The recently debated burning question as to whether foreign medical specialists have a right to work in the private hospitals in Sri Lanka leaves an open-ended question. According to the Private Hospitals’ Association (PHA) this burning issue is now adversely affecting the health sector by disrupting the clinical activities of the specialist centres of their hospitals.


In the last fifteen years, the major hospitals invested over Rs.50 billion by way of total expenditure to increase capacity-building within the private healthcare sector by investing in necessary infrastructure, cutting edge technology and continuous development in human capital in the clinical discipline. The centres have created several hundreds of employment opportunities with more than 45,000 servicing the sector directly and over 100,000 indirectly. The centres were set-up under Section 17 of the BOI Law of Sri Lanka, and even then, the agreements signed with BOI had no restrictions imposed on the Hospitals on the number of foreign nationals being employed, if the hospital management considered recruitment of such personnel as necessary for the proper and efficient functioning of the business enterprises.





Health Ministry recommendation
 What’s more, it is the accepted norm as per the recommendations of the Ministry of Health that a foreign Specialist can be contracted in the event that the post cannot be successfully filled by a local Specialist. Section 67A of the Medical Ordinance stipulates that a temporary registration of such a foreign medical practitioners can be made for a period of 1 year. This procedure was followed strictly and the Private Hospitals successfully infused the know-how of an international medical team to uplift their medical services. More and more investments were injected into the medical services pipeline, where the Private Hospitals proudly competed with each other to better their service offering. The beneficiaries of this development were none other than the people of the country, irrespective of social standing, who could now make avail of the best in class medical facilities and expertise at a fraction of the cost, right here in Sri Lanka.

According to the PHA, the process is such that if and when the local Specialists do not fulfil the application criteria, that the opportunities are exposed to the international medical fraternity. As the recent influx at Private Hospitals show, there are a few foreign Specialists who have seen the merits of joining Sri Lankan Private Hospitals. Their contributions to uplift our local medical standards have been personally experienced by the local community, who if not for these facilities and experience would have travelled overseas seeking medical care and support. And so it is the large scale private hospitals combined vision to position Sri Lanka as an emerging healthcare hub in the region to attract medical tourism and medical travel. Their vision is to be greater – to elevate Sri Lanka’s medical services in order to be on par with the best in the region.



What’s the real issue?
The crux of the matter is therefore, what really is the issue with the foreign Specialists? Why is there concern about their suitability? Who really is questioning? After all, a point to ponder would be: if the SLMC is recommending the registration of these foreign Specialists for 3 to 6 months but not for more than a year, what exactly is the logic? If these Specialists are neither qualified nor suitable, then why would they be allowed register for even 3 months? On the other hand, why reject the doctors who have been serving in this country for over 10 years to date? Why is that they are suddenly deemed to be unqualified?

It is the collective view of the member hospitals of the PHA that their main concern is nothing but the safety of their patients in addition to the trickling effect that a medical mishap of any sort would have on the reputation and sustainability efforts of the respective hospitals. So why would they employ the said ‘unqualified’ doctors?  

In any case, in the western world, there are several thousands of foreign medical specialists working in healthcare institutions in the public and private sectors. The Middle East and Asia Pacific region, to mention a few countries, Malaysia, Philippines, Singapore and Thailand and also Australia and New Zealand, continue to retain foreign medical specialists in the major public and private healthcare institutions. These medical specialists add great value to the healthcare sector in those respective countries. There are many Sri Lankan medical specialists working continuously for more than two decades in the countries mentioned above, and the authorities there, are retaining such expatriate specialists until they reach their retirement age, recognizing the great value they add.  

Another fundamental case in point is the “time factor”. On a comparison, the local specialist does not favour the “resident-doctor” service model and do not join a hospital on full-time basis. As representatives of the major hospitals having dedicated centres in super speciality core disciplines for Neurology, Nephrology, ENT, Eye, Surgical Care and for cardiac surgical procedures, especially for open heart surgery and other invasive and interventional cardiac procedures, it is imperative to have full-time competent dedicated teams of specialists for 24 hour coverage. For instance the cardiac centres that have been set up by the private sector have saved thousands of lives since the introduction of the Super Specialty Centres by having dedicated competent expatriate teams as mentioned above.  Comprehensive services cannot be provided with clinicians who are available on part-time basis. They will not be able to perform interventional procedures without full-time dedicated teams of cardiac surgeons and cardiac anaesthetists at these cardiac centres – a truth common with all other super speciality centres set up by private sector in the different hospitals as mentioned above. At any given time, there are approximately 50 patients admitted to the Heart Centres as inpatients and awaiting surgical procedures to be performed. This is in addition to the monthly schedules in the waiting list which may run well over 160. A fair number of patients belong to the high risk category. On an annual average, the centres referred to above perform 2,800 open heart surgical procedures and approximately 10,000 invasive and interventional procedures in addition to the hundreds of different surgeries and procedures performed in non cardiac speciality areas. This is a number that national hospitals will never be able to cope with. But it is these specialized centres that save more than Rs. 6 Billion in foreign exchange to the country annually.



Patient’s freedom
Looking at this matter from a completely objective point of view, it is fair to deduce that a patient should have the freedom and privilege to choose a specialist of their choice. There is absolutely no discretion allocated to foreign Specialists who function on the same capacity as the local Specialists. It is after all, not the medical institution but the patients who peruses the Specialists available and then consult at will. It is they who even postpone their surgeries – waiting for the right specialist to be on their case. In this situation, word of mouth and the proven track record of a Specialist plays a role in the decision making process. With the digital medium at the fingertips of the people, making one’s decision based on information, past experiences and influencer opinion, is very common. Therefore to assume that the Sri Lankan Private Hospitals promote unqualified Specialists is a stand that has no basis whatsoever.

It is also important to consider the bona-fide of the private hospitals. It is a given that these institutions are profitably run businesses. It is because of this very same reality that a private hospital is able to invest with largesse towards bringing the world’s most technologically advanced equipment to Sri Lanka. It is the very same reason that has led these hospitals to infuse the best expertise into the system, irrespective of whether they are foreign or local, simply because only they will have the prowess to carry-out the medical procedures to the standards required. It is after all the private sector that leads the industry where quality and standards are concerned. They strongly believe that only those with the best international exposure and experience will really have the capacity to deliver a world-class medical solution – a medical miracle in some instances – for this trend has been set by none other than their own medical colleagues in Sri Lanka. The trend of knowledge sharing. Every year foreign doctors are brought down for workshops – be it from India, UK, US or anywhere in the world. This example is what is now being followed by the private sector hospitals. And as far as the beneficiaries are concerned, it is not just the patients, but even the fellow doctors, the medical fraternity and the country as a whole who gain merits from these efforts.



Standstill
It is evident that the large scale private hospitals in the country have been contributing significantly to the people of Sri Lanka. The major hospitals are even in the process of working on quality assurance accreditations in total healthcare delivery. However, all these strategic directions have now come to a standstill due to the delays they have experienced in the re-registration and new registrations of foreign doctors. If this disruption continues with the existing bottleneck, this will have a chain impact and being a matter of life and death, the patients would lose confidence in success rates. This would affect the total healthcare delivery and patients who have means will seek healthcare services overseas, resulting in a massive drain on our country’s foreign exchange reserves.

We as a grateful nation, take pride of our medical services. We salute our honourable medical professionals who even to date uphold the Hippocratic Oath to serve their patients with kindness, care and to their utmost. No country can develop in isolation – sharing of knowledge, experience and exposure is vital. As even though our local doctors are amongst the best in the world, the universe is changing so fast, that there are skills and knowledge that don’t exist here, and there is no harm in sharing such expertise. So to those who sensationalize issues for no apparent reason, we extend our sincere sympathies. There will come a time when you too will be in dire need of the best medical care in the world. It is then that you will be faced with the reality that no matter how rich, poor or of what social standing you are, it is the best medical mind that is the need of the hour; because it’s your life on the line.

(The opinions published in this article are of Private Hospitals’ Association which consists of Asiri Hospitals Group, Nawaloka Hospitals PLC, Durdans Hospitals PLC and Lanka Hopitals PLC. The contact person is Dr. Vibash P. Wijeratne, Representative of the Private Hospitals Association e-mail: [email protected])