Nigeria’s public health system is not collapsing overnight; it is collapsing slowly, visibly, and avoidably. The warning signs are everywhere: deserted residency programmes, endless waiting lists, emergency departments staffed by exhausted juniors, and a conveyor belt of medical graduates planning their exit before their first day on the job. What once sounded like an alarm has now become reality – Nigeria is running out of doctors.
Across teaching hospitals and federal medical centres, wards that used to be training hubs for future specialists are now running on survival mode. In many departments, the entire workload (clinics, theatre, and emergencies) is resting on the shoulders of a handful of resident doctors who are simply not enough. The residency pipeline, once the engine room of workforce supply, is now on life support.
Read also: How bureaucracy, brain drain break healthcare workers
Over the past five years alone, at least 9,000 Nigerian doctors have left the country, according to the Nigerian Association of Resident Doctors (NARD). Many more are in the queue, saving from their NYSC posts to pay for foreign exams like PLAB and USMLE. Consultants now admit they are literally begging candidates to apply for residency positions that once attracted hundreds.
Twenty years ago, Nigeria had about 25,000 resident doctors. Today, the number fluctuates between 11,000 and 15,000, and the figure says little about the operational crisis on the ground. With a doctor-to-population ratio pushed to 1:9,000 or worse, there are not nearly enough hands to run critical services.
This is not simply a migration problem. It is a system problem, one that begins with chronic underfunding and spirals into moral injury: poor pay, unbearable schedules, unpaid arrears, unsafe work environments, and the crushing knowledge that even excellence does not guarantee dignity.
“In other words, federal hospitals are bleeding out not only because doctors are leaving but also because the system refuses to replace them.”
The picture nationwide is chilling. At the University of Benin Teaching Hospital, units that once had 30 to 40 junior residents now run with six or seven. A routine prostatectomy that once took weeks to schedule now takes months. A resident may leave work at 7 pm, only to be called back for a night shift because there is simply no one else.
At the Federal Teaching Hospital, Lokoja, there are 89 senior specialists, but only about 32 residents. Such an imbalance is mathematically incompatible with continuous patient care.
At LUTH, Lagos, there are departments where a single junior resident holds the fort, covering emergencies, outpatient clinics and ward care. And at FMC Keffi, a residency workforce of nearly 400 doctors in 2017 has declined to under 180.
This is not inefficiency; this is collapse in motion.
While brain drain drains supply, bureaucracy prevents replenishment. Teaching hospitals and federal medical centres cannot hire directly; approvals must come from Abuja. Interviews are conducted, candidates selected, then nothing happens for months. By the time appointment letters finally arrive, many candidates have already migrated or joined the private sector.
The three-year federal employment embargo under the Buhari administration deepened the crisis, creating a generational staffing vacuum. Meanwhile, state-owned teaching hospitals like LASUTH and ESUTH now attract talent more easily, not because they pay dramatically more, but because they hire without delay.
In other words, federal hospitals are bleeding out not only because doctors are leaving but also because the system refuses to replace them.
The toll on those who remain is brutal. Calls of 20 to 30 days per month, 72-hour shifts, and unpaid allowances have turned residency training into a humanitarian crisis.
Deaths are no longer isolated tragedies; they are patterns.
Oluwafemi Rotifa (2024) collapsed after a 72-hour call. Ahmed Isaiah (2022) collapsed in the theatre during surgery. Okeoghene Edigba died after back-to-back procedures with no rest.
Each case exposes the same reality: a system that demands superhuman sacrifice but offers no safety net, no protection, and no honour.
Everything hinges on residency training. Without residents today, there will be no consultants tomorrow. Without consultants, there will be no training at all. The collapse of the residency pipeline is therefore not a workforce crisis; it is an existential threat to Nigeria’s healthcare future.
Already, patient waiting times have increased; elective surgeries are being cancelled; emergency care is overstretched; junior doctors are training without mentorship, and specialists are retiring with no replacements. This is how a healthcare system dies.
Read also: Reverse Brain Drain Turning Talent Flight into National Strength
The crisis is not irreversible, but denial and token intervention will not fix it. The ideal and practical pathway is clear. First and foremost, immediate recruitment to fill emergency gaps. Hospitals should be allowed to hire directly within approved budgets without waiting months for federal letters.
A competitiveness reset of wages must reflect inflation, include hazard allowances and medical insurance, and reward specialisation. Protected working hours and enforced staffing ratios should be the norm. Residents must not legally be allowed to work 72-hour shifts, and the system must protect its workers, not consume them.
Priority should be given to the most depleted departments, with funded training slots and modern facilities. The promotion of welfare and dignity should be paramount. Accommodation, mental-health support, insurance, functioning theatres and consumables must be viewed as basic infrastructure, not luxury.
Nigeria does not lack talent; it lacks retention. It does not lack patriotism; it lacks policy. The real question is not whether doctors are leaving; it is whether the system gives them a reason to stay.
If leadership acts with urgency, Nigeria can rebuild its workforce and strengthen health security. If it does not, the country must confront a reality far worse than brain drain – a healthcare system without healers.
