The medical conundrum

The pulse of the country is feeling weak today. Thousands of undergraduate, postgraduate and senior doctors of the country are aggrieved with the health ministry’s recent decision to make one-year rural posting mandatory for medical graduates.

The move, they say, will not help 

much in achieving the aim of providing good healthcare facilities to people in the rural areas. “There are not enough facilities in the villages for providing quality healthcare to the people. These include proper infrastructure, equipment, laboratories, regular power supply, medicines, security, good living conditions and support paramedical staff for the doctors. The posting should not be mandatory, but voluntary and students should be given points or credits for this so that they can easily get a seat at the postgraduate level,” says Dr Narendra Saini, secretary general, Indian Medical Association, representing the Save the Doctor campaign.

Doctors are also wondering how this move will be implemented. “There are about 23,887 primary health centres functioning in the country as on March, 2011, out of which there are just 2,866 vacant seats as per the right to information. How can this be implemented with more medical students at the undergraduate level,” asks Dr Saini.

Another related issue is a huge gap between the number of undergraduate and postgraduate seats for medical students in the country. “Pursuing postgraduation in any stream of medicine is essential for a doctor to become a specialist. Today, India lacks specialist doctors due to fewer number of clinical PG seats in medical institutions. Nine out of the top 10 diseases in the world can’t be treated without specialist doctors. The doctor-patient ratio in our country is 1:2000 which is 40% less than the world average. Though India has the largest number of medical institutions, the disparity in the number of seats allotted for PG and UG students along with the mandatory rural posting will affect young doctors and they will end up spending 13 years just studying,” says Dr Navneet Motreja, coordinator of Save the Doctor campaign, that started under the aegis of IMA and Association of Healthcare Providers India.

“We have just 12,000 PG seats. There are about 45,000 UG seats and the number of students taking the PG entrance tests keeps on increasing every year. In comparison, in the US, there are 19,000 UG seats and 32,000 PG and fellowship seats. With a pass rate of 80% to 90%, nearly 40,000 doctors graduate every year and compete for 12,000 seats with their batch mates and over one lakh seniors. In the last PG entrance exam under NEET, over 110,000 doctors appeared for the test to claim one of the 12,000 seats,” says Dr Manosij Maity, national joint secretary, Indian Medical Students’ Association (IMSA).

Suggesting a few alternatives, Dr Saini says, “Every PG student must do six months of rural posting as part of their course during internship and PG. Every medical officer during their tenure is entitled for at least four to five promotions. For every promotion, one year rural posting can be made mandatory. Also, simultaneously, opening more medical colleges in rural areas, upgrading district hospitals into medical colleges, giving incentives along with housing facilities, security and improving infrastructure in the rural areas will be other additional factors which will attract medical graduates to join rural services. As there are fewer PG seats, it should also be increased in a paced manner to provide affordability and quality healthcare for all including rural population.”

Medical students feel that the mismatch in the number of UG and PG seats is one of the major reasons of brain drain. “If we won’t get an opportunity to pursue postgraduate studies here, we will have to go abroad. There are so many students from rural areas who come to cities to study for their MBBS. They would want to go back to the villages and serve the people,” says Dr Nitya Nagesh of Save the Doctor campaign.