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Democracy, Diktats and Doctors

“I am a Doctor.” The instant reaction to this statement in a layman’s mind varies from respect, admiration and/or interest to envy! And why not, after all medical practice is one of the most coveted careers in the country. It earns you reverence, money, power and all the good things that come with these. However, what most people fail to see is the intense, rigorous hard work and long years of toil and dedication which goes into its making. Where the rest of the students graduate in a maximum of 3-4 years, the MBBS students have to devote five and half years of the prime of their lives to get the degree.

As if the elongated course structure was not enough, the Union Health Ministry has announced a mandatory one-year rural posting for all aspirants of a postgraduate medical course as an ‘eligibility criterion’. This is not only being enforced as compulsory, it also obviously comes without any sense of responsibility of the doctors’ lives and careers on the part of the government. The reason stated is to make up for the lag in the required number of qualified doctors in the rural and remote areas, especially the Primary Health Centres (PHCs).

The young doctors’ stance which has mostly been put forward by the Indian Medical Students’ Association and the ‘Doctors for Villages’ (earlier, ‘Save the Doctor’) campaign, which had the support of Indian Medical Association (IMA), Delhi Medical Association (DMA) and Association of Healthcare Providers India (AHPI), remains that they are not against rural posting but need apt modifications to be incorporated within it.

This ‘Diktat’ is completely unacceptable and condemnable. There are several flaws in such a mandate, some of which are:

Firstly, the government remains mute on the security questions of the doctors posted in rural and remote areas. There have been several incidences of physical assaults on young doctors by locals. Especially in the case of female doctors, molestation could be one of the most gruesome crime against which they need to be secured.

Secondly, the irony of the government’s excuse lies in the fact that the inexperienced, unsupervised fresh MBBS graduates are left to alone handle the rural population. At this phase of their career they require supervised training and mentorship in clinical skills before they become competent enough of handling patients independently.

Thirdly, the attitude of the government that money spent on medical colleges is a favour on the medical student is disputable. It is a basic function of the government and providing healthcare to the masses includes training manpower to provide the same.

Fourthly, the needs of people in the rural areas go beyond medical help. They at times require counselling to help improve general health and prevent diseases, proper explanation of diet, physical activities and lifestyle changes, etc for which social workers and dieticians are needed to work as a team and share the load. Also, the infrastructure of most PHCs is said to be in an utterly hopeless state. These requirements conveniently go unnoticed by the authorities.

Fifthly, young doctors are usually not accustomed to the socio-cultural values, language or even religion/caste of the allocated area. Given that our nation is in practice organized along those lines, efforts need to be made to acclimatize the doctors to such dynamics.

Although following the recent agitation by young doctors across the country, the union health ministry has put the implementation of mandatory one-year rural posting temporarily on hold, a fair solution needs to be worked out so that the students can peacefully focus on their education and the medical world continues to ooze its charm and draw the best of people into its folds!

2 Comments

  1. Dr Neeraj Nagpal Dr Neeraj Nagpal Monday, February 17, 2014

    This is an incomplete assesment of the problem. We had already raised our arguments published in India Medical times earlier titled “Bonded Labour MBBS”. The Post Graduate Medical Education Regulations 2000 Amendment 2013 Part I clearly states that to appear in PG entrance a candidate has to hve done 1 yr rural service in a Primary Health Centre (PHC). There are 2700 posts for MBBS doctors vacant in PHCs all over country in March 2012 (Information obtained by us under RTI) 95000 MBBS doctors appeared for PG entrance recently. How were these 95000 going to be fitted in 2700 posts was the mystery. Basically either the doctors were going to be left to get the highly coveted 1/2700 job by merit or by bribe or the Govt wanted Doctors to work for free. We had raised these issues in representations to the ministry, As questions given to Members Parliament to be asked in question hour, and under RTI. Working in rural area is not what the regulation amendment says, it says working in PHC is neccessary. I still feel this is a problem which will raise its head again later and we will continue to collect data and prepare our case against it to be used at the appropriate time.
    Dr Neeraj Nagpal
    Convenor Medicos Legal Action Group

  2. Dr Yogesh Mittal Dr Yogesh Mittal Monday, February 17, 2014

    Agreed

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