Poor remuneration haunting health sector in India

Importance of a decent remuneration in any job cannot be undermined. Though the nature of the medical profession is such that concerns of remuneration take a backseat in general, yet there is a vast difference of pay scales existing in the public and private sector for the same posts, preventing the youth from joining public sector health institutions.

Similar notions have been voiced by the recent Parliamentary committee on health, which noted with serious concern that medicine is no longer a priority for the brightest among the youth. This issue has also become glaringly visible with the increase in the disinterest of the country’s brightest to opt for teaching jobs in the public sector health institutions. The commitee pointed out that pay structure for the medical profession should be designed specifically to make the remuneration commensurate to the commitement, skills and accountability

Why is this happening?

Medical Profession at one point was the most coveted one in India. However, with the passage of time lesser and lesser of the brighter youth is showing interest in Medicine today. An expert deposing before the committee clearly pointed out

“……the medical profession should be made more attractive.  In 2011 or 2012, there used to appear three lakh candidates in the Rajasthan, for the PMT examination. In the very next year, less than 50,000 students appeared.  Nobody wants to join medicine stream today….”

The primary reasons as pointed out by the committee for this can be into the following

Long Duration of Study to Livelihood Period

“.. an MBBS and an MD or a DM requires 12 years of study. By then, he ( a doctor) will be around 30 or 31 years old. He is already married with children, while he is doing his DM.  And, on the other side, an engineering or a business school guy has four years plus two years. At twenty-five, he is good. He is an earning member of the family.”

Vastness of the study of medicine

“The medical courses are voluminous because the doctors can get patient with any type of medical problem, and the teachers have the habit of asking most difficult things. So, students keep reading…..But if you compare medicine with other branches, the courses are very limited in other branches.  Medicine is unlimited.”

Lack of Commensurate pay in relation to other sectors

“When the student passes out, after his super-specialization, he gets Rs. 70,000 to Rs. 1,00,000, while the other guy (other fields) gets close to five lakh rupees, three lakh rupees immediately. As far as working hours are concerned, doctors have to be there all the time. The others have flexi hours. You can work from home. All the time, there are chances of litigations on doctors. There is nobody to save them. The profession is under deep trouble because of this.

And then there is public distrust

“Doctors are beaten up. So, the students are not trying to become doctors today.”

Not only this, there is an even sharper downfall in the young doctors joining the public sector. An  governement expert appearing before the parliamentary panel summarised the problem beautifully by giving his own example

“Today, Government colleges do not have teachers. Everyone is in private. My student who passes out gets four times more pay after my thirty-five years of work—four times more pay on the day he passes.  So, why should he continue in Government service? So, what we want, in Government service, give him increments as it is.  Second, anybody who is doing clinical, teaching and research—there are three heads—pay him three times. Believe me, this is the biggest fear that I have.  Tomorrow, five years down the line, there will be no good teachers in the medical colleges. You will have colleges. But the new AIIMS would not have teachers. To keep teachers there, you must pay them their worth”.

Solution- Nowhere in sight

Although these issues have been visible to the medical sector as well as the authorities for a long time, not much has been done about it. Already the country is dedicating a decresingly meagre share of the GDP to the health sector, showing it’s lack of committment to the growth of the health sector in the country. No special position has been awarded to the remuneration in health sector that still runs on UGC payscales

An IMA representative pointed out

“We make a big hue and cry that people are not opting for teaching posts.But, there are various considerations where there is no regulatory mechanism.  Even today, when we are talking of payment of scales and service conditions, it is the UGC scales that become accruable and there is nothing with the MCI or any mechanism associated with the medical education for the purposes of regulating the service conditions of medical teachers, accruable pay-scales of medical teachers and all other incentives and benefits which, of course, would be adding as a big incentive for people to take up the assignment as full-time faculty in medical education”.

MCI, in the year 2011 set up a committee under the chairmanship of Narayan Murthy on the agenda of remuneration packages in health. The commitee clearly summarised one point “PAY THE DOCTOR HIS WORTH”

“What are three main things? Medical profession needs higher commitment, skills, accountability than any other stream. So, the pay should be as per the number of years of training. Suppose the engineer or an MBA is trained for six years. When he starts his service, he gets amount equal to six years of training. The medical student, if has read for nine years for his M.S., give him three additional increments in UPSC, when he joins.  If he has become a super-specialist by putting six extra years, give him six increments at the time he joins. This was a clear recommendation, and I think, if you implement it, this will make a huge change in our profession.”

Sadly, the report was never picked up and is currently gathering dust at the office of the health ministry.

Even the current parliamentary committee in health has recently stressed upon the adequate remuneration packages for government doctors and teachers if the medical sector has to sustain itself

“that the whole medical education system will collapse if there are not good teachers for our medical colleges. Let us also not forget that today’s medical student is tomorrow’s physician and no society can afford to leave healthcare in the hands of mediocre doctors.All these facts warrant that measures to attract good talent towards medical profession and retain them, by way of offering attractive remuneration packages are required to be immediately initiated. The Committee fully endorses the view that medical profession demands much higher commitment, knowledge, skills, competence and accountability and doctors have to work under very trying conditions. It is, therefore, imperative that the pay structure of doctors and faculty should be so designed as to provide compensation to medical fraternity commensurate to their years of training and research.”