Efforts to solve hospital staffing crisis hampered by red tape

Abu Dhabi needs to double the numbers of doctors and nurses over the next decade, but overly strict rules deter qualified medics from coming.

Doctors, nurses and hospital bosses say efforts to avert a medical staffing crisis are being hampered by a slow licensing process and needlessly strict criteria. Abu Dhabi needs to double the numbers of doctors and nurses over the next decade to cope with its ageing, expanding population. However, doctors say it will struggle if the health authority does not change licensing rules.

Staff at public and private hospitals say it can take up to a year to licence a doctor. Many coming from abroad are not prepared to wait that long. One senior manager at a major public hospital in the capital said the problems affected recruitment, licensing and retention. The official said the Health Authority-Abu Dhabi (HAAD) was "overwhelmed" in re-evaluating staff, and was using strict criteria to licence new ones. "They are processing all the existing licences, and also the new ones," he said. "They don't have the capacity. For the existing staff, they want documents that might not even exist any more, like school certificates. The process is simply too long. We lose out on good staff."

He said the process started last year, and with more than 4,000 doctors and 8,000 nurses now working to re-evaluate, it could drag on for one more, delaying new licensing applications. Some hospitals, public and private, allow staff to work - at their own risk - while their licence is being processed. "This will stop next month. The health authority sent a memo. Applicants can be very highly qualified but have one form missing, so they won't get a licence," the official said.

"I can understand about wanting good quality, but it is just not being carried out well." HAAD's Personal Qualification Requirement checklist covers all roles and lists required experience and qualifications for licences. However, some say the checklist does not recognise many international medical boards. To be a consultant, for example, a doctor must have been in that role for at least two years. Many younger doctors applying to Abu Dhabi are newly qualified as consultants and would, therefore, not be eligible for the same title, responsibilities and benefits.

George Jepson, the chief executive of Al Ain Hospital, agreed the licensing process was sometimes problematic, particularly for newly qualified doctors. "For the case of a highly trained doctor, this is seen as below the level at which they would expect to be treated," he said. Al Ain Hospital is undergoing massive expansion and will require many more staff. Mr Jepson said he was aware that HAAD was working on a streamlined licensing procedure.

"I would hope it would enable us to attract younger, highly trained specialists and consultants, particularly from western-educated areas," he said. "It's a great opportunity." Last month the health authority published figures highlighting shortages in gynaecology, paediatrics, oncology, dentistry and psychiatry. The number of nurses needs to increase from 6,900 to 13,900, a task also affected by the licensing process. M Higgins, who was licensed in the United States, said she gave up trying to work as a school nurse in Abu Dhabi because of the time it took to apply. She left the country after eight months. "I am more than qualified for the job, although I was unable to obtain a licence after eight months," she said. "I don't understand why a nurse, who has a current valid registered nursing licence from the States is unable to get a health authority licence in a timely manner." The licensing issues do not only affect the public sector. Certain private groups, especially those wanting to expand, also complain that the rigid criteria and delays in licences costs them valuable staff. Dr Bavaguthu Raghuram Shetty, managing director and chief executive of the New Medical Centre, said the emirate's hospitals risked losing staff to countries such as India because of the delays. "Healthcare is booming in other countries, so they don't need to wait here," he said. He agreed the health authority needed to change its licensing criteria to take into account foreign medical boards, asking "would someone take a step down by moving here He also expressed frustration with the relicensing. "We have staff here for 30 years who need to give the health authority all their documents, which they sometimes don't have," he said. "It is very difficult for everyone." According to HAAD, 16 per cent of doctors and 13 per cent of nurses quit their jobs each year. To hit its expansion target, the emirate needs an additional 1,600 new doctors and 1,800 nurses each year. Alison Ramsay, the director of nursing at the German General Hospital, said she needed to recruit up to 500 nurses over the next two years, which was made difficult by the licensing process. "There is no flexibility, the criteria is very rigid," she said. However, she said that she was sympathetic to the complexity of licensing medical staff from all over world. HAAD declined to comment, but said it would announce potential changes to the licensing process in August. [e-mail]