Nicaraguan Health Ministry Imposes Government Service on Doctors

The Nicaraguan Ministry of Health (Minsa) has issued a new regulation imposing a draconian condition on primary care doctors who wish to study a specialty: work ten years for the government or pay them back US $61,706.

The new clause was incorporated into the contract signed by 213 general doctors who classified for the program “Medical-Surgical Residency 2024-2028,” promoted by Minsa and offered through the Nicaraguan National Autonomous University (UNAN).

This is the first time the Ministry has included this clause in the contract for those wishing to study a specialty, according to several doctors from the country’s private and public hospitals who spoke with Confidencial.

The health workers stressed that the measure is an attempt on the part of Minsa to “keep the doctors in the country,” in the face of “a massive brain drain.” The latter problem is the result of the socio-political crisis that Nicaragua has been going through. The measure will also force the new specialists to “be at [Minsa]’s disposal.”

The document entering residents must sign establishes that the doctors will have to pay a sum of cordobas, equivalent to approximately US $61,706 dollars at the current exchange rate, in the case of four eventualities:

1. Abandoning their studies without due cause.
2. Failing to fulfill the terms of the contract or the disciplinary norms for residents.
3. Sudden resignation from the health establishment where they’re realizing their studies.
4. Refusing, abandoning, or resigning from their work at the health establishment where they were placed.

Minsa will determine the doctors’ futures

Once the residency is completed, doctors will not have a voice in deciding which medical unit they’re assigned to, nor in what part of the country. The Ministry will assign them their workplace “according to the needs” of the institution.

“This will put them in a very complex situation, since if they leave the residency program they’ll have to pay an exorbitant amount of money – far out of proportion with the salaries we receive,” stressed a health worker from the private sector.

“Some private institutions have similar practices. If they give you a scholarship, in payment you have to work for a certain number of years. However, it’s generally four or five years, and afterwards you’re free. It’s something they’re copying from these private institutions,” the private doctor stated.

Entrance into the residency program is considered a “scholarship”

Minsa opened 213 spots for 18 medical specialties: anesthesiology, general surgery, maxillofacial surgery, pediatric surgery, dermatology, physiatry (pain management and rehabilitation), gynecology and obstetrics, internal medicine, neurosurgery, ophthalmology, orthopedics and traumatology, otolaryngology, pathology, pediatrics, radiology, psychiatry, radiation oncology, and urology.

Of these 213 openings, 107 will be awarded to doctors who apply directly through Minsa; 70 others will be offered by UNAN-Managua, and 36 more from the UNAN medical school in Leon.

Those selected will pay a pre-enrollment fee of 1,500 cordobas [just under US $41] if they’re graduates of a public university; those who graduated from a private college will pay 3,000 cordobas [just under US $82]; and those who studied outside the country will be charged 4,000 cordobas [close to US $109]. Any foreign doctors who want to apply will be charged 4,500 cordobas [US $122.50] for their pre-enrollment.

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Minsa is promoting the program as a “scholarship and stipend,” since it includes a salary that the residents will receive.

“The conditions are outrageous, because during our years of training, the level of work in the teaching hospitals is akin to slavery. The salary (“scholarship” according to Minsa) is more than fully earned,” a health worker emphasized.

“This [program],” the worker added, “will only worsen the crisis further. Next year, the doctors that want to specialize will have one more reason to do so outside of Nicaragua, and those left will be the least capable.”

Another doctor from a public health unit also lamented the measure, noting: “the only thing lacking is for them to declare that the work done by residents will be unpaid, like in Cuba.”

Minsa utilizes doctors for Party proselytizing

Minsa has become an institution loyal to Daniel Ortega and Rosario Murillo. The doctors in the health centers are forced to engage in political proselytism.

During the recent March 4 elections in the Atlantic Coast regions, Urnas Abiertas citizen observatory denounced the mobilizations of students and medical residents from the UNAN campuses in Managua and Leon.

“They’ve threatened them with not being allowed to continue their careers, with the cancellation of their scholarships, or with the loss of their residency,” the organization denounced.

Since 2018, Minsa has carried out purges of health workers who question the Ortega-Murillo dictatorship. In 2023, it was revealed that approximately 686 doctors are owed compensation from the Ministry. 

The group is made up of doctors who were fired for protesting in 2018, expressing their scientific opinions  or criticizing Minsa’s poor management of the health crisis triggered by the Covid-19 pandemic.

This article was published in Spanish in Confidencial and translated by Havana Times. To get the most relevant news from our English coverage delivered straight to your inbox, subscribe to The Dispatch.