Exploring Physicians' Perceptions of Registered Medical Officers in Galle, Sri Lanka

Abstract

<p>The purpose of this qualitative research study aimed to explore physicians' perceptions of registered medical officers (RMO) in Galle, Sri Lanka. The RMO is a mid-level practitioner, analogous to physician assistants in the United States or mid-level health workers of several other countries. The position of the RMO was vital to the Sri Lankan healthcare system for decades, providing basic care within the country's universal healthcare program for lower costs and minimal training and filling in the gaps in delivery in smaller centers and remote areas. As similar countries move towards task-shifting strategies, Sri Lanka has eliminated the RMO program and has commenced the replacement of current RMOs with physicians in an effort to increase the quality of healthcare provided at even the basic level. </p><p>This study aimed to understand better the perceptions of physicians regarding RMOs and the RMO profession, the perceived value of the RMO position, the role RMOs have played within the system, and reasons surrounding the elimination of the RMO. Fifteen physicians were selected from the Galle District of Sri Lanka to participate in a semi-structured interview regarding the RMO profession. The resulting responses illustrated a fairly low perception of the RMO profession and its members, with repeated concerns shown for the lower quality of care provided and the lower level of education attained. Physician perceptions of RMOs suggest that the working relationship between the two professions is frequently strained, and it was clear that most physicians were in support of the government's elimination of the RMO training program. Furthermore, the government initiative to replace RMOs was being met through the high numbers of medical graduates that were annually entering into the healthcare system. While the actual value and abilities of the RMO could not be accurately determined, it was apparent that poor perceptions of their value and abilities may have played a role in the termination of their training and the possible advantages to the position had not been fully considered. The involvement of politics in both professions further solidifies the understanding that other factors may have influenced the removal of RMOs. Moreover, given the current status of Sri Lankan healthcare, it must be questioned whether the already strained system will be able to carry the burden of the additional physicians' salaries, and additional resource improvements necessary in peripheral health centers, and still succeed in increasing and advancing the overall level of care and coverage currently available.</p>