A recent piece published on India Medical Times reported that medical students want the government to increase postgraduation places. It is indeed sad that students have to point out to us what is obvious and something really associations like Indian Medical Association ought to be pushing for.
In the 21st century to be able to practise modern medicine, one needs further training and mentoring for a number of years in his/her chosen vocation before feeling able and confident to practise independently. There is little point in creating doctors if we can’t then offer them adequate postgraduate training at reasonable remuneration.
Inevitably, such a move will require upgrading Primary Health Centres across the country significantly to include and develop Primary Care as a specialty because a large number of doctors will be working in the Primary Care. We further need to build more district medical colleges and one of the suggestions has been to identify and upgrade some of the existing Community Health Centres as well as upgrade the existing medical colleges so that they are fit for purpose in 2017.
We further need to understand that postgraduate medical trainees don’t just learn things; they also provide a vital component of the care in any government establishment and currently the remunerations are so pathetic they feel they owe the system nothing and as a result, in parts of the country, patients suffer due to sub-standard care. I would suggest significantly enhancing their remunerations so that they are all earning somewhere in the range of Rs 50,000 – 60,000 as basic pay. There should be a further 30-40% supplement for those working in small towns and perhaps 60-70% supplement for those working in rural facilities. There should be further remuneration for those working more than 50 hours a week and those working during nights or weekends. Let us face it; these are qualified doctors and should hence be remunerated as such. Financial exploitation of junior doctors lies at the heart of some of the grave ethical issues our health sector faces today. If we as a society take care of our side of the bargain, we can then rightfully demand that doctors deliver theirs by following a strict moral code of conduct and showing professional accountability.
We should further be able to offer employments to all these doctors at a starting pay close to what would be twice that of a trainee. This would be possible if we can build and upgrade facilities as suggested above.
I am under no illusion that doing any of this would come cheap; it won’t. It might even mean that we would have to treble our healthcare budget over the next five years to bring it closer to what developed countries spend on health. India’s aspirations of becoming a developed country can only be achieved if the state looked after the health of the people. Sooner we realise it the better.
Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.