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Career focus: Working in Barbados Ramon Salazar reports from an island where it's summer all year Barbados is a beautiful tropical island 431 km2 in area lying in the Caribbean region close to the South American subcontinent. Its topography is generally flat along the white sandy coast and somewhat hilly in the interior, the highest point on the island being 336 m above sea level.1 This country began as an English sugar producing colony in the early 1600s and gained its independence in 1966. Today, tourism, sugar, and offshore businesses are the economic mainstay of the island. As a popular tourist destination, it is served by most major airlines, and the prosperity the island has enjoyed from tourism has contributed to a first rate infrastructure.
The population is roughly 266 100 (1997), with a density of 618.8 people per km.2,1 Education is free for all citizens between the ages of 5 and 16, and technical schools and a campus of the University of the West Indies are available to older people.1 Living standards are relatively high ($2 Barbados equals US$1), and, despite its small size, the island was ranked 29th last year in a list of the world's best places to live.2 The Barbados doctor Training to be a medical doctor in Barbados can begin immediately after A levels and is divided into two phases. Phase 1 (preclinical) is done outside Barbados in either of the neighbouring islands of Jamaica and Trinidad for three years. After passing the phase 1 examination, students return home to begin their clinical training at the Queen Elizabeth Hospital for two years, after which there is the phase 2 examination and final graduation - an MBBS degree is awarded. Elective students are always welcome, and foreign undergraduates are taken on, especially in Trinidad. Barbados medical system Health care in Barbados is divided into private and public. In the public system all citizens are provided with care free of charge, and caregivers are paid a monthly salary. At the pinnacle of the public system is the main hospital, Queen Elizabeth Hospital, supported by clinics spread throughout the community. Public care is paid for through general taxation levied by the government of Barbados. The pinnacle of private care is Bayview Hospital, about five minutes' drive away from Queen Elizabeth Hospital and supported by general practitioners in the community. However, Queen Elizabeth Hospital also caters to private patients: generally, medical care of private and public patients is equivalent, but paying patients receive additional perks such as private rooms and personal consultant visits. Many consultants work in both the public and private sectors of health care. Those who seek private medical care tend to have personal health insurance, which covers their visits to hospital, but this is not necessarily the case for visits to general practitioners in the community. Working in the Barbados system As a major tourist site, Barbados offers many amusements - nightclubs, sailing, pubs, restaurants, tennis, golf, surfing, diving, and much more. In addition, email, express mail, and internet access are readily available and efficient. The number of holidays in the year is similar to that in Britain, and English is the main language.
Queen Elizabeth Hospital, opened in 1964, provides quite comprehensive care, and diagnostic tests such as computed tomography, radionuclide imaging, mammography, and ultrasound are available (magnetic resonance imaging is not). Reports are generally prompt as they are done in-house, and admitting patients is straightforward. Departments are managed by full time consultants elected by their colleagues in the department who are responsible for allocation of staff, proposals, departmental annual estimates, the training of doctors on their firm, and the management of this team. For this they are paid an honorarium, and contracts are usually for between two and three years. Care of public patients is divided broadly by department, and each department is allotted wards with a set number of beds. Each ward is then subdivided by firms. A firm consists of a consultant supported by a registrar, senior house officer, and house officers or interns. Patients are allotted to a firm for the duration of their care. Unlike in Britain and some other countries with new labour laws for doctors, working hours for registrars and subordinates include 32 hour periods on call every three to four days. The average registrar salary range is US$2111-$2280 (£1319-£1425) a month (Accounts Department, Queen Elizabeth Hospital). However, to work in Queen Elizabeth Hospital, you need to apply directly as openings are quickly filled and seldom advertised, and once accepted for a position you must register with the Barbados Medical Council before starting duties. The population demographics of Barbados mirror those of larger developed nations, with an increasing elderly population. The rates of diabetes and hypertension are alarmingly high. Currently, the main medical causes of death are malignancies, followed by heart disease, cerebrovascular accidents, and diabetes mellitus. Working in Barbados, you will have the opportunity to see more of some diseases, such as sickle cell disease, than in most Western countries. The University of the West Indies, through Queen Elizabeth Hospital, offers undergraduate and postgraduate opportunities in anaesthetics, child health, medicine, psychiatry, family medicine, obstetrics and gynaecology, and the only accident and emergency and family medicine programmes in the Caribbean. All the hospital consultants are invited to be associate lecturers for these programmes and, if accepted, are given a travel grant and study leave for three months every three years. Full time university medical staff are given two and a half days a week to pursue private consultations within Queen Elizabeth Hospital and are required to conduct research relevant to issues facing the health service of the island concomitantly with their post. Private practice Private practice in Barbados also requires registration with the Barbados Medical Council and, in addition, permission from the Barbados immigration department for a work permit. General practitioners in private practice open offices in residential areas within converted homes or rent space in malls (expensive). Because of the island's small size a doctor is never in isolation - Queen Elizabeth Hospital is nearby and is serviced by an efficient ambulance service that accepts calls island-wide. There are also privately run ambulance services. Diagnostic tests can also be performed by several private laboratories on the island, and pharmacies are abundant. The average cost for a patient to see a general practitioner is US$25 without an appointment. After hours calls are infrequent as 24 hour emergency clinics are now available. The number of doctors per 10 000 people is 11.5.3 Apparently, most applicants to the Barbados Medical Council are accepted, especially those from Britain as a reciprocal agreement exists between the UK General Medical Council and the Barbados Medical Council. To be fully registered to practise, your internship must have included rotations in medicine, surgery, social and preventive medicine, child health, and obstetrics and gynaecology.
If you do decide to come expect lots of sunshine, temperatures of 25°C to 32°C year round, and lovely beaches. I wish you the best and hope we will meet sometime in the future. Ramon Salazar final year medical student University of the West Indies School of Clinical Medicine and Research (czar@cariaccess.com)
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