Her Open Letters 004

Her Open Letters: To the Ghana Medical and Dental Council


Re: The Hours You Have Never Regulated


Dear Members of the Ghana Medical and Dental Council,


I am writing based on your own published guidelines and on public research involving your trainees.


Your 2015 Guidelines on Housemanship Training set out the structure of training clearly: two years, six-month rotations, progression from House Officer to Senior House Officer. The guidelines do not set a limit on shift length. They do not set a minimum rest period between shifts and does do not include mental health support as part of the training structure. A document that regulates duration and sequence in detail says nothing about the physical condition of the person carrying out that sequence.


The data on what this produces is public. A study of obstetric providers at Komfo Anokye Teaching Hospital found that 62 percent reported burnout (Lawrence et al., 2021). A study of health workers in Accra hospitals found burnout severe enough to produce measurable physiological strain (Konlan et al., 2022). A cross-sectional study of Ghanaian doctors found that 71.8 percent intend to emigrate, and doctors aged 20 to 29 are nearly three times more likely to want to leave than older colleagues (PMC, 2024).


These figures connect to a wider staffing problem. Ghana has roughly 0.14 physicians per 1,000 people, below what adequate coverage requires. Every doctor who leaves increases the caseload on those who remain, and those who remain are disproportionately your youngest trainees, the same group your own data shows is most burned out and most likely to leave. The guidelines you regulate are training the next generation of doctors under conditions that push a majority of them toward exhaustion and a majority of the youngest toward the exit. This is attrition, built into the structure you certify.


There is also a patient-facing dimension to this. A fatigued doctor does not lose competence in principle, but judgment, reaction time, and attention degrade under prolonged sleep deprivation. This is established across health systems worldwide, not specific to Ghana. Every hour of uncapped shift length is an hour where the person reading a scan or calculating a dosage is doing so with a fatigued brain. The patients affected by that are the same public your Council exists to protect.


This letter asks to close the gap between what your guidelines regulate and what your trainees actually go through. Amend the Housemanship Training Guidelines to include:


1. A maximum continuous shift length.

2. A minimum rest period between shifts.

3. Scheduled mental health days built into the training calendar.


These should be written into the guidelines with the same specificity as the rotation schedule, and monitored through the same reporting channels hospitals already use to confirm rotation completion. A hospital that cannot document compliance with rest requirements should face the same scrutiny as one that cannot document rotation completion.


You already certify when a doctor is fit to practice independently. Please certify the conditions they are trained under as well.


With Respect and Urgency,

Stephanie Hephzibah


Refrences 

Lawrence, E. R., Yeboah, M., Arthur-Komeh, J., Stabnick, A., & Rominski, S. D. (2021). Predictors of burnout: the role of agency among obstetric providers in Kumasi, Ghana. Global Health Action, 14(1). https://doi.org/10.1080/16549716.2021.1978662


Konlan, K. D., Asampong, E., Dako-Gyeke, P., & Glozah, F. N. (2022). Burnout and allostatic load among health workers engaged in human resource-constrained hospitals in Accra, Ghana. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08539-5


Factors influencing the intention of doctors to emigrate: a cross-sectional study of Ghanaian doctors. (2024). PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603628/


Ghana Ministry of Health / Medical and Dental Council. (2015). Guidelines on Housemanship Training. https://www.moh.gov.gh/wp-content/uploads/2016/02/GUIDELINES-ON-HOUSEMANSHIP-TRAINING-2015.pdf

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