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Bonded Labour (MBBS)

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.

Dr Neeraj Nagpal

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.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh
9316517176

54 Comments

  1. Dr Anutosh Chakraborty Dr Anutosh Chakraborty Monday, June 29, 2015

    What is the pay package for 6 years experienced BHMS ? who had done honorary house staffship in Gynae , Obstetrics and Child health from Allopathic Institution of Govt of West Bengal.

  2. Dr Anshum Dr Anshum Monday, May 11, 2015

    Dear Sir,
    Regarding your comment about secure life of Armed Forces doctors, I would like to mention that we serve in rural areas ridden with militancy. Everyday for the next 2-4 yrs of our rural/field posting is a challenge. Shortage of basic medicines, inadequate manpower, answers to the higher echelon regarding each and every patient, and god forbid if u were unable to evacuate a serving soldier due to heavy snowfall or unavailability of helicopter then you as a doctor will be had by everyone. No one will hold your hand. Regarding equality and no under the table dealings, well I did suggest please enrol yourself for 5 years as an SSC. Things would be crystal clear

  3. DeadDoc DeadDoc Friday, April 3, 2015

    @An helpless senior resident

    We live in India. Your rights are directly proportional to your lack of education or lack of money and proportional to your political value. Its a sick communist system that sucks the life out of anyone trying to earn an honest living. Its just legalized exploitation in the name of socialism. It never applies to the so called leaders and civil servants. It only applies to us. It would be better if your interns finished their posting alive and then get the hell out of here to a country where human rights of doctors isn’t merely a piece of dusty paper that no one gives a shit about.

  4. An helpless senior resident An helpless senior resident Thursday, April 2, 2015

    I would like you sir to point out the despair and tortorous routine of work schedule that our young doctors undergo in some famous institutions like Christian medical college, vellore…Y cant rules of the factories act be brought fr our poor interns, pgs, senior residents, non- pg residents and fellows who have to do work fr more than 16 hrs daily for 6days a week in the hospital??? Lets stop the blame game on the govt n other take other excuses..wen will these people be freed from physical, mental and financial torture??

    Dr.Anonymous
    Cmc vellore

  5. swathi swathi Tuesday, February 11, 2014

    What is this 12 lacs thing?

  6. Dr Neeraj Nagpal Dr Neeraj Nagpal Tuesday, December 31, 2013

    There is no denying that rural India needs doctors. However other countries when solicit doctors to work in area of need give them incentives and not force to do free bonded labor.
    How then should doctors be made available
    1) Increase spending on healthcare to incease number of job vacancies for MBBS in primary health centres from current 2700 to 90000 plus that are needed.
    2) Give substantial hardship allowance to doctors for working in area of need
    3) Give benefit of rural service in Post graduate enterance examinations irrespective of whether rural service has been in Government job or in a non governmental / public sector / charitable institution located in area of need. To be noted is Case of Dr Kamini Singla vs State of punjab 2013 where rural medical officers appointed under Zila Parishad were denied benefit of rural service in PG admission.
    4) Those who take advantage of any kind of reservation or financial help during MBBS should have a bond to serve in area of need (but again paid not free)
    5) Improve infrastructure, provide support staff.
    6) Have stringent laws with visible implementation of Prevention of Violence against medical personnel / institutions

  7. Dr Neeraj Nagpal Dr Neeraj Nagpal Tuesday, December 31, 2013

    The argument given by the Government for compulsory rural service is that it unds a doctors education. This is not true even in Government institutions what to talk of private institutes. Even in Govt Institutes it is not as if the faculty is employed and utilized only for teaching purposes. Training of manpower is an integral part of the function of providing healthcare to the masses which is Government’s responsibility and duty.

  8. Dr. Sagar Walvekar Dr. Sagar Walvekar Tuesday, December 31, 2013

    To,
    Dr. Nagpal,

    sir, you mentioned that if rural service is made mandetory, then those student who have completed their MBBS from private colleges need to exempted from this service.
    Though students from private colleges have paid money for their UG completion, it doesn’t mean that they should be exempted for this rule because almost all private colleges have taken land on lease or in low prize from govt, they get consesion in bills like electricity, water etc, also on purchase of costly machinery like CT, MRI & many more because they are also serving our society.( because most of them owened by Miinisters, MLAs etc) Because all of this their are some rule & rugulation for charging fees wich was other wise not as low as today. Fees are high only because these colleges take all advantages from govt but dont follow the rules for fees & take donation too. That why they must serve the society too.We all know very well that how they are serving poor people in private hospitals. How about rural service ?

  9. B.Ravi Kumar B.Ravi Kumar Monday, December 30, 2013

    They will only look at the political angle.

  10. dr.pk dr.pk Sunday, December 29, 2013

    Dr M.C GUPTA
    REALLY GUD REPLY 🙂

  11. Dr.S.Balaji Dr.S.Balaji Friday, December 27, 2013

    I completely agree with you sir . please point out on the IIT / regional engineering college graduates they have no ethics no obligation towards the society as most of them go to the US (brain drain). Why we doctors ? regarding the pay of 12 lacs ? sorry sir even in private sector the pay for a post MD is only 75000 to 1 lac.

  12. Dr.SushamaAnil Dr.SushamaAnil Thursday, December 26, 2013

    what is the point in having only doctors for health service in the rural area?
    what about other paramedics and infrastructure?
    will the doctor be held responsible by consumer protection act if something goes wrong due to the non availability of facilities in the rural areas?

  13. Dr salil Saha Dr salil Saha Thursday, December 26, 2013

    Dear Dr MM Khan and Dear Indian Resident Doctor
    Please don’t pick up fight at this junction. Try to understand the frustration and pathetic situation this profession is going through. Let us find out the best of solution rather than hurting the sentiments of each other. We are here for a cause. We are bestowed up on with a special privilege of giving smiles to the millions of suffering mass by handling their health with caring hands. It is the Political class who purposefully, by giving least attention and negative importance making this mess for the people in general and doctors in partcular. We need to give adequate importance to this profession in all respect— let it be optimum -infrastructural facility or , medico-legal safety ( say free from CPA, adequate security and stronger criminal law for violence against medical professional and institutions), financial sovereignty ( enough pay for our work minus corruption– Taking kick back is a corruption ) or recreation and satisfaction of life or any other thing. But dear friend who will do it ?– We have to do it. Come and join politics– for Swaraj of this profession. I have a model for this. We have answer for every situation . Till we can do this there is no use of fighting ourselves. Using foul language will heart only to our cause.
    Thank you .
    Regards
    Dr salil

  14. Dr salil Saha Dr salil Saha Thursday, December 26, 2013

    Think once more Why we are not keen to move to rural areas and there is the solution.
    1 Create a tough competition among graduates and post graduates to compete for a rural post How? 1– Financial model——- Why 12 lac ? Why not 20 Lac ?. Good Houses and Very good schools.s for children ( all infrastructure need to be developed ( it is possible by fast tracking rural growth ) High tax benefit etc.. should be the additional benefits besides attractive fellowships, Holidays, Incentives in higher education for children , after all they are going to stay with parents and sacrificing certain benefits of life.
    Simultaneously reduce the benefits of staying at Cities. Stop Private Practice for Govt. doctors ( Let them spend some time in quality politics. Start giving a competition to the pretty – Gonda Raj of present politics. It is not the congress alone, all the parties are alike)
    For City docs— Increase tax liabilities. Make PG and Fellowship program getting more difficult. Make charges for a surgical/medical procedure cheaper in the cities for doctor to charge. And they can charge higher in the rural settings if they desire ( By allowing subsidy from the Gram Sabha )
    Stop politician and Business class who are the main cause for this massacre from entering our domain—- only possible by taking over medical Governance.. Keeping the charges fixed for services other than professional charges by doctors. Presently 90 % of all charges taken from a patients are for other than actual professional charges ( Check some of the bills of major corporates)
    So —– take over the Governance on our own hand with a political revolt

    Blood is boiling. Don’t miss out the chance. Doctor should start placing their stake in health Governance. OK ?
    Dr Salil

  15. Dr Neeraj Nagpal Dr Neeraj Nagpal Thursday, December 26, 2013

    Dr Salil you have said what is absolute truth. The intent is to keep the intelligentia busy safeguarding their daal roti so that they do not have time or inclination to question the loot being done in name of political leadership. Someday your words will come true, I hope within our lifetimes.

  16. Dr salil Saha Dr salil Saha Thursday, December 26, 2013

    Hii Every Body
    I think the time is just ripe to go for all out ACTION. The thinking process of the political class has gone mad and not by chance rather by choice. This is the time to take over control of governing health policies by qualified doctors. We must develope Health Sabha Like Gaon Sabha Model of true Swaraj. It is Only possible by coming in to true politics. We have to step in to gutter to clean the gutter itself. We should stop giving the political class a free ride any more.

    We need to stop Brain Drain, politician class will never want stop it . the lesser the good brains around the better for them to manipulate votes .and the control of the wealth of the country . It will be foolery to think that they don’t understand the implications of making the life of doctors or any other high skill professionals difficult .The net benefit is that their life become easier. They do it intentionally. They have already looted and sold out the assets of this country. Sacrificing few professional hardly a matter of worry for them We need to develop an intense interest among our professional to join active politics and make it clean from inside. Sacrifice of Arvind kejriwal should inspire us. This is the right time to strike. Think about it.
    We should not miss out this opportunity
    Dr Salil

  17. Dr. Gian Chand Rana Dr. Gian Chand Rana Thursday, December 26, 2013

    Very well done. Lage raho.

  18. M C Gupta M C Gupta Thursday, December 26, 2013

    डा० खान साहिब,

    आपने हिंदी को इज़्ज़त बख़्शी, बहुत शुक्रिया. अब ज़रा असलियत को भी बख़्शिए:
    ****०
    इस देश की आबादी का 80% हिस्सा गाँव में रहता है.
    >>> सन २०११ में इस देश की आबादी का 31.16% हिस्सा गाँव में रहता था.
    http://www.indianexpress.com/news/urban-population-in-india-jumps-to-31-/991619/

    **

    उनपर प्रयोग करके सीख तो सकते हो मगर उनके लिए कुछ कर नहीं सकते हैं.
    >>> डाक्टर मरीज़ों पर प्रयोग करके नहीं सीखते. वे डाक्टरी मेडिकल कालिज में सीखते हैं. जो सीखते हैं उसके लिए फ़ीस देते हैं और साथ ही मुफ़्त सेवा भी करते हैं. मरीज़ों पर प्रयोग करना कानूनन अपराध है. यदि आपको ऐस अपराध होने की जानकारी है तो अपराध की सूचना पुलिस को और सरकारी अधिकारियों को दीजिए. झूठे इलज़ाम जन-संचार के माध्यमों के ज़रिये ग़ैर-ज़िम्मेदाराना ढँग से मत लगाइए.
    **
    अनाज गाँव का पैदा किया हुआ खाओगे मगर अपमे हिस्से के कुछ साल गाँव को नहीं दे सकते हैं. कितने शर्म की बात है.
    >>> डाक्टर अनाज खरीद कर खाते हैं, मुफ़्त में नहीं. वे गाँवों में काम करेंगे तो काम की तनख़्वाह पाने के भी हकदार होंगे. तनख़्वाह मिले तो कुछ साल नहीं, पूरी ज़िंदगी गाँव को दे सकते हैं. सच्चाई यह है कि सरकार के पास तनख़्वाह देने के लिए न पैसे हैं न दिल. डाक्टरों से बेगार चाहते हैं जो ग़ैर-क़ानूनी है.

    ***
    सरकार सब्सिडी में पढ़ाती है तो आखिर कुछ तो वापस करोगे सरकार को.
    >>> सरकार सब्सिडी में पढ़ाती है, यही उसकी सबसे बड़ी बेवकूफ़ी है. सरकार सब्सिडी के बदले डाक्टरों से बाँड भरवाती है कि डाक्टर बन के गाँव में नौकरी करेंगे. बाँड के अनुसार कार्य करने का काम सरकार का है. उसके पास देने को नौकरियाँ हैं ही नहीं. बाँड धरे के धरे रह जते हैं.

    **

    भाई डॉक्टर हो तो हिप्पोक्रेटिक ओथ भी ली होगी
    >>> आपको भ्रम है. यह ओथ भारत में कोई डाक्टर नहीं लेता. डाक्टर निम्न कानून से बाध्य होते हैं—
    “The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, commonly referred, in short, as “Code of Ethics Regulations, 2002”, made by the Medical Council of India under section 20A read with section 33(m) of the Indian Medical Council Act, 1956 (102 of 1956), with the previous approval of the Central Government and duly published in Part III, Section 4 of the Gazette of India, dated 6th April,2002).”

    **

    एक डॉक्टर होने ही हैसियत से मै ये मानता हु की…..
    >>> आप डाक्टर हैं तो आपको तथ्यों की जानकारी होनी चाहिए. आपके ग़लत मानने से कुछ फ़र्क़ नहीं पड़ता.
    ***
    अब आपको इतनी इज्ज़त मिली की आपको भगवान् कहा गया, मगर आप इससे भगवान् नहीं हो जायेंगे.
    >>> इस भावनातिरेक को छोड़ कर तथ्यों के धरातल पर आइए. न डाक्टर भगवान हैं, न हो सकते हैं, न कोई यह मानता है.
    **
    आप चाहें तो इस पत्र का उत्तर यहाँ अथवा मुझे व्यक्तिगत रूप से दे सकते हैं—

    —-Dr. M C Gupta (Former Professor and Dean)
    MD (Medicine), LLM
    Advocate (Delhi Bar Council no. 857/2001)
    http://in.groups.yahoo.com/group/medico-legal-queries
    Ph: 9999-333-801
    26 December 2013
    To join the MLQ list, send a mail to–
    medico-legal-queries-subscribe@yahoogroups.co.in

  19. Rishabh Grover Rishabh Grover Thursday, December 26, 2013

    cont…

    I ought to correct myself, this Congress Govt. is not “stupid”, in fact very clever.

    Why did they make rural service mandatory for only for PG ??

    Why not compulsory for all medical graduates!! ?? (So as the to-be Doctors know what they are heading for in future before-hand, and also give govt. the requisite time to develop PHCs by then)

    The answer is very simple, this would ensure that they get doctors to work in PHCs almost immediately, as compared to 5-6 years gestation for the above process (ie. making rural service compulsory to all medical graduates rather than PG takers)

    This Congress led UPA govt does not care a damm for anyone, all this is plain and simple eyewash and vote-bank politics!!!

    …..Just came to my head @ Sir Dr. Nagpal

    this heading would catch more eyeballs..”Indian Govt. giving another incentive to medical graduates!!!…amm to serve American people of-course !!”

  20. Dr Neeraj Nagpal Dr Neeraj Nagpal Thursday, December 26, 2013

    Dear Dr Sunil
    Few years ago in the budget, IT exemption was given to 100 bed hospitals being set up in rural areas. I would love to know how many were set up. This was only intended to attract corporates who are bosum buddies of the powers that be. Giving same income tax exemptions to doctor enterpreneur running a 5 or 10 bed rural hospital is ofcourse against Principles of Governance Congress Style.

  21. Rishabh Grover Rishabh Grover Thursday, December 26, 2013

    Already more than 50% of medical graduates from reputed medical colleges across the country prefer going abroad, particularly to the US. This will only ensure increased brain drain. Those who were ambivalent earlier will now be nudged towards USMLE or other career paths.

    Though this might not be well known, medical graduates from the topmost medical colleges like AIIMS (of which I am a product myself) are are already ditching medical profession altogether, leave PG, for other “easier” and more “lucrative” paths like IAS, MBA, Finance, etc. The number of such 4-5 graduates becomes significant considering the total batch is of 50 students (ie. around 10%). I bet this number will only grow in future, as the discontent increases.

    This stupid Congress govt. with such absurd decisions will only move this country backwards.
    The time has come to seriously think (rather DO) what needs to done.

  22. Reeti Mehra Reeti Mehra Thursday, December 26, 2013

    Dear Dr Neeraj ,
    I am in total agreement with your opinion .
    Those selected on reservation need to give
    back To the govt . The pay incentive of 1 lakh is hardly
    Fat today . Income tax rebate is well justified .
    Reservation for wards of children who serve more
    than 5 years in rural areas can be considered .
    I also wish that all other students …. Law ,
    Engineers , IAS , teachers and all other vocations be also
    Required to serve in villages as only sending doctors to villages with no
    Infrastructure is not going to uplift anything .
    Better roads and housing
    bybthe new engineers , teaching , admin , lawyers
    To manage law and order , judiciary to solve their
    Day to day fights , all is a must . Just sending doctors
    Is never going to uplift the villages . All faculties must join hands
    If they really wish to do something for the villages . If the govt really wants to do something for the villages . Otherwise it will lead to either brain drain or
    A team of unwilling oppressed doctors feeling victimized be sent to villages and serving no purpose . Dr Reeti Mehra

  23. Dr Neeraj Nagpal Dr Neeraj Nagpal Thursday, December 26, 2013

    Going through comments by all it is heartening to see that I am not a lone voice shouting in the wilderness. For the dissenting few; I hope I can can make you realize the folly of supporting this move.

    As already mentioned this will dissuade youngsters from taking medicine as a career. Security of lady doctors is a serious issue. Local goons/politicians demanding medicolegal favours is a reality which will end many young careers. And where is 7200 crores budgeted which will be needed if these young doctors are to be paid even a residents salary plus hardship allownce.

    It is a harebrained scheme with purely political vote catching motive using lives and careers of 45000 young doctors yearly at stake.

    This is a very serious matter and I request everyone to honestly debate without use of any harsh words.

  24. Dr Neeraj Nagpal Dr Neeraj Nagpal Thursday, December 26, 2013

    Dear Dr Kannan
    The Army does not want its young doctors to work for free. It pays them regular salary with benefits and hardship allowances. If Regular Government jobs with hardship allowance is similarly available many young medical graduates will opt for it. Do you realize that for every such post advertised by Govt there is cut throat competition and even reservation for various castes and areas etc. If doctors did not want to do rural service why is there a need to reserve seat for these regular government jobs.
    The Govt does not want to spend money to create jobs in rural areas. It wants to force young doctors to work for free. I am sorry I think this is misuse of power and blatant highhandedness of authorities.

  25. Dr. Sagar Walvekar Dr. Sagar Walvekar Thursday, December 26, 2013

    Thr is no need of saparate clinical training before going to rural posting bcoz same thing they r doing in thr Internship. Wht they need is training fr administrative work at PHC. I hv worked fr 1yr at PHC & wht i feel is ” Plane MBBS is d only candidate who can work effectively at PHC” bcoz thy hv basic knowldge regarding al branches like Obs-gyn, Paeds, Medicine etc & can do simple & basic interventions wich wl save life of many patients. No need of invasive procedurs to b done at PHC level. But thr must b proper safety fr al ths doctors with good infrastructr nt d best. Definately good salary & tax consession must.

  26. Dr. Sagar Walvekar Dr. Sagar Walvekar Thursday, December 26, 2013

    Though students frm pvt coleges hv paid money fr their UG completion, it doesn’t mean that they shld b exempted fr ths rule bcoz all pvt colleges hv taken land on lease or in low prize frm govt, they get consesion in bils lik electricity, water etc, also on purchase of costly machinery like CT, MRI & many more bcoz they r serving our society. Bcoz al of ths thr r some rule & rugulation fr charging fee wich was othr wise nt as low as today. Fees r high bcoz ths colges take al advantage frm govt but dont follow d rules fr fees & take donation too. That why they must serve d society too.

  27. Dr Sunil Dr Sunil Wednesday, December 25, 2013

    There is mention/suggestion of IT exemption to the doctors employed in rural service or other high need areas in main article and few other postings. With due respect to all those who have given this suggestion , I shall like to point out that there is not such example of IT sops to salaried citizens in any profession. If there are examples not known to me, I shall like to be instructed. And why we should take an approach of tax exemption in case of individuals? Why shy away from handsome increase in pay package if the need for doctors is overwhelming. One Lac per month is no great shakes in these times. Look at the packages of IITians. What is making people think that MBBS are less rigorously trained, or there job is of less importance to the society. In fact , it is so important that it can never be adequately compensated in pecuniary terms.
    The administration must not flinch from giving generous incentives and remuneration to the doctors, instead of coercing them to work in rural areas by holding their career on ransom. A policy of browbeating or blackmailing is not used for any other profession to harness services. Somebody has given example of army culture above. The comparison is not apt , as in army it is part of a well structured, well recompensed career. Thee is no gainsaying that it is not a freelancing profession , whereas in medicine most professionals are self employed. They are entitled to an autonomy vis a vis their career options like any other professionals– lawyers, architects, engineers. Can somebody tell me what coercive methods are being used to get service of these professionals in far-flung and interior areas. If doctors’ services are unique , people must learn to reward and respect them also so that they are motivated to make sacrifice for their fellow beings. Coercion does not beget compassion.

  28. Dr Sunil Dr Sunil Wednesday, December 25, 2013

    Language is never illegitimate . It is the person who spites his own fraternity , who deserves an adjective more derogatory than illegitimate. I am glad that Indian Resident Doctor put across so forthrightly. In name of noble profession the society has put a yoke of unrealistic expectations upon neck of doctors. They save and serve the most precious commodity on earth i.e human life and deserve best recompense , career opportunities, and social status.
    Amongst us, unfortunately there are many doctors , who are otherwise laggards and drop outs, who are given to sermonizing others , feigning as paragon of virtues. With such reprehensible elements lurking inside,you don’t need external enemies for undermining the interest and respect of medical profession.

  29. Dr M M Khan Dr M M Khan Wednesday, December 25, 2013

    Dear colleague I’am in PMHS doing rural service & it gives me immense pleasure to serve the needy. perhaps our perspectives are quiet different. Ur language is very illegitimate & it denotes ur moral character. u may have achieved a lot but u r mortal. but please when u go in rural area on duty pleasemake sure that every person licks ur feet, otherwise u’ll hurt ur ego.

  30. An Indian Resident Doctor An Indian Resident Doctor Tuesday, December 24, 2013

    Dr. MM Khan, you should go and lick the feet of all those rural people.

  31. An Indian Resident Doctor An Indian Resident Doctor Tuesday, December 24, 2013

    One more thing to add to the above post,

    all the SC’s, ST’s and OBC’s should not be given any rural posting. After all they are dalits…”How can we make them work, right ??!!”

  32. An Indian Resident Doctor An Indian Resident Doctor Tuesday, December 24, 2013

    Dear Indian Common Man,

    Few suggestions:

    1. Let us all make slaves out of the resident doctors and make them do all the household chores, wash your clothes, babysit your children and wash your toilets as well after you do your business.

    2. Let us not pay them a single penny, after all they belong to the noble profession, “How can they charge money for it ??!!”

    3. Meanwhile you do not work hard at all in your life, earn money by as many corrupt means as possible, and anjoy life to the fullest.

    Is that OK with you, let’s make it final then,

    An Indian resident doctor.

  33. Dr.PSG Dr.PSG Tuesday, December 24, 2013

    Well I would say it would take much time for people to digest this whole concept but it is feasible if govt takes sufficient steps to provide security and a good salary of atleast 60k per month. Also internship currently is very poorly executed and doctors learn minimal in this course. It should be more clinical and one should really be confident enough to handle common medical emergencies like burns, snake bite etc at rural centres.

    Only time will tell if the policy of employing fresh graduates is a disaster or a change in rural health system.

    Yes the fresh doctors of the next couple of years are guinea pigs to this policy as everything has been announced last minute.

  34. Drs.k.singhal Drs.k.singhal Tuesday, December 24, 2013

    dikahawati despremi aur village premi log hein jo rural posting ka support karte hein

  35. Drs.k.singhal Drs.k.singhal Tuesday, December 24, 2013

    badi badi batein karana asan hai kya aap khud vanha jane ke liye taiyar hein aur kya aap apne bacon ko bejne ke liye taiyar hein….uske alawa yeh bhi galat hai ki villages me koi jana nahi chata hai….agar permanent posts nikalti hein to hajaro doctors jana chate hein

  36. jack jack Tuesday, December 24, 2013

    Secondly reservation at the PG level should stop or atleast the qualifying marks for all categories should be equal. How did the supreme court decided that 40% marks in entrance exam are adequate for reserved category to do PG. One thing the court should understand is that the fellow u r sending in for PG is going to deal with lives of million of people he is going to treat. So the standard or the merit should not be compromised. The society has done there part by providing them opportunity to be in the system where they are going to be Dr. after that it should be there own merit that should take them further. Or I suggest why not give one AIIMS to each SC, ST, OBC where the entire staff is from one community for one year and then compare there working of each.

  37. jack jack Tuesday, December 24, 2013

    Not denying that rural India need Doctors but at the same time asking 45000 graduates to have a year stint in lieu of 10000 govt pg seats is like carrot and stick policy. Will the private medical colleges open up there gates for a national exam for admission or is the govt planning to increase the no. of seats in govt colleges. Majority of MBBS graduates have no clinical knowlegde due to least hands on during there clinical postings, during internship majority are studying to clear PG entrance exams. So this is a half baked decision and politically motivated move.
    Now as the central govt conduct exam for only 5500 seats through all India exam and these seats will be open to all after there rural stint so I think central government should pay each MBBS graduate posted in rural posting with same salary as paid to Junior residents in Central govt hospitals which is around 65000/mth or annually 7.8 lakh plus incentive of working in rural area which should be 25% additional to this total salary then will be 9.8 lakh now this multiplied by the no of doctors who will appear for pg exam i.e 72000 = 7200 crore. where has the govt made this budgetery allocation nowhere so for now this is just a gimmick.
    Secondly with no supervision and all by themself novices will be disastrous for not only the patients but also the legal issues arising out of this malafide practice , recent event where a trained lady gyne SR wal molested in LNJP is not forgotten. How the govt prepare to provide security to these Novice no idea. The point in contradiction to what govt plans to do are several and will not be easy to digest. Bes

    Solution for rural healthcare is to sent post graduate to villages for a limited time say 6 mth in there 2nd or 3rd year of PG and to conduct PG entrance every 6 mth. So to increase the total seats in PG.

  38. prerna keshari prerna keshari Tuesday, December 24, 2013

    dr Devashis Sir
    I am a mbbs student .Your views in the above context are really appreciable.My only concern is in the process of arriving at a compact and acceptable structure a lot of people on both sides of road….. in this case those who serve in primary health care as well as those who receive it will be in jeopardy

  39. vipin vipin Tuesday, December 24, 2013

    While some people are talking about armed force
    medical college
    Serving in remote areas before getting post
    Graduation..I think they will be aware of advantages
    That they receive..
    A)There are more post graduation seats in afmc
    as compared to undergraduate seats so they are
    Not worried about their future..at the end
    Everyone gets a pg seat of their choice
    B)their salary in internship is around 28k which
    Is I think we dont get even in 1st year pg in some
    Of the states
    C)the kind of facilities and security they get is
    what we cannot even imagine of.
    D)at the end only thing that matters is no or
    I would rather say minimal corruption.
    All men are equal..no bribing,no under table
    Sort of funds..everything is on time..everyone does
    It..and what do we get here..corrupted children of
    Corrupted politician use their power or whatever to
    Get rid of rural postimg.only the middle and lower
    Class suffer.

    While 2of my friends doen rural posting ryt now
    Have yet not received their last 3 months salaries
    Dey are constantly under threat of local politician
    Regularly receiving call from dem ko bhai main ek
    Pt bhej Dekh raha hun..Dekh lena..
    N wat else should I say..its countless..its useless to debate
    With these so called ruthless but then brainless
    Politician who are obsessed with their undeniable
    Powers..(bdw next year we have elections..Its just
    A matter of time that we are being used as a
    Puppet for their vote banks..hope it all resolves
    Soon..)

  40. Dr M M Khan Dr M M Khan Tuesday, December 24, 2013

    इस देश की आबादी का 80% हिस्सा गाँव में रहता है. उनपर प्रयोग करके सीख तो सकते हो मगर उनके लिए कुछ कर नहीं सकते हैं. जितने लोग सरकारी सर्विस करते हैं उसमे से ज़्यादातर भागे रहते हैं. देशप्रेम के नाम पर खाली फ़िल्में देखते हैं और बड़ी बड़ी बातें करते हैं. असली देशप्रेम का मतलब बहुत लोगों को पता नहीं है. मेरा देश मेरे गाँव में भी बसता है. अनाज गाँव का पैदा किया हुआ खाओगे मगर अपमे हिस्से के कुछ साल गाँव को नहीं दे सकते हैं. कितने शर्म की बात है. सरकार सब्सिडी में पढ़ाती है तो आखिर कुछ तो वापस करोगे सरकार को. माँ बाप तक औलाद को पालते हैं तो भी इसलिए की कभी बाद में वो उनके काम आयेगा. उपरवाला भी बिना इबादत के नहीं मानता है. कमाल करते हो भाई, जितने डॉक्टर नए नवेले आते हैं उनमे से बहुत लोगों को इंजेक्शन लोड करना और टीका लगाना नहीं आता. भाई डॉक्टर हो तो हिप्पोक्रेटिक ओथ भी ली होगी या वो खाली ऐसे ही पढने के लिए होती है. एक डॉक्टर होने ही हैसियत से मै ये मानता हु की जितना काम हम ओग करते हैं उससे ज़्यादा वैल्यू हम अपने काम की लगते हैं. भाई आप अपनी मर्ज़ी से डॉक्टर बनने आये थे. अब आपको इतनी इज्ज़त मिली की आपको भगवान् कहा गया, मगर आप इससे भगवान् नहीं हो जायेंगे. 1 साल अपने गाँव को दे दोगे तो अपनी नज़र में भी इज्ज़त बन जाएगी. समझो इसको की देश भी तुमसे कुछ चाहता है

  41. d. Saroja d. Saroja Tuesday, December 24, 2013

    dear Chandru,
    what about the reservation candidates when they get the post and position, they too start discrimination against their fellow reservation colleagues and poor patients. They become big bosses and ill treat the community to which they belong.
    This is human attitude and the merit sufferes because of reservation

  42. chandru chandru Tuesday, December 24, 2013

    To Dr neeraj nagpal:
    1.Y u want reserved pg to serve 5 years in rural areas? U mean to say all the pg’s. Who got seat in unreserved category got on the basis of there merit? U better look into the history of aipgme results and the cases pending state wise, hw the top rank holders got the set.
    2.Take a look into the post held by the unreserved candidates in the premier institutes in india, and think if they really deserve, unlike some reserved candidates who really are suitable for that post. Just don’t generalize doctors based on reservation.
    3.Ask urself from ur ancestral till ur era, whether u r treating reserved people the same way u treat the people of unreserved category. And now if some reserved guy/ gal have become a doctor u have problem with them.
    4.And y ur son/daughter should get benefit just bcoz u have served in rural area.?

  43. Drs.k.singhal Drs.k.singhal Tuesday, December 24, 2013

    according to some person ……….
    to increase business of shops of Corporates /private medical colleges and universities by increasing seats may be priority than unemployment may be in future in doctors

  44. Doctor Drama Doctor Drama Tuesday, December 24, 2013

    So why did this eminent physician not choose to continue to work in rural area after his masters? Did the people living in rural India were not in need of physicians and people capable of endoscopy then? The whole argument surrounding the government spending money to train doctors and doctors choosing to stay in the cities does not make sense. We in India do not work on the principle of prevention of common diseases. Even today diarrhea is one of the most common causes of death in under 5 age group, to say that it is because of lack of doctors is wrong, it is because of lack of proper sanitation, potable water and control of disease vectors. Of course doctors can save lives of those sick but have you been to those villages? Where is the infrastructure. Rather than forcing it on doctors as many engineers can also be recruited (I don’t believe that government is spending money on engineers in IIT’s and other colleges to train them to earn good packages or move abroad) and infrastructure be developed for the basic needs of people in masses so that at least people will access to good sanitation and filtered germ free water. Of course one has right to health as much as one has right to food, water, air and sanitation. No doctor will go around villages making latrines and providing clean water.

    Blaming doctors for poor health facilities in the rural sector is like blaming sun for there being dark at night. They never had the infrastructure in place in these rural setup and now they want all junior doctors to pay for their misdeeds. After long they shut down public works department, ignored the poor and what about the urban poors? Are they having access to the medical facilities in spite of being in cities?

    You are not just blind, you are deaf heartless and pathetic law makers who want to be comfortable in their chairs and just push other around to get things done. Most of you are not even aware of ground realities after all your air-conditioned chambers have made life too comfortable for you.

  45. Pathetic Joker Pathetic Joker Monday, December 23, 2013

    You have a vacancy of about 2500 for MBBS and about 31000 seats in all – then where are you going to accommodate all of us!? We are over 1 lakh or more! Would you triple your seats in a matter of months, or will you only give those 2500 seats to those people who come and lick your boots? What a pathetic joke!

  46. Dr.c.k.lohra Dr.c.k.lohra Monday, December 23, 2013

    I agree with your thoughts.Why all rules putting restrictions are being forced on medical profession
    Whereas IITians,Advocates and others getting govt. Subsidy are kept free ,may be because they join politics and make laws.
    Dr.C.K.Lohra

  47. d. Saroja d. Saroja Monday, December 23, 2013

    The System is not able to stop rape in Capital, will they be able to stop rape of lady doctors posted in rural area?
    What is the guarantee that young male doctors will also be not sodomised?

    When public in Delhi has not spared lady doctors how one can think that they will be spared in rural areas.

    will then be a discrimination only male doctors for rural posting.?
    Oh dear , are you dissuading young people to come to this profession ?
    What were you doing so far during last 66 years . This ailment is not new.

    Still there is shortage of specialists and super specialists.
    Some one wrote on concept of Mini Medical Colleges in Every district.
    The next step may be population and area based allocation of new medical colleges.
    I think that is what is going to solve the problems of shortage of doctors, their problems with rural bias and orientation and the rural health care for which the experts are beating around the bush by some times introducing B Sc. in Rural Medicine and posting doctors in rural areas without assuring their safety.

  48. DR. BHARAT DR. BHARAT Monday, December 23, 2013

    AGREED WITH DR DEBASHISH TARRA

  49. Dr Neeraj Nagpal Dr Neeraj Nagpal Monday, December 23, 2013

    Dear Dr Devashish
    1) Pay packet of 12 lacs per annum for an MBBS is bare minimum and no way near “Fat”
    2) Prolonging medical education has an effect to push MBBS graduates abroad causing brain drain. Open meritorious candidates should be left to choose their own path and not forced to do rural service which leaves those who have taken advantage of any reservation.
    3) Parents go to gulf countries / different cities for the sake of earning money for their children. If sufficient emoluments are given to them in area of need and their wards are given benefit it may solve the need for rural doctors without having to resort to forced labor by fresh MBBS passouts.

  50. Kannan Kannan Monday, December 23, 2013

    Rural service for doctors

    I am fully in favour of this step. No private practitioner will serve in an area of need after he/she is well settled. There is a certain amount of honour and social responsibility in delivering health care in areas of need and this should not be forgotten in the crass capitalism which one sees today.

    The armed forces send fresh graduates to distant under served areas and all these doctors not only respond to the challenge by delivering care to the soldiers AND the local civilian population ( who have been forsaken by the phc doctors) and earn good name. Post graduation in the armed forces system is available only after 3-4 years of primary health service. I fail to understand how this idea will fail provided there is a strong will to implement it. In reality that I sincerely doubt the courage sincerity and willingness of the government or the MCI to rigorously implement this without fear or favour across the board.

    Incentivization of the phc doctor is the need of the hour to which income tax sops, better pay, better facility in the form of medicines and medical equipment, access to Internet and medical journal and a stable referral and professional support service will make the period of primary care beneficial to society and the doctor.

  51. Dr Devashish Tarra Dr Devashish Tarra Monday, December 23, 2013

    Dear Dr Nagpal,

    While most of your arguments in the above article are entirely tenable, especially the point about fresh MBBS graduates not being equipped with the skills required to practice medicine in the rural hinterland, I am a bit confused by the solutions proposed for getting doctors to serve in the rural areas.

    1. “Salary package of Rs 12 lakh per annum for fresh MBBS graduates to work in areas of need”. On one hand you say that fresh MBBS graduates are not trained enough to be capable of practicing in the rural scenario and they need supervised training and nurturing. At the same time, you want them to be incentivised with a fat pay packet to shift to the rural areas and practice unsupervised?

    2. “Parent’s rural service should give a one-time benefit to their children for PG admission”. Why may I ask? In what way is a parent’s rural service related to their children getting a benefit in PG admission? Isn’t this a bit like reservation, which everyone know is the root cause of all the malady in our system where pure merit is taken precedence over by every other privilege?

    3. Again restricting rural service mandate to those in the reserved categories who have availed the benefit for MBBS or PG admissions, will create another divide between the so-called “reserved” and “open” category candidates. I think we have enough acrimony over this issue already. Why aggravte it even further?

    4. Income tax benefits are ceratinly a welcome thought. But in my view it will take a lot more than IT sops to attract doctors to the rural areas. Firstly, let the government promote primary care in the country’s healthcare system with all possible means and support. Create a career profile for primary care physicians in the country and bring them on par with specialists in terms of recognition, financial benefits and continued medical education. Then create an environment that is decent enough for them to work in the rural areas. Give them low-interest loans to set up their own clinics when they have served a predetermined time in rural service.

    5. Build public-private partnership models for primary care in the rural areas and encourage doctors to apply for these positions. Allocate adequate budgets for financing these PPP models and then make sure that pay-outs are connected to showing positive healthcare outcomes in each PHC’s area of service.

    Simple financial incentives or PG-quotas alone will never work. Unless the government puts its efforts behind incentivising doctors to become good primary care physicians, there will never be a long term solution to this. The nation needs both specialists as well as primary care physicians. But if the incentive for doctors to serve in rural areas is a post-graduation, then we will always be looking at doctors who only view primary care in rural areas as a stepping stone to becoming specialists and never really looking at primary care as a career choice. There is enough evidence to show that India’s healthcare environment needs more and more trained PCPs if we aim to bring down the costs of healthcare.

    All these steps need strong political will-power and strategic thinking by the government, MCI and the Ministry of Health. Easier said than done!

  52. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Sunday, December 22, 2013

    Doctors are required in rural areas. At the same time, conditions are not conducive for fresh MBBS graduates to work in rural areas. Though I do not think that offering a salary of Rs 1 lac per month is the way out, I think that some tax benefits should certainly be extended to those who serve in the rural areas. Courts are unlikely to interfere in this matter. My suggestion to all respected doctors: put your thoughts together and make a presentation to the Petition Committee of Rajya Sabha. If approved by the Rajya Sabha, things can be better at least after a year and a half for those who go and serve in rural areas.

  53. Suicides Suicides Sunday, December 22, 2013

    Every single suicide in young doctors that results because of this half-baked decision, should be investigated, and those responsible should face prosecution for abetment of suicides. You can’t give us jobs and you freeze our careers for no fault of ours? You incompetent congress-walas couldn’t ensure proper healthcare to the people for 45/65 years you were in power? Now you want to go for an eyewash at the cost our lives? Are we criminals? Why this murderous treatment to us? Just because we have no voice? Just for politics and another chance to rob the exchequer? The mental torture that this corrupt government has meted out to us needs to be condemned severely. I would request every doctor to go for country-wide strikes till we are recognized as human beings. I hope someone goes to the courts and exposes this fraud.

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