Compulsory rural service should come up with additional benefits for doctors

Saturday, May 26, 2012

by Rajni Pandey

The Medical Council of India (MCI) is reportedly working on the proposal to increase the duration of the MBBS course from the existing 5.5 years to 6.5 years. The proposed one-year increase is being contemplated to set aside the additional year for mandatory rural service of MBBS graduates. In the light of this, AalaTimes spoke to young doctors to know what they think about the proposal.

Edmond Fernandes

The move has made a stir among the young doctors. Edmond Fernandes, officer for internal and external affairs at the Indian Medical Students’ Association and a final year MBBS student at Father Muller Medical College, Mangalore, said, “Increasing the course duration is insanity at its peak and exposes the pernicious underbelly of compromise. Do they understand the human face beyond policy making?”

Dr Deepak Tanwar, resident (orthopaedics) at Safdarjung Hospital, New Delhi, said, “Already there is a lack of interest among students to pursuing medicine as a career; the increase in course duration will further lead to the crunch in the number of students applying for MBBS.”

Dr Deepak Tanwar

Dr Nishu Raj, resident (radiology) at Lady Hardinge Medical College, New Delhi, said, “It is not right to increase the duration of MBBS course because it already takes almost six years to complete the course. Then if you want to do postgraduation, it will take another three years for that. Due to circumstances, if you don’t get selected for postgraduation right after MBBS, you will spend another two-to-three years to get admission into postgraduation course. So, it almost takes 9-10 years to complete postgraduation and over that the government is planning to add another one year. I think it’s not justified.”

Dr Nishu Raj

On the union health ministry’s proposal to make one-year rural service mandatory for MBBS students, Dr Raj said, “I don’t know how they are going to force students to work into rural areas. It would become more difficult for girl students to work in rural areas. Often in rural medical colleges and hospitals anybody comes in and beats doctors and no one can do anything. We can’t say that don’t post girl students in rural areas, as education rules and regulations are same for both genders. But safety is really a serious concern, especially for girls. I don’t know if many students, after this proposal (mandatory rural service) gets implemented, will see medical profession as their first career option.”

Supporting the idea of mandatory rural service, Dr Tanwar said this could ease the burden of city hospitals where people from rural areas come even for minor ailments such as skin problems, infections and ante-natal checkups, which can be easily managed by MBBS students who have completed their internships and gained sufficient experience to treat such patients. “If you go to city hospitals, almost 40 per cent of the patients coming to the medicine OPD are those who can be managed by the experienced gained during the undergraduate medical study along with an internship. So, adding a doctor in rural setup will lead to decrease the load of patients rushing to city hospitals,” he said.

Dr Tanwar further said, “The compulsory rural service should come up with some additional benefits for doctors, such as higher stipends and reservation in postgraduate medical seats. Also, rural hospitals need better road connectivity, along with essential medicines and emergency equipments. Doctors working in rural areas would also require some assurance for their personal security. If soldiers posted in Siachen border areas can get an extra pay, why not doctors who work in rural area. In areas where soldiers die in landmine blast how can a doctor be safe? Also, when doctors are being beaten by patients’ attendants even in city hospitals, you can well imagine what can happen in villages.”

Reacting on the health ministry’s decision to ask the medical students going to the US for higher studies to sign a bond with the ministry that they will return to India after completing their study, Fernandes said, “The country will continue to have brain drain until the healthy competition is not maintained. How many doctors come out and how many PG seats are available? Most of those also have reservations. Where do they go? In the US, it’s not like that. In Harvard, they compete for a ratio of 1/8 and likewise. In India be it for any entrance, it’s a volume game. Let them address this first. If they cannot solve it on their own, they should involve us. We know the grassroots reality and the niche sectors.”

When asked how to deal with the shortage of doctors in rural areas, Fernandes said, “Addressing the shortage of doctors in rural India is very simple. The people staying there can be educated in medicine. I am very sure there are people who are interested to learn medicine. Instead of spending Rs 1.7 crore on every AIIMS doctor passing out, half, if not quarter, of that money can be spent on educating a rural youngster. Just imagine how every village will be transformed. The ministry lacks vision, the MCI plays it safe. This is the problem of this country. It exists because of the powerful middle class that builds it brick by brick.”

by Rajni Pandey

Categories: FEATURES

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Comment by Dr Anil
2012-05-26 22:25:43

It is toatally unacceptable to increase the duration of MBBS … I am sure no one among the meical students will accept it unless some benefit /priority will be given in postgraduation admission..

Comment by Dr. M C Gupta, Advocate
2012-05-27 10:52:16

The issue of increasing the duration of the MBBS course by an year shows how casually the government treats medical education. Does a health minister increase the duration of the medical course simply because there are too few doctors working in the rural areas? If that is logical, why not increase the duration of engineering and management and law courses also because most of such professionals are concentrated in urban areas? Let everybody be covered by the government’s utopian decision to make available professional expertise in the rural areas by the magic device of increasing the duration of the professional course and making rural service compulsory!

Has any committee of educationists recommended increase in the duration of the medical course? Is the field of medical education the whimsical playground of the health minister meekly followed by the high sounding group of the “Board of Governors”, both of whom can, at the drop of a hat, tinker with the medical education system established in the country for more than a century?

I fail to understand why the IMA is a mute spectator to this. Is it not the bounden duty of the IMA to come out with its views in this regard and, if such views are against the proposal, to not stop merely at airing its views but to take necessary legal steps to prevent this folly?

The MOH and its servant, the MCI, are mixing up issues that are not mixable. The lack of doctors in rural areas and the duration of the MBBS course are issues unrelated to each other. The schizophrenic approach of the MOH is laughable–On the one hand it wants to bring out a three and a half years BRHC course; on the other it wants to make MBBS a seven year course!

Has the MOH ever appointed a commission to look into the causes of skewed doctor distribution in rural-urban areas and to recommend steps for improving such distribution? Why not?

BTW, what happened to the ISM / AYUSH? Have all of them suddenly become useless and incompetent and irrelevant for serving the health needs of the country? Why are only MBBS doctors factored in when presenting the doctor: population ratio? If they do not count, let those of the existing AYUSH colleges that are willing be converted to regular MBBS colleges governed by the MCI regulations. After all, the ministry of health seems to be very keen to increase the number of medical colleges in the country.

–M C Gupta



Comment by Dr Satya
2012-05-28 02:47:36

Making MBBS a seven year affair is ridculous and will damage the quality of medical expertise. Every meritorius student deserves to aspire for any higher degree as he/she wishes. Obstructing it is unfair.
Secondly, if at all the Govt. thinks that young doctors should work in rural areas, the bset way to do it is the year immediately following admission to a PG course (Pre-P.G. mandatory service). Once the student qualifies and gets admission to his/her subject of choice, he should serve for 1 year in a rural set up. That way students’ careers would not be threatened, and the Govt. will get its rural doctors at least for 1 year. As every year students will join PGs, every year a new batch of doctors will go to rural service. Whats wrong about it? This happened to me and my batchmates in Odisha in 2002, we joined rural srvice for 1 year after qualifying and getting admission to PG courses. All of us completed our services, but still had control of our careers. Why the Govts have gone back on this system I dont understand.

Comment by Dr Feroz
2012-05-28 10:41:34

Does the govt ever bother to take the opinion of the doctors whose careers and lives will be most affected by this knee-jerk reaction of the ministry to solve a complex problem? As it is, many students are not opting for medicine as their first choice because of hardships in kick starting their career; MBBS is not enough, u need a pg degree and in some branches a DM/MCh to kickstart your career. With so few seats available for pg and lesser still for DM/MCh, u can very well imagine the time it takes for a doctor to start his career leave alone how he/she survives on the low salaries/stipend(many are married/have kids by the time the are in pg/super speciality.
On top of all this the govt wants to further burden the poor doctor instead of giving incentive so that the bright students take it up as their chosen carreer. What it needs to do is increase MBBS/pg/DM/MCh seats, increase pay and give incentives, basic amenities and security to doctors who want to work in rural areas.

2012-06-14 21:01:39

I fully agree to the suggestion of Dr Satya the the Central Govt should make it compulsory for PG entrants to serve one year in a rural area . This will give the villagers true medical service by full f
ledged professionals and will not increase the duration of study. Is there any profession in the world except for the doctors who works 24×365 without a break in 24 hrs. Does the govt or the public look into the sacrifice these people make as to the deprivations to their their family . All the bad names against little money they get working overtime whole life. A doctor in a rural or a semi urban area work on meagre payment as they know the patients.
The govt should set up small RHTC s in true rural areas where the learning doctors can work and learn under supervision. Keeping the duration constant , improving the rural infrastructure the rural service should be made enjoyable to the young doctors . The postings must be beyond political interference of any sort and in the true sense of giving service to the needy. Mappings , Surveys must be done before blaming the doctors that they donot go to thye villages. Politicians must assess these by themselves.

2012-07-06 05:40:28

One fails to understand the logic of increasing the duration of MBBS. It is not solong ago the government is in ahurry to produce halfbaked rurall Doctors to serve the ruaral public. These raw MBBS gradraduates are just a shade better perhaps.The basic fact is that these House surgeons and junior doctors need guidance by senior doctors. otherwise rural population is the experimental area for the Govenmental whims and fancies. The main problem is lack of infrastructure and minimum facilities for the residen t doctors.Once te Goerrnment recognises this essntial fact, there will be progress in solving this essential problem.

Comment by Kusuma Kumari G
2014-04-03 20:10:11

It is a very good move by the Govt of India. Doctors must serve teh poor in rural areas, Their aim should be only service and nothing else/

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