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Appointment of doctors for rural healthcare

The present idea of the Health Ministry of Government of India to extend MBBS course by one more year and post them in rural health centres for one year is hare-brained and least to say is stupid and absurd, for the following reasons.

Dr K Kishore Kumar

After completion of medical studies, no one is competent enough to practise without the help and supervision of senior doctors. At that junior most level, they do depend on a great deal of laboratory and medical imaging services to make proper diagnosis and treatment. These facilities are grossly inadequate at the rural level.

All that the government is achieving is to sacrifice the poor and ignorant villagers as “guinea pigs” for future medical practitioners and possibly as a population control measure.

Furthermore, the young doctors are looking for more experience before they start on their own practise. It is the time for them to get married and enjoy life after five and half years of gruel and hard work and study to pass MBBS. It will be a sadistic policy of the health ministry to impose this punitive posting for these young budding doctors to be imposed on the ignorant and poor rural flocks.

Will all the elected members of the government at all levels, high court and above judiciary and all first class civil servants at all levels will be submitting themselves and their family for their medical care to these junior doctors and only junior doctors for their medical needs?

An alternative, viable, useful, more humanitarian, compassionate and effectual alternative would be to appoint all those doctors, nurses and paramedical staff in service who have attained the age of 50+ years to be posted in rural areas and allow them to be in service up to the age of 75 years.

In today’s lifespan, it is possible for one to work up to the age of 75 and almost all doctors do work to that age anyway. Give them 50 per cent additional salary for rural postings.

The rural people will have confidence in such experienced medical persons and in all likelihood, a doctor continuously working in the same rural area will know the person’s health need and will be in a position to give the best medical care.

It is imperative that these doctors should not be transferred and should remain in the same area for the duration of their service. The cost will also be much less than a young and fresh doctor’s treatment.

4 Comments

  1. Krishna Shastry Krishna Shastry Saturday, February 25, 2012

    The article indeed has some thought provoking points, thanks to Dr. Kishore Kumar. However I feel the article could have been more valuable if multiple dimensions of this issue were considered in depth and more comprehensive (as well as realistic) solution was provided.

    Same is the case with Health Ministry’s idea too, if they think such mandatory posting of young doctors will drastically improve healthcare in rural areas, then they are wrong, I feel.

    At a high level, I would like to suggest following:

    1) Make rural posting more attractive instead of enforcing mandatory service. While trying to make rural posting attractive, consider all kinds of healthcare professionals i.e.
    a) All age groups i.e. young/fresh graduates as well as matured/senior professionals
    b) All classes i.e. doctors, nurses, paramedical staff, lab technicians, pharmacists and also other supporting professionals
    A good mixture of various kinds of healthcare professionals is the key towards effective healthcare.

    2) How to make rural posting attractive? Different people would look for different things, and the key is to “provide what they want”. Some generic examples are:
    a) Fresh graduates might get attracted if they get preference in getting postgraduate seats
    b) Senior professionals might get attracted if they are assured of relatively more relaxed life, good quality residence and other facilities, permission for extended leaves to go back to cities for their own healthcare
    c) Some young staff (especially non-doctors) might get attracted if Indian government makes alliances with foreign governments in developed countries and post these staff in such countries for few years in exchange of excellent service in rural areas for few years OR a 6 month divided posting in Indian rural places and high earning foreign places

    3) Another point on making rural posting more attractive. Even among rural places, there should be grades depending on infrastructure, connectivity and other parameters that might be agreed upon as important. This can be analyzed scientifically for different states, districts in India. The worse the place is, government should try to compensate professionals more through other offerings – a ONE solution for entire India won’t work.

    Disclaimer: I am not a doctor myself, but I have seen, heard and experienced several dimensions of healthcare throughout my life since I am connected to healthcare providing system in many ways.

  2. Laxmi Laxmi Saturday, February 25, 2012

    Dr Kishore has a raised a very valid debatable arguments. However, 50% enhancement of salary does not make any sense. Because cost of living is relatively less when compared to the urban area. Secondly, service period upto 75 years is bit too much. One need to introduce evaluation procedure for the doctors of more than 65y like that is done in Western country. They may be called as an advisor rather than practitioner.

  3. Dr Yuvaraj Dr Yuvaraj Friday, February 24, 2012

    Dear Dr. Kishore kumar
    I would hearty congratulate your unique Idea which is into discussion at the national level.
    Implementation and execution as per your suggestions has to to be streamlined with some standard clauses. How many retired medical doctors are willing to practice in rural areas? How many are physically and mentally fit for this operation? I am sorry to put this point into discussion board but it is must that how many doctors are ready to learn software skills and update the patient data or e-medical record? I have practically involved in PHC as a doctor, health care provider on PPP basis and have experienced difficulties to manage the senior doctors incontext to their routine practice stan
    Standards. But I will highly appreciate the motivation skills among general public.
    I would disagree on rural postings for an year for fresh graduates. At present, 3 month rural postings is must under compusary rotatory internship but overall achievements are minimal. I am sorry to write this because I have seen interns visit once wa month to there posted place and sigh for the whole month in some medical institutions. Any human resource should be accountable with quality management and adequate resource to expect probable benefits.
    Indians health care system can reach to every individual if all the senior health care providers form a group to achieve the targets as stated.

  4. A Fresh graduate A Fresh graduate Thursday, February 23, 2012

    Sir,
    Thank you for the post and bringing this topic up for discussion on a national level. The post is to be appreciated for the fact that it is devoid of the general mentality of the medical fraternity of handing over all responsibilities involving heavy and uninteresting work to the junior most among the workforce available.
    I would like to make a few points in regard to the post.
    I feel that the recommendation of posting fresh graduates in rural area is one of the most apt and feasible options to improve healthcare among the masses. It is in itself a far more sensible idea than implementing a BRMS course with a second cadre of half baked doctors and a backdoor entry into this competitive profession.
    Posting of junior doctors is, in my opinion, be the need of the day in these areas. I myself have worked in a rural area and did not feel any less capable of handling the cases presented. Although it can be safely assumed that the fresh grad will in no way be equal to an experienced doctor in handling the cases. But the majority, more than 90%, of cases presenting to a PHC will be minor infections and chronic diseases. the acute/long term management of these is included in the curriculum of medical education with strong emphasis on its importance. An inability to handle these will reflect on the state of the medical education in the country, and being a graduate of a Government owned college, I strongly believe that the training for this has been adequately provided. To not trust the quality of the fresh grad would infact be a strong reason to question the fundamentals of medical education in the country.
    Regarding your comment on the young doctors being allowed to get experience and enjoy life, is to be appreciated as again, you are among the few who consider the humanitarian cost to the health care provider, a thing often ignored by policy makers and very often gained secondarily by means of strikes and protests. From a limited window of view on the situation fresh grads face, I would like to disagree with you. The main aim for a graduate in our country is post graduation. This stems from various pressures, including social, egotistical, and economical. But as a professional, being allowed to enjoy life cannot be considered as a fair enough reason to put the health status of a country at stake.
    The question then remains what would be an adequate solution. The most straightforward solution that could change the current scenario is infact to make rural service attractive and viable to the doctor. A forced/bonded service is worded and the current suggestion in particular is suggestive of the putting into place a contract which says the graduate should work in an area decided by the government at a stipend fixed by them. This entitles the govt to make sure the Doctor will not be entitled for the benefits of a Salary(as opposed to stipend/honorarium) as enjoyed by other government servants. The doctor deserves be paid a fair salary equivalent to the salary an entry level doctor with the same qualification would get if he/she enters the Health service through the proper channel and not bonded service.
    The second and most important fact to make sure the doctor enters and completes the one year of service should be that he/she should be given preference in the postgraduate entrance exam. A graded system which increases weightage with number of years served(with a ceiling in place) would be an ultimate attraction to the young doctor.
    If these are implemented, one can expect the doctor to serve not one but multiple years before going for his/her post graduation/ working in urban areas.
    Thank you for taking the time to read through the whole comment.

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