The proposal of Medical Council of India (MCI) to amend the Post Graduate Medical Education Regulations 2000 to make one year rural posting at a PHC (Primary Health Centre) mandatory for a MBBS student to apply for admission in a PG medical course has been approved by the health ministry and is proposed to be implemented from the academic year 2015-16. This was stated in Rajya Sabha by Hon Shri Ghulam Nabi Azad on 17-12-2013.
It has been stated that it is the ethical obligation of doctors, on whom Government spends a lot of money to train and the poor contribute to this training by allowing medical students to test their skills, to serve in rural areas. I am a practicing physician endoscopist in Chandigarh for the past 22 years but out of choice had spent one year immediately post MBBS as a medical officer in a rural hospital near Ludhiana. I am also father of two children already doing MBBS. Allow me to give the other perspective to these arguments regarding ‘ethical obligation’.
First, I would dispute that money spent on healthcare is a favour on the medical student. It is a basic function of the government and providing healthcare to the masses includes training manpower to provide the same. An argument can however be made that those who take advantage of reservation for medical education be made to serve for a certain period in area of need. This model has worked well in institutions like CMC Ludhiana and Vellore. But those who get MBBS seats on their merit should be free to choose their path as regards their post graduate training.
Secondly, Govt spends a lot to give subsidy for diesel, power, food etc. Does this mean that all taxi drivers or those using diesel generators who avail the Govt fuel subsidy have to “pay their debt to society” by providing free service to poor.
We already know from reply given under the RTI Act that all over the country as of March 2012 there are a total 31,867 posts for MBBS doctors in PHCs, and there is a shortfall only of 2,489 doctors in PHCs. I fail to understand how 95,000 doctors who applied this year for PG admissions can be given Government jobs in PHCs in rural areas immediately after internship and be relieved with certificate of rural service given to them on their last working day. We all know how the system works. Corruption will be institutionalized at the cost of medical graduates.
Private colleges charge an arm and a leg for medical education. How then is it justified in the name of social responsibility that an MBBS graduate from a private medical college not availing any government subsidy be forced to do rural service, probably free of cost and then pay the local Tehsildar/Patwari for a certificate of completion of rural service.
The Punjab & Haryana High Court has already refused benefit of quota in PG admissions to 1100 doctors who did more than five-year rural service stating that it was only for doctors in regular government civil medical services.
I, however, agree that we need doctors in rural areas. The untrained, unsupervised fresh MBBS pass outs being unloaded on rural population, who become guinea pigs, is a recipe for disaster. At this phase of their career they require supervised training and nurturing in clinical skills before they can become capable of handling patients independently. The fresh MBBS pass outs are not equipped with required skills to treat patients in rural settings. They require to undergo supervised training in teaching institutes before they can become competent clinicians.
How can doctors then be made available for rural healthcare?
1) All beneficiaries of reservation in any form taking admission in MBBS in Government Medical Colleges should have a two-year bond to serve in rural area after MBBS and five-year after PG.
2) Parent’s rural service should give a one-time benefit to their children for PG admission.
3) Salary package of Rs 12 lakh per annum for fresh MBBS graduates to work in areas of need.
4) IT (Income Tax) exemption to MBBS doctors who work in identified areas of need whether in Govt or Private sector.