12 February, 2010 - Even with about seven doctors joining every year, it would still take Bhutan another five to six years to be in a “comfortable” situation, which is having two doctors in each hospital in the country, say health ministry officials.

Bhutan immediately needs 40 doctors to meet the acute shortage, said health officials. As per their projections, Bhutan needs 90 doctors, 15 MBBS doctors and three dental surgeons, graduating every year, by the end of the tenth plan. “Only 21 doctors have joined us since last year and we still need 79 more,” said the officiating chief human resource officer, Mindu Dorji.

This requirement of doctors will increase with 14 new BHUs coming up, and some dzongkhags upgrading their grade two BHUs to grade one. “This projection was made, based on the old facilities, and with the health system improving, more doctors would be required,” he said.

In January this year, 13 new doctors and three drungtshos (traditional medicine doctors) joined the health ministry, the second largest batch to join at a time, said Mindu Dorji. Three years ago, only four doctors joined the health ministry, said Mindu Dorji. “Then, the number of slots for MBBS was less and sometimes our students didn’t meet the criteria,” he said.

Of this group, two have been placed at the Thimphu referral hospital, six sent to Mongar, Samdrupjongkhar, Gedu, Punakha, Trongsa and Trashigang hospitals and five to Zhemgang, Pangang, Gasa, Nanglam and Lhuentse BHUs. One of the three drungtshos was sent to Gedu and the rest placed at the national institute of traditional medicine in Thimphu.

“We placed them on priority basis, even though the need to have two doctors in a district hospital is felt in all dzongkhags,” said Mindu Dorji.

But a gap remains because the number of doctors leaving for specialisation courses is almost equal to the number of new doctors joining the health service.

Today, there are 31 doctors away doing specialisation courses that take between three and five years to complete.

Last year, seven doctors left for studies and this year 15 will be leaving, of which five have already left, said Mindu Dorji. “Next year, we’re expecting only about seven to join us, so we’ll have to continue recruiting doctors on contract,” he said.

The public health director, Dr Ugen Dophu, said the health ministry’s human resource triangle is inverted with the number of specialists outnumbering general doctors. Specialists include surgeons, gynaecologists, paediatricians, dermatologists, orthopaedists and ophthalmologists.

“Ideally, general doctors should outnumber the specialists, which is not the case, at least with JDWNR hospital,” he said, adding that, in a few years time, the number of specialists required for Bhutan would be fulfilled. He explained that the health system’s human resource triangle should have fewer specialists at the top and a large number of general doctors at the bottom. “We shouldn’t invert the human resource structure, because a triangle cannot stand on its apex,” he said.

Dr Ugen Dophu also said the ministry is discussing in developing a system that would help decide who should go for specialisation. “Not all 100 MBBS doctors should go for specialisation. Only those with quality and attitude should be sent,” he said.

While the tenth plan aims to place at least two doctors in each district, health officials said that ruling government has promised to have three doctors, including a gynecologist, in each district.

The doctor-patient ratio today is 2.6 or three doctors for every 10,000 people, but given Bhutan’s terrain the ratio should be four doctors for every 10,000 people, said the public health director.

The Thimphu referral hospital has 35 doctors to attend to about 2,000 patients everyday.

With MBBS slots increased and the Bhutan institute of medical sciences (BIMS) to be established soon, health officials are optimistic that by 2013, the requirement of doctors for Bhutan will be fulfilled. “By comfortable, we meant that the hospitals in the periphery would have a doctor at any given time,” said Mindu Dorji. “Even with some doctors on tour or attending seminars, no hospital would be without a doctor.”