Member

This is in support of the token strike by medical students in Tamil Nadu [News reports here & here].

As usual the print media devoted a few column inches to the strike and promptly forgot about the issue after the processions and strike were over. I do not know if the TV news shows provided any ‘in depth’ coverage.

The students are protesting the Union Minister for Health and Family Welfare, Dr Anbumani Ramadoss’s proposed Parliamentary Bill to introduce mandatory one year rural postings for all medical students. The rural medical service forces students to work in a rural Primary Health Centre (PHC), a Block or District level hospital for a period of one year after the completion of Compulsory Rotatory Residential Internship (CRRI), before they get their basic medical (MBBS) degree. This effectively increases the duration of the MBBS course from five-and-a-half years to six-and-a-half years.

The Health Minister has been publicly declaring his intent to introduce mandatory rural postings as a part of the MBBS curriculum for some months now. There was a sort of agitation by medical students some weeks ago. At that time the students withdrew their protest following an assurance from the Minister that the issue would be solved amicably. Some political parties, which are part of the ruling coalition (both in the state and the central government) and the Tamil Nadu Chief Minister extended their support to the students when they organised rallies to protest the scheme.

Following this it was reported that the Union Health Ministry constituted a committee headed by Dr. Sambasiva Rao to look into the Government’s decision on making rural medical service mandatory for medical students.

Responding to questions from mediapersons, Dr. Anbumani said a committee under the chairmanship of Dr. Sambasiva Rao had been constituted to inquire into the students’ protests against the proposal to make a year’s service mandatory in a PHC. This committee would tour 20 cities. Grievances should be conveyed to the committee. Over 28,000 doctors’ positions exist in over 23,000 PHCs. However, only 16,000 to 17,000 doctors were actually serving in rural areas, he said…..[source]

Even before the Committee could meet the representatives of those who were likely to be affected by this proposal and submit its report, Dr. Anbumani had announced that his ministry would introduce the Bill in the Parliament during the ongoing winter session. The students are right in claiming that…

The Minister’s announcement has defeated the very purpose of the formation of the committee and hence we’ve come to the conclusion that the constitution of Sambasiva Rao Committee is a mere eyewash. [source]

There is a justified fear amongst students that this will affect their careers adversely. For one thing, it will put off by a further year their plans to choose, apply for and write the entrance exams for entry into post-graduate specializations.

There is no question that this is a valid argument. As it is medical students face an immense uphill climb. Just completing a rigorous undergraduate course is not enough to guarantee them success. The basic pay scale of an MBBS graduate has remained woefully low in spite of the booming economy and the growth in the basic pay in other sectors, most notably the IT industry. The average MBBS graduate earns less than an arts college graduate who is employed in a BPO or call centre.

The only way to progress in a medical career is through postgraduate specialisation. Given the level of competition for the available postgraduate residency programs, the average MBBS student has to take time off to prepare for the entrance exams. It is quite common to find groups of young newly graduated doctors sitting in libraries in places like Dr. MGR University in Chennai and attending special coaching classes in places like Kottayam to prepare for the various entrance exams. There is also a group who eschew the entire Indian scene and sit preparing for the PLAB and USMLE with the hope of getting a job in the UK or the USA respectively. These are doctors who ideally should be working as Junior Medical Officers in hospitals learning and gaining experience.

According to the press reports the striking students claim that compulsory rural postings would deny permanent employment to the doctors in rural areas since students would be posted there on temporary basis on a consolidated pay. They say their agitation is not against rural services, but against mandatory rural service and temporary postings in PHCs, taluk and district hospitals. The students want to know why they could not be given permanent postings in the rural health services. They also want to know whether compulsory rural service was applicable only to students from Government Medical Colleges.

There are many facets to this argument, not all of them valid.

Is there a shortage of doctors in rural hospitals and PHCs?

Yes, most definitely. If the Health Minister wants to fill in the vacancies in the rural areas or in other government-sector hospitals, he has to make the jobs attractive by increasing the pay, providing better infrastructure and granting some proper means of career advancement or specialisation. And he has to do something about getting back the thousands of government service doctors who are ‘absconding.’

Mandatory temporary rural postings for students is not the answer. The Indian army, according to some news reports that I read a while ago, faces shortages of personnel in many areas. So is the Defence Ministry going to introduce mandatory military service or is it planning to conscript people?

The students are being politically correct and media savvy when they say they are not against rural service. The vast majority of medical students want to obtain a postgraduate degree as early as possible. Going into rural service is not going to help them do that. Some states, like Tamil Nadu, provide a ‘government service’ quota for postgraduate programs. Doctors who have been in government service for more than two years are eligible for the quota in Tamil Nadu. They still have to appear in competitive exams and score high marks to get into postgraduate residencies of their choice. If this was not difficult enough, the issue is further complicated by caste-based reservation. That is an entirely different can of worms that I do not want to open now.

Why are the students demanding ‘permanent’ postings in rural areas? The government service quota for postgraduate programs is one reason. The other is the option to have one’s own private practice. Anyone who knows about the government-run rural hospitals in Tamil Nadu will understand. The Tamil Nadu government does not prohibit private practice by doctors employed in the government sector. The prospect of a cushy ‘permanent’ government job with the option to practice privately and augment one’s income and the additional advantage of a quota for postgraduate specialisation would be very attractive. The current proposal for temporary rural postings denies these benefits to the students.

Another valid question is the one about whether this ‘mandatory rural posting’ will be applicable only for students from government-run medical colleges. If that is so, it is discriminatory and the students are likely to sue the government. If it applies to students from privately-run medical colleges, it is doubly unfair. These are students who pay unbelievably high fees and ‘donations’ compared to those in government colleges. They are also very likely to sue. Interesting times are ahead for the Health Ministry and its Minister.

The very fact that the government says ‘mandatory’ is going to raise the hackles of free-thinking people.

Why pick on medical students alone?

Why not introduce mandatory government service for IIT & IIM graduates since there is already a debate on their supposedly subsidised fee structure?

I expected an editorial from The Hindu on this issue. But there is not a word in the Op-Ed pages. It seems like the media is not going to bother about what happens to a few thousand medical students in the country.

If the media’s role has been less than salutary, more condemnable has been the silence from the various professional medical associations and the Medical Council of India. Would the current office bearers of the associations and the MCI have accepted mandatory rural postings in their time as students? Are they turning a blind eye because they are not directly affected?

The question should be directed to the Health Minister too who is a medical doctor who graduated from Tamil Nadu. Would he have agreed to work for a year in a village before getting his MBBS degree?
There is already a noticeable shift away from medicine as a career choice among students because of the fast-paced growth of the IT industry. Senseless legislation of this kind is going to push more students away from medicine. If the Health Minister thinks the country faces a shortage of doctors now, he should think about what it will be like ten or fifteen years from now after he has forced more students to turn to fields other than medicine.

Health care in India is a mess. What we do not need right now is someone raking up the muck trying to earn political brownie points.

Note: I would be very thankful if Indian bloggers with a wider readership blogged about this or linked here. People at Desipundit & Blogbharti, please note.

Newsflash: From the online edition of The Times of India at 14:45 hrs IST today….

Rural postings bill not in coming Parliament session: Ramadoss

CHENNAI: The proposed bill to make rural postings compulsory for MBBS students will not be tabled in the ongoing Parliament session, Union Minister for Health and Family Welfare, Dr Anbumani Ramadoss said here on Saturday.

Speaking to reporters on the sidelines of a convocation programme, he said that the Dr Sambasiva Rao Committee, set up to take the opinions of stakeholders in this issue, was yet to submit its report. “The Committee will tour 20 small and big cities and towns in the country and present their report,” he said. He also condemned the agitation by medicos in Tamil Nadu against making rural postings compulsory. “Some individuals are instigating them (he did not name them). If the students continue with the protests, only they will be affected,” he said

Students in the state have been opposing the proposal since October, alleging that it would risk their career prospects.

Ramadoss pointed out that it was not his recommendation to make the rural stint compulsory, but the idea of experts in the National Rural Health Mission (NHRM). In fact, a high-level delegation of Health Ministers from all states also recently resolved to implement the scheme in their states, he said.

“Only Tamil Nadu is witnessing protests by medicos,” he said Medicos had staged a protest all over Tamil Nadu on Nov 15, boycotting classes and taking out a rally in Chennai. Representatives of medical students’ associations will meet in Chennai on Monday to discuss the future course of action.