•Fewer than 30, 000 licensed doctors in Nigeria – NMA
•One consultant to 2,500 patients
•Why appointments to see consultants take months
By Oluseye Ojo
In November 2024, a Lagos resident in his 40s was diagnosed with cardiovascular problems at one of the tertiary hospitals in the state. After the diagnosis, the general doctors told him that he should proceed to a particular department, to see a consultant.
On getting to the department, he was given a date in February 2025. But by the middle of December 2024, his condition had deteriorated. He developed swollen legs, shortness of breath, and he could not walk for three minutes without sitting down to relax. He also complained about indigestion. Luckily, he discussed with relevant people that stepped in and presented his case as an emergency.
The man is one among many Nigerians with health conditions. To see a consultant, they have to wait for between two and five months. Sadly, for some, they’re already dead long before their date with the consultant.
For countless outpatients seeking specialised medical attention, securing an appointment with a consultant is often a challenge. Investigations show that the long appointment waiting times could lead to tragic outcomes. Lives could be lost while waiting in limbo for essential treatments.
Findings from some of the teaching hospitals in Nigeria show that the situation is the same for outpatients, whose cases might not be of emergency as at the time they presented themselves in the hospital.
The records of the number of Nigerians that died in the country while they were waiting for the time of appointment with consultants could not be ascertained as a result of unavailability of data.
But for patients that have been admitted in public hospitals and pregnant women, findings show that accessing consultants in private hospitals might not be as difficult.
Medical consultants
Available records reveal that medical consultants are specialist doctors who have completed extensive training beyond general medical education. This typically involves several years of residency in their chosen field, such as surgery, paediatrics, or internal medicine.
In Nigeria, becoming a consultant requires rigorous academic qualifications, including medical school, a residency programme, and successful completion of board examinations.
It was further gathered that their expertise enables them to manage complex medical conditions and provide advanced care, making them indispensable within the healthcare infrastructure.
According to the Medical and Dental Consultants Association of Nigeria (MDCAN), as of February 2024, there were approximately 6,000 medical consultants practising in Nigeria. However, this number is dwindling alarmingly. Hundreds of consultants are believed to have either travelled abroad or retired between March 2024 and January 2025. But the data on the latest development is not available yet.
Prof. Muhammad Aminu Mohammad, the current president of MDCAN, reported that about 1, 300 consultants have emigrated in the last five years in search of better opportunities abroad, a phenomenon popularly referred to in local parlance as the ‘Japa syndrome.”
Training of consultants
Investigation from experts revealed that training a medical consultant is a lengthy process that often take upwards of 11 years post-medical school. After earning a medical degree, graduates enter a residency programme that usually spans between four and six years, depending on the specialty.
During the period, they undertake rigorous clinical rotations, engage in research, and may even serve in remote or underserved areas of the country as part of their training.
Some medical professionals told Saturday Sun that the extensive training of consultants could stand in contrast with the inadequacies that many consultants face upon entering the workforce.
They mentioned situations whereby equipment shortages, inadequate hospital facilities, and poorly maintained infrastructure often diminish the potential for effective training for the next generations of consultants and care delivery.
Consultant shortage
Saturday Sun also gathered that consultant shortage is a multifaceted crisis that is being exacerbated by ‘Japa’ which refers to the trend of highly skilled professionals leaving Nigeria for opportunities abroad.
Prof Mohammad, the MDCAN President, at the National Executive Council (NEC) meeting of the association held in Ilorin, Kwara State some days ago, raised the alarm that a significant demographic of the 6,000 consultants is nearing retirement because they are to retire at 60 years.
He added that about 1,700 consultants are currently over the age of 55. He noted that as the consultants leave the workforce, the anticipated influx of newly trained consultants would struggle to keep pace with the realities on ground and the development would widen the gap in care delivery.
The Chairman, Nigerian Medical Association (NMA), Oyo State, Dr Happy Adedapo, told Saturday Sun that the World Health Organisation (WHO) has long recommended an optimal healthcare provider-to-population ratio of one doctor per 600 patients.
Currently, according to him, the reality on the ground reflects a staggering contrast. He explained that some consultants, particularly in urban centres, might be responsible for managing up to 2, 500 patients at a time. He stated that according to the Master Register of Doctors in Nigeria, there are 30 , 000 licensed doctors.
But he said among them, some have retired, some have ventured into farming, information technology and so on, and are no longer in the medical profession.
He added that their names are still on the register because they still renew their practising licences every year.
Adedapo noted that the disparity could have drawn attention to a broken healthcare system that cannot efficiently meet the community’s needs.
Barriers to quality care
The significant delays in securing appointments with consultants stem from both systemic and operational inefficiencies.
Findings showed that hospital systems are overloaded, and exacerbated by the shortage of consultants, and increasing patient volumes, leading to a backlog.
As gathered from experts, such systemic shortcomings have been manifesting in heart-breaking ways. There have been numerous accounts of patients whose conditions deteriorated or who tragically passed away while awaiting the chance to see a consultant.
A middle-aged man, who had an encounter with Saturday Sun at the General Outpatient Ward of the University College Hospital (UCH), Ibadan, earlier in the week, who introduced himself as Stephen Adigun, recounted a story on the painful wait.
“My uncle had to wait several months to see a heart specialist. By the time his appointment came around, it was too late because he had suffered a cardiac arrest. So, I don’t want my own case to be like that. I do not have a heart problem. But I have one health condition that I will not tell you about. I am here to see a consultant for it. I was booked for this appointment two months ago.”
Adigun stated further that patients are compelled to navigate a web of bureaucracy, and the task of obtaining an appointment could feel insurmountable. He added that if he had the money, he would have sought medical care in a private hospital.
“Do you know that it is not difficult to see a consultant when you go to a private hospital? They will call them, and within a week, you can see a consultant. Why the case of private hospitals is like that is what I don’t know. Is it because of money?
“I have also observed that some of the doctors have established their own private hospitals. They give attention to their own private hospitals and they would refer patients to the public hospitals to their private clinics. Is this not cheating?”
A cross section of outpatients at UCH stated that the majority of doctors are not compassionate towards patients, especially those that do not have money for their treatment, despite subscribing to the Hippocratic Oaths.
While some may seek private healthcare options for expedited access, the costs can be prohibitive, and for many Nigerians, unattainable.
It was further gathered that a consultant’s dual role in balancing his responsibilities between public service and private care,often leads to ethical dilemmas.
The legal framework in Nigeria allows for doctors to establish their own clinics.
However, the reality of private practice versus public care creates a dichotomy that might not serve the broader public well.
The talented few who choose to remain in the public sector are often overwhelmed and don’t have the luxury to see patients privately for fear of abandoning their public responsibilities.
Emotional toll on consultants
For consultants in Nigeria, the daunting task of managing an unsustainable patient load, while trying to provide quality care can take a severe emotional toll.
The pressure to balance compassion for their patients with their mental and physical wellbeing could leave many feeling overwhelmed. The expectation to care for thousands of patients could also be diminishing the quality of care and could lead to burnout, which is a form of empathy fatigue that hampers their ability to deliver the compassionate care they aspire to provide.
Dr. Happy Adedapo, the Chairman of the Nigerian Medical Association (NMA) in Oyo State, emphasised the mental strain experienced by consultants.
“When they are faced with insurmountable numbers of patients, it becomes increasingly challenging for consultants to maintain the same level of compassion.
“In a system where their salaries are not commensurate with the sacrifices they make, we must ask ourselves what it means for our doctors,” he said.
Adedapo stated that compassion is a foundational principle in medical practice. He listed the challenges of financial strain, inadequate resources, and overwhelming patient demand as some of the factors that could erode the humanitarian ethos that should define professional healthcare delivery.
Addressing systemic challenges
To confront the issues, experts have recommended a multifaceted approach as essential. They also mentioned collaboration between the government, healthcare institutions and medical bodies, such as NMA, and its affiliate bodies, including MDCAN, as crucial for developing sustainable solutions.
Recommendations put forth by healthcare leaders include enhanced salaries to discourage the outflow of talent, investment in infrastructure, solving issues of power outages, securing more resources, promotion of health awareness, strengthening primary healthcare to ease the burden on consultants by ensuring that patients receive adequate care before it becomes critical, and streamlining processes to reduce bureaucracy and streamlining patient appointment processes.
The MDCAN President, Mohammed, stated that the association is optimistic that retirement age for consultants would be jerked up from 60 years to 70 years, while other healthcare workers would continue to serve up to 65 years
According to him, the move would enable medical and dental consultants that have chosen to remain in Nigeria to continue to contribute further in the health field.
He also advocated that lecturers in the medical field should be placed on the Consolidated Medical Salary Structure (CONMESS) towards addressing disparities in the emoluments of lecturers in the field and their colleagues in actual practice.
Mohammed added: “We also want to have an environment where we will be able to practice and deliver the best quality healthcare in Nigeria.”
Of doctors in public service owning private hospitals
The Chairman of NMA in Oyo State, Dr. Adedapo, said there is “no law that prevents a medical doctor from establishing his own private hospitals. There was a time in the early 1980s when this Japa Syndrome was very rapid. So, the Federal Government, as at that time, I think it was the IBB era, addressed the situation.
“Then, doctors were moving in droves to Saudi Arabia, Oman, Kuwait and other oil rich countries. The government then made a rule to make doctors stay in Nigeria. The government said if the salary you are collecting is not enough, you can also find time for what we called ‘Extramural Practice.’. You can try it and find your own private facility so that at least you can generate additional funds.
So the government actually approved it. But there is an extent to which this could be done. You are not expected to run a full-fledged hospital. You can actually have a clinic.
“For people saying it is easier to see consultants in private hospitals, how many people get to see them in private hospitals? It is if you have the money.
If I have a private practice and I have to see two patients immediately, would you compare it to seeing 1, 000 people waiting for you in UCH in a day?
“So, the analogy of comparing seeing consultants in private facilities and being difficult to see in government hospitals is not correlating at all. They are parallel, you cannot compare them. There is no way consultants will not give appointments when you have 1, 000 patients, waiting to see you in the public hospitals.
“In the United Kingdom, you can hardly walk into any specialist department and get seen immediately. We are not talking about them paying doctors over there also out of pocket. But because of the sheer numbers of people that want to see doctors, they have to give appointments. Yes, you have to be there. You have to book. You have to do what we called triad, which is a medical term, and it means which one is more important?
If we want to be fair to consultants, we have to look at the fact that when it comes to emergencies, irrespective of whether you have money or not, consultants must be on ground to see you.
“If it is not an emergency, you can say this one can stay for another two months; let him come back in two months, so that they can attend to the people that really need emergency care.
“Then, we are talking about a reduction in the number of personnel. So, the few personnel on ground, they too have to sustain their health and mental wellbeing. They must find a way to cut-down on activities everyday so that they can stay alive.
“If the person you spoke about in Lagos had actually presented his case as an emergency, because of his swollen legs, lack of strength and others, a consultant would have seen him.”
Doctors and compassion
Why are doctors not compassionate when it comes to care for patients, especially those that do not have money, despite the Hippocratic Oaths that every doctor swore to? Dr. Happy Adedapo also provided an answer.
“There is an element of Hippocratic Oath that says that ‘The care of patients is paramount’. But we have a modern Hippocratic Oath, which says that ‘The doctor must cater for his own health and well-being.
“We need to balance things for a doctor that is poorly remunerated, poorly improved, poorly trained, and poorly motivated. Let us think about all these things.
“You want a doctor that cannot pay his children’s school fees to be compassionate? By the time they tell you that a doctor’s child has been sent away from school, how compassionate can that doctor be? How compassionate can a doctor that is supposed to attend to 600 people be when he is attending to 2, 500 people? The ultimate goal is to see all the 2, 500 people.
“Yes compassion is good and it is a cardinal aspect of healthcare. But compassion is a personal thing. It is individualised. It is not something that you can say you teach; it has been individualised.
“Should doctors’ rewards be in heaven? If my rewards will be in heaven, how do I pay the school fees of my children? If I cannot live a normal life, and I cannot buy a new car, what do you expect? It is not like this abroad.
“Here in Nigeria, is the government giving doctors car loans? Is the government providing basic working tools? You said doctors are chasing after money, what do you want me to chase after? He is not even getting job satisfaction, and he is just getting fulfilment.”
Push and pull factors for doctors
Dr Adedapo also addressed the pushing and pulling factors for doctors involved in the Japa syndrome.
“The WHO recommendation used to be one doctor to 600 patients. Now, a doctor is seeing 2, 500 patients. This is the situation.
“We have identified the factors that are pushing our best hands out, and the factors that are also pulling them out. We are talking about the push and the pull factors now.
“What are those things abroad that are really pulling them? For example, the premier hospital in Nigeria, UCH, has been in darkness for almost three months. There is a power outage. They placed UCH on Band A, and the energy bill is very astronomical. The IGR cannot cater for it.
“What we are saying is that the Federal Government should come to the aid of an institution like UCH and find a way to defray the bill. UCH, in the last five years, had paid over N3 billion as electricity bill. How much is the hospital generating that you will be spending everything you are making on energy?
“What the government should do now, and I think the country is ripe for that, is to practice Independent Power Project (IPP) in some of these facilities. Let them generate electricity. That is the direction that the Minister of Power should be looking into.
“Now that the National Assembly has made a law that states in the federation can generate electricity, the state government should not leave everything to the Federal Government.”
Hope for Change
The aggregate opinion of experts in the medical field is that the healthcare system in Nigeria is at a critical juncture. They noted that though many of its challenges loom large, there is hope for meaningful change.
The Chairman of Nigeria Union of Journalists (NUJ) in Oyo State, also took a cursory look at the healthcare system and stated: “The call to action must resonate not only within government halls but also with the communities they serve. As individuals and families continue to suffer in silence, the collective voice for a more robust healthcare system is paramount.
“A commitment to reform can lead the way toward a sustainable future, where no patient has to plead for a chance to see a consultant, and where timely care is a standard, not a luxury.”
