission in to tertiary centres? Naturally people assume automatic death sentence on anyone being referred to a tertiary health centre. It is no doubt that the services of these categories of workers are important to holistic patient care and the smooth running of the hospital, what is rather strange is their clamour for unorthodox nomenclature that will not add any value to the health care of the patients.
Department of Internal Medicine,
Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria.