The recent government decision to change the obligatory assignment system for doctors to that of voluntary physicians has triggered a wave of reaction across the nation’s medical community.

The old system aimed to ensure equitable access to healthcare by placing fresh graduate doctors in areas where they were most needed, often in remote or underserved regions. Doctors were typically required to serve in these assignments for one to three years, depending on their specialty, before they could pursue other career opportunities or specialisations.

Ministry of Health and Population Spokesman Hossam Abdel-Ghaffar pointed out that rationalizing — not annulling — the obligatory assignment system was driven by several factors, including financial considerations and the desire to improve job satisfaction among doctors. The government spends approximately LE500 million annually on the assignment system, covering costs related to salaries, logistics and additional incentives for doctors placed in less desirable locations. Rationalising the mandatory placements will enable the government to reduce costs and redirect resources to other areas of the healthcare system.

Moreover, the government, according to Abdel-Ghaffar, recognised that the mandatory system often led to dissatisfaction among young doctors who felt that being forced into assignments regardless of their preferences or career goals led to a lower quality of patient care. “The new voluntary system gives doctors the right to choose positions that align with their skills and aspirations, ultimately improving job satisfaction and healthcare outcomes,” Abdel-Ghaffar said.

At the same time, the health minister noted that starting from 2025, the ministry will begin assigning based on the number of doctors needed and geographic distribution in each governorate. “In the past, everyone was assigned, but the law doesn’t state that, and logic dictates that hospitals should only take what they need,” the minister said.

The Doctors Syndicate opposes the new decision, having reservations following multiple government studies indicating a shortage of medical doctors and nurses in hospitals, according to Abu Bakr Al-Qadi, assistant secretary-general of the Medical Professions Union.

Al-Qadi said the mandatory nature of the assignment meant that doctors often had little say in where they were sent, leading to dissatisfaction among many who were placed in areas far from their homes or desired fields of practice. “Despite these challenges, the system was seen as a necessary measure to prevent an uneven distribution of medical professionals and to ensure that all Egyptians had access to healthcare services,” Al-Qadi said.

According to President of the Doctors Syndicate Osama Abdel-Hai, the new system could lead to significant disparities in healthcare access, particularly in rural and underserved areas. Without a mandatory system to ensure that all regions are staffed, there is concern that doctors will gravitate towards urban centres, exacerbating existing inequalities in the healthcare system.

Abdel-Hai also expressed concerns about the potential for increased job insecurity among newly graduated doctors. Without guaranteed placements, young doctors may face greater competition for positions, potentially leading to higher levels of unemployment or underemployment in the medical field.

The decision to end the mandatory assignment system has been met with mixed reactions from doctors themselves. Many younger doctors have expressed support for the change, viewing it as a step towards greater professional autonomy and a more modern healthcare system.

“The annulment of the mandatory assignment is a welcome change,” said Omnia Ahmed, a recent medical graduate. “It allows us to take control of our careers and choose positions that are best suited for our skills and interests. This will ultimately lead to better job satisfaction and, I believe, better patient care,” she added.

Islam Osama, who had previously been assigned to a rural area, noted the challenges faced under the old system. “Being placed in a remote area with limited resources was incredibly difficult. The new system gives us the flexibility to work where we can be most effective and continue our professional development without feeling trapped,” Osama said.

However, not all doctors are in favour of the change. Some worry that the absence of a mandatory assignment system could lead to an oversupply of doctors in urban areas.

Ahmed Harhash, an ophthalmologist who works at a health insurance hospital, said the mandatory system was annulled three years ago for doctors working at health insurance hospitals, thus causing severe shortages in the number of doctors. “The fear is that without a structured system in place, many governmental hospitals will struggle to attract and retain qualified doctors,” said Harhash, adding that this could have serious consequences for public health in those communities, especially since doctors who were assigned in remote areas were paid a maximum of only LE7,000 a month.

* A version of this article appears in print in the 15 August, 2024 edition of Al-Ahram Weekly