{"id":225832,"date":"2025-06-30T05:29:15","date_gmt":"2025-06-30T05:29:15","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/225832\/"},"modified":"2025-06-30T05:29:15","modified_gmt":"2025-06-30T05:29:15","slug":"doctor-shortage-casualization-pushes-doctors-out","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/225832\/","title":{"rendered":"Doctor Shortage: Casualization Pushes Doctors Out"},"content":{"rendered":"

As the wave of emigration among Nigerian medical professionals persists leading to rising morbidity and mortality rates, hospitals are worsening the crisis through the casualisation of health workers, particularly doctors. Hospitals employ these doctors without benefits, or job security, and pay them less compared to their colleagues on permanent employment, forcing some of them to leave the profession, investigations by SODIQ OJUROUNGBE show<\/strong>\n<\/p>\n

When<\/strong> Dr. Chukwuemeka Njoku wakes up each morning, he wears the same white coat, tucks a stethoscope into his pocket, tightens the laces of his faded black shoes, and heads to the hospital where lives hang in the balance, including his own.\n<\/p>\n

For over two months, Njoku worked tirelessly as a locum doctor in a government-owned hospital located in the eastern part of the country. Day and night, he attended to patients with conditions ranging from minor infections to life-threatening emergencies.
\n\"\"Pate\n<\/p>\n

He stood shoulder to shoulder with permanent staff in the wards, wrote prescriptions, conducted reviews, and performed life-saving procedures. But unlike his colleagues, Njoku went home with nothing, not even the promise of a paycheck.<\/p>\n

\u201cI kept showing up because I didn\u2019t want to risk losing the job altogether. But by the end of the second month without pay, I was borrowing to survive,\u201d the doctor told PUNCH Healthwise.\n<\/p>\n

Unable to meet basic needs like transport fare, feeding, and toiletries, Njoku downloaded his first loan app. Then another. And another.\n<\/p>\n

He recalled, \u201cIt started with N30,000 just to get through the week. But when they didn\u2019t pay me again the following month, I had to borrow to pay back the first loan. Before I knew it, I was trapped.\u201d<\/p>\n

Njoku lamented that he is now indebted to at least seven different loan platforms, each charging punishing interest rates.\n<\/p>\n

His phone never stops ringing. Messages from lenders come at dawn, threats disguised as reminders; some even reach out to his contacts.\n<\/p>\n

\u201cI am a doctor, but I feel like I am drowning. The same people I swore to help are the ones I now avoid because I owe them money,\u201d he lamented.\n<\/p>\n

Still dependent after employment<\/strong>\n<\/p>\n

Dr Musa Abdullahi often stares at his hospital ID card in disbelief as he works with one of the few teaching hospitals in the North Central region of the country.\n<\/p>\n

For many, that name commands respect. To his family back in Kwara, it signifies success, that their son has made it. But for Abdullahi, the ID feels more like a burden than a badge of honour.\n<\/p>\n

\u201cI used to think the hard part was getting through medical school. I didn\u2019t know the real suffering would start after I became a doctor,\u201d he bitterly told our correspondent.<\/p>\n

Abdullahi works as a locum doctor, employed temporarily with no job security, meagre pay, and no access to the standard benefits given to full-time staff.\n<\/p>\n

After completing his housemanship, he was offered a contract position at the teaching hospital where he trained, and though grateful at first, reality soon set in.\n<\/p>\n

Out of his take-home salary of N115,000, Abdullahi revealed his monthly transport bill alone gulps up nearly N45,000, almost half of his income.\n<\/p>\n

The doctor who lamented the emotional toll has been heavy added, \u201cWhat is left after transport, feeding, and rent? Nothing. Most months, I am in the minus.\u201d\n<\/p>\n

Back home, his parents, retired civil servants who sold land, borrowed money, and made endless sacrifices to send him through medical school, now look to him for relief.\n<\/p>\n

They need help with medications, upkeep, and supporting younger siblings. Instead, Abdullahi is forced to make excuses or send paltry sums that leave him deeply ashamed.\n<\/p>\n

\u201cI am supposed to be the one lifting my family now. But I still depend on them. I still call my mother at the end of the month to ask for small help, like N5,000 here and N10,000 there. It breaks me.<\/p>\n

\u201cThey didn\u2019t sleep at night so I could become a doctor. They skipped meals, sold their harvests early, and carried my cross. And now, after all that, I am earning less than what a fresh graduate in banking or tech would even consider,\u201d he stated.\n<\/p>\n

Abdullahi, who has been under temporary employment for more than two years, lamented that he remains stuck in a contract that offers him no pathway to progress.
\n\"\"Ekwueme\n<\/p>\n

He added, \u201cSome of my friends have left the country. Those who stayed are either full staff or, like me, stuck in these ghost roles. We are seen, but we are not really there.\n<\/p>\n

\u201cI heal others, but I am not even surviving. This is not what we signed up for.\u201d\n<\/p>\n

For Njoku and Abdullahi, their stories may differ in location and details, but the pain is the same \u2013 the quiet, grinding hardship of being a locum doctor in a country where being a medical professional should come with dignity and reward, not debt and despair.\n<\/p>\n

Their reality, our correspondent gathered, is the face of a systematic casualisation of medical labour that, while originally designed as a temporary stopgap to address staff shortages, has morphed into a trap for many young Nigerian doctors.\n<\/p>\n

PUNCH Healthwise gathered that locum employment, also known as casual or temporary medical staffing, was introduced by the government to quickly fill staffing gaps in hospitals, especially during periods when bureaucracy delayed official recruitment into the federal scheme of service.<\/p>\n

Disguised form of casualisation<\/strong>\n<\/p>\n

The doctors employed under short-term contracts, some renewed monthly or quarterly, and are excluded from standard entitlements, including pension contributions, health insurance, paid leave (including maternity\/paternity leave), residency or specialist training slots, hazard and call duty allowances, and promotion or official recognition.\n<\/p>\n

In many cases, their salaries are significantly lower than those of full-time colleagues, even when performing identical duties.\n<\/p>\n

It was observed that some are paid by the hospital directly, not the federal government and the amount often depends on what the hospital can \u2018afford\u2019.\n<\/p>\n

At its inception, locum roles were meant to last only a few weeks or months, during which the facility would complete the proper documentation and budgeting needed for permanent employment. Locum doctors would then migrate into permanent positions, enjoying full benefits, job security, and access to career progression.\n<\/p>\n

However, over time, this emergency solution has mutated into a permanent system of exploitation.\n<\/p>\n

Findings by PUNCH Healthwise showed that many Nigerian hospitals, especially federal teaching hospitals and specialist centres, rely heavily on locum staff to function daily.<\/p>\n

Our correspondent also discovered that because locum doctors\u2019 jobs are not protected by civil service rules, they are often at the mercy of hospital administrators.\n<\/p>\n

It was observed that this power imbalance has led to silencing, fear of victimisation, and lack of advocacy for better conditions.\n<\/p>\n

Stakeholders in the health sector argued that the current use of locum employment in Nigerian hospitals had become a form of labour casualisation, a practice where workers are kept in insecure, poorly paid positions to reduce costs and avoid long-term obligations.\n<\/p>\n

They lamented that locum doctors, despite holding the same medical degrees, licences, and responsibilities as full-time colleagues, are now treated as second-class professionals, trapped in a cycle of temporary work, limited benefits, and economic instability.\n<\/p>\n

They added that worse still, many young doctors accept locum roles not by choice, but out of desperation, the only way to gain experience, remain active in practice, or hope for eventual permanent absorption.\n<\/p>\n

The President of the Nigerian Association of Resident Doctors, Dr Tope Osundara, condemned the practice, lamenting that locum employment, originally intended as a temporary stopgap, is now being used to keep doctors on insecure contracts for months and even years.\n<\/p>\n

\u201cThis locum employment has become labour casualisation. Doctors on locum contracts have no job security, no protection under labour laws, and often face arbitrary dismissal. It is unfair and unsustainable,\u201d Osundara said.<\/p>\n

Amid worsening shortage<\/strong>\n<\/p>\n

Findings by PUNCH Healthwise showed that about 564 locum doctors are currently employed in hospitals across the country to temporarily fill staffing gaps and sustain healthcare delivery amid a worsening shortage of medical personnel.\n<\/p>\n

The NARD president exclusively told our correspondent that data the association obtained from doctors across the country showed that the use of locum doctors is becoming alarming.\n<\/p>\n

In April 2025, the coordinating minister of health and social welfare, Ali Pate, revealed that over 16,000 Nigerian doctors have left the country in the last five to seven years in search of greener pastures abroad.\n<\/p>\n

He said the exodus of doctors has created a doctor-to-population ratio of 3.9 per 10,000, which is far below the global minimum standard.\n<\/p>\n

Pate explained that training one doctor costs more than $21,000, representing a major financial loss for Nigeria.\n<\/p>\n

While expressing concern over the exodus of medical personnel from Nigeria, the minister added that only 55,000 licensed doctors are left to serve the growing population of over 200 million.<\/p>\n

Despite this acute shortage of doctors, it was observed that the employment of doctors on a temporary arrangement is becoming a new normal in many of these federal health facilities.\n<\/p>\n

Long wait without end<\/strong>\n<\/p>\n

PUNCH Healthwise\u2019s investigation revealed that many of these locum doctors remain trapped in temporary employment for years, waiting endlessly for regularisation that never comes.\n<\/p>\n

In major hospitals such as the National Hospital Abuja, Federal Teaching Hospital Lokoja in Kogi State, University of Port Harcourt Teaching Hospital in Rivers State, Ladoke Akintola University Teaching Hospital in Ogbomosho, Obafemi Awolowo University Teaching Hospital in Ile-Ife, Osun State, and University of Nigeria Teaching Hospital in Enugu State, locum doctors continue to toil under harsh conditions. Despite their critical roles, these doctors remain temporary workers, often powerless to voice concerns due to their precarious employment status.\n<\/p>\n

One internal document from a federal hospital obtained by our correspondent clearly stated, \u201cTemporary appointments may be made by the Chief Medical Director where, because of exigencies of the service, it is not possible to conduct the usual interviews for appointment. An offer of temporary appointment on locum tenens basis may be made pending such time the formal interview would be arranged, at which time, without prejudice, the locum appointee should be interviewed within three months.\u201d\n<\/p>\n

Yet, despite this clear directive that locum appointments should last no more than three months, conversations with several locum doctors showed that many have been in this temporary status for two to three years, with no concrete plan from their hospitals to regularise their appointments.\n<\/p>\n

In some institutions, our correspondent gathered that locum contracts are renewed every three months, while in others, renewals happen every six months, both far exceeding the intended duration of temporary employment and directly contradicting the hospital\u2019s own conditions of service.<\/p>\n

Many of the doctors lamented that despite their qualifications and commitment, they remain caught in a loop of uncertainty and insecurity.\n<\/p>\n

A locum doctor at a Federal Teaching Hospital in the South-West simply identified as Abiola said he has been on contract for over two years with his fate hanging on three-month renewals.\n<\/p>\n

He stated, \u201cI start my day before dawn and often leave late in the evening.\n<\/p>\n

\u201cMy workload matches that of permanent staff, sometimes even exceeding it during busy periods. Yet, my salary is barely half of what my colleagues earn.\u201d <\/p>\n

For Abiola, the pain is not just financial, it is also psychological.<\/strong>\n<\/p>\n

\u201cThere is always this looming fear that my contract won\u2019t be renewed. I avoid complaining or raising issues because I know I can be easily replaced. It is as if I am a ghost in the system,\u201d he stressed.\n<\/p>\n

Another locum doctor at the University of Port Harcourt Teaching Hospital, Rivers State, Dr. Amaka Okonkwo lamented that she has been on locum status for nearly three years, renewing her contract every few months, with no end in sight.<\/p>\n

She added, \u201cThe hardest part is the uncertainty. Every few months, I live in fear of whether my contract will be extended. I plan nothing because there\u2019s no guarantee I\u2019ll still have a job.\u201d\n<\/p>\n

Despite working long shifts and handling complex cases, Okonkwo said her salary barely covers her living expenses.\n<\/p>\n

She explained, \u201cMy salary is less than half of my permanent colleagues. I can\u2019t afford decent accommodation near the hospital, so I spend over 1,000 naira daily commuting. That\u2019s money I can\u2019t get back.\u201d\n<\/p>\n

\u201cI feel guilty because my parents are still supporting me after all they invested in my education. I should be able to stand on my own, but this system keeps me in this loop.\u201d\n<\/p>\n

A doctor simply identified as Suleiman has been working on locum contracts at the National Hospital Abuja for over two years.
\n\"\"Osundara\n<\/p>\n

As a northern-based doctor, he said he faces added pressure to support his extended family back home.\n<\/p>\n

\u201cMy salary barely reaches 120,000 naira per month. But my daily transport to and from the hospital costs me about 1,500 naira. By the time I pay rent and feed myself, there\u2019s nothing left to send home.<\/p>\n

\u201cThey expected that once I go to this job, I\u2019d start repaying them and helping with family needs. But with this locum status, I am barely surviving, let alone supporting them,\u201d he lamented.\n<\/p>\n

He described his contract renewals as a constant rollercoaster, unsure if he would keep working or be forced to start over somewhere else.\n<\/p>\n

He added, \u201cIt is mentally exhausting. You cannot plan for the future, buy a house, or even think about further training.\n<\/p>\n

\u201cThe disparity is painful. We do the same work and attend to the same patients, yet our pay and benefits are worlds apart.\n<\/p>\n

\u201cWhen you speak up, you risk not being renewed. I feel silenced and powerless. It\u2019s a lonely struggle.\u201d\n<\/p>\n

Impact on mental health<\/strong>\n<\/p>\n

A consultant psychiatrist and mental health advocate, Dr. Teniola Adebayo, warned about the psychological toll that prolonged locum employment could have on Nigeria\u2019s young doctors.<\/p>\n

According to her, the constant state of uncertainty, economic instability, and professional inequality are creating fertile ground for burnout, anxiety, depression, and even suicidal thoughts.\n<\/p>\n

She stated, \u201cThis is a mental health crisis hiding in plain sight. You cannot place someone in a high-stakes, high-pressure job like medicine, where lives are at risk daily, and deny them job security, adequate compensation, or even the respect they deserve, without consequences.\u201d\n<\/p>\n

The psychiatrist noted that while all doctors face stress due to the demands of their profession, those under locum contracts are particularly vulnerable because they have no control over key aspects of their lives.\n<\/p>\n

She stressed, \u201cThey can\u2019t plan financially, they can\u2019t commit to long-term relationships or family building, and they live in fear of abrupt contract termination. These are classic risk factors for depression and anxiety disorders.\u201d\n<\/p>\n

\u201cA mentally exhausted or emotionally depleted doctor is more likely to make mistakes. They may suffer from decision fatigue, lose empathy, or develop resentment towards their job. That\u2019s dangerous in a hospital setting.\u201d\n<\/p>\n

The mental health expert added that the disparity between locum and permanent staff can also lead to feelings of inadequacy, low self-worth, and social exclusion.\n<\/p>\n

\u201cImagine working side by side with a colleague who does the same thing as you but earns double, gets time off, hazard pay, and insurance, while you don\u2019t. Over time, it becomes demoralising. Some doctors internalise this and start to question their own value.\u201d<\/p>\n

The physician urged hospital management and policymakers to consider the psychological implications of prolonging temporary contracts.\n<\/p>\n

\u201cIf a doctor is good enough to save lives, they are good enough to be fully employed. This idea of rewarding loyalty and hard work with indefinite uncertainty is deeply harmful and unjust.\u201d\n<\/p>\n

Reform hiring process<\/strong>\n<\/p>\n

A former president of the Association of Resident Doctors at the UNTH chapter, Dr. Chinazom Ekwueme, recommended the dismantling of bureaucratic bottlenecks that delay permanent employment.\n<\/p>\n

According to her, the government must identify critical sectors like healthcare and introduce waivers that allow for expedited recruitment.\n<\/p>\n

\u201cThere are key sectors where the current federal employment structure is simply too slow. There should be provisions for faster recruitment processes when there are clear manpower gaps,\u201d she added.\n<\/p>\n

She also called for the immediate implementation of a one-for-one replacement policy, whereby doctors who resign, retire, or migrate are replaced without delay.<\/p>\n

This, she said, would eliminate the prolonged vacancies that often lead to the hiring of locum staff in the first place.\n<\/p>\n

The former ARD president urged the government to treat health workforce planning as a matter of national priority, warning that the ongoing reliance on locum staff not only devalues the medical profession but also contributes to the continued exodus of Nigerian doctors.\n<\/p>\n

Scrapping of locum doctors<\/strong>\n<\/p>\n

Stakeholders in the health system called for the scrapping of locum employment across medical institutions in Nigeria, describing the system as exploitative, unsustainable, and a key driver of brain drain in the country\u2019s health sector.\n<\/p>\n

The Nigerian Medical Association appealed to the federal and state governments to immediately stop casualisation of doctors working in public hospitals across the country.\n<\/p>\n

NMA\u2019s first Vice-President, Dr Benjamin Olowojebutu, contended that ending the casualisation of doctors would help to check the brain drain and restore sanity to the health sector.\n<\/p>\n

\u201cAll doctors working in public hospitals must be given permanent and pensionable employment after a clearly defined probation period.<\/p>\n

\u201cTemporary contracts must not exceed one year,\u201d Olowojebutu said.
\n\"\"Olowojebutu\n<\/p>\n

Olowojebutu lamented that casualisation had become the norm rather than the exception for medical doctors in Nigeria, particularly in state-owned hospitals and teaching institutions.\n<\/p>\n

\u201cYoung doctors are hired as a locum or contract staff with no pension, no health insurance, and salaries that are slashed arbitrarily.\n<\/p>\n

\u201cMany work under this exploitative arrangement for years, with no hope of confirmation or permanent employment.\n<\/p>\n

\u201cThese doctors are treated like expendable tools, recruited when needed and discarded without explanation.\n<\/p>\n

\u201cHow can a government that claims to value healthcare allow such inhumane conditions to persist?\n<\/p>\n

\u201cHow can a system demand excellence from doctors while offering them crumbs and chaos in return?,\u201d he queried.<\/p>\n

On his part, the NARD president expressed deep concern over the misuse and overstretching of locum employment.\n<\/p>\n

\u201cWhat is supposed to be a short-term measure lasting no more than three months has now turned into a long-term trap.\n<\/p>\n

\u201cSome doctors have remained on locum for over two years, with no clear pathway to permanent employment,\u201d he said.\n<\/p>\n

According to him, this extended casualisation does more harm than good, both to the doctors and to the nation\u2019s fragile health sector.\n<\/p>\n

He added, \u201cYou cannot expect retention in a profession where people are undervalued, overworked, and left in limbo. Many of these young doctors are simply biding their time until they can leave the country.\u201d\n<\/p>\n

Osundara also pointed out that doctors under locum status are not protected by labour laws in any real sense.\n<\/p>\n

He explained that many facilities abuse this imbalance of power.<\/p>\n

He explained, \u201cA locum doctor has no leverage. If you speak out, raise concerns, or step on toes, you can easily be dropped at the end of your contract cycle, sometimes without explanation. You are entirely at the mercy of the facility\u2019s management.\u201d\n<\/p>\n

\u201cBecause they know these doctors are desperate, they use the locum status to avoid responsibility. No pension. No hazard allowance. No career progression. They just get the work done and discard you when they\u2019re done.\u201d\n<\/p>\n

The NARD president urged governments to prioritise permanent employment pathways.\n<\/p>\n

He stated, \u201cIf you want to keep your doctors, treat them with dignity. This half-measure called locum has outlived its usefulness. It\u2019s time to dismantle it and build something more just, more sustainable.\u201d\n<\/p>\n

Corroborating the NARD president, Ekwueme called for the complete scrapping of the locum employment system in federal health institutions, describing it as unsustainable and exploitative.\n<\/p>\n

She stressed that locum appointments, initially designed as temporary stopgaps, have over time become a tool for casualising medical doctors, depriving them of job security and essential benefits.\n<\/p>\n

\u201cI don\u2019t believe in casualising any medical doctor for any reason. If there is a service gap significant enough to warrant temporary employment, then there is a good enough reason to initiate full employment processes,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":"As the wave of emigration among Nigerian medical professionals persists leading to rising morbidity and mortality rates, hospitals…\n","protected":false},"author":2,"featured_media":225833,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4316],"tags":[26406,89036,89037,89038,105,89039,4348,89040,89041,89042,3007,89043,16,15],"class_list":{"0":"post-225832","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-brain-drain","9":"tag-casualization","10":"tag-doctor-shortage","11":"tag-emigration","12":"tag-health","13":"tag-health-workers","14":"tag-healthcare","15":"tag-healthcare-crisis","16":"tag-locum-doctors","17":"tag-medical-professionals","18":"tag-nigeria","19":"tag-nigerian-doctors","20":"tag-uk","21":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114770671507820854","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/225832","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=225832"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/225832\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/225833"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=225832"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=225832"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=225832"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}