Don’t force young doctors to serve in rural areas

The acute shortage of doctors in India, especially in rural areas, is a nuisance for the government, a problem that has not been successfully tackled till now. The forced compulsion of one year of rural service after five and a half years MBBS course, just to be merely eligible to apply for a PG seat is however a futile, ineffective and vastly unpopular method to fill this shortage. The primary reason being no priority was given to students voluntarily opting for rural service, in PG entrance exams. Also worse, it would made it much more difficult for them to prepare for the PG entrance test when they are in a very demanding job without adequate facilities. Not surprisingly, the new government has decided to scrap the proposal of one-year compulsory rural-service after completion of MBBS and asked the Medical Council of India (MCI) to include it instead as a part of the PG course.

But that alone is not the solution. There has been a nationwide agitation under different banners like ‘Save the Doctor’ and ‘Doctors for Villages’ etc with medical students and established doctors from premiere medical colleges, hospitals protesting actively against numerous other problems which are evident even to the common man with average intelligence. Lack of proper infrastructure at primary health centres (PHCs), unhygienic sanitation, shortage of medicine and emergency equipment, malfunctioning labs, absence of lab assistants, nurses and experienced doctors for mentoring, adequate security of female doctors, deprivation of residential quarters due to unavailability etc are the most common and undeniable laggings which require immediate addressing.

There is undoubtedly an utter dearth of qualified allopathic doctors throughout the country. Considering the norm of one doctor per thousand, there should be a minimum of 12 lakh doctors for 120 crore Indians. However, currently there are only around 7 lakh allopathic doctors in India. There are just a meagre 32,000 sanctioned posts of MBBS doctors roughly with 50,000 new MBBS graduates every year. The government needs to find a permanent solution for this immense shortcoming instead of making scapegoats out of budding doctors. Temporarily posting them in rural areas will not serve any purpose unless they willingly subscribe to the same.

Various methods can be tried and tested to resolve this issue at hand. There were suggestions to start a new three-year BSc-CH (Community Health) degree course, whose graduates would serve in rural areas. This was vehemently opposed by doctors and experts alike, and correctly so, because promoting MBBS for urban people and BSc-CH for rural population is not a great idea, as it may create double standards in treatment culture, which can lead to utter chaos and confusion.

Even the new government’s latest decision to introduce one-year compulsory rural service as a part of the postgraduate medical course is not without its flaws. This is opposed on the ground that for one year, the PG students would be deprived of studying, acquiring skills that would help them later practice as a specialist. Also, many PHCs, by their very nature, won’t provide avenues for PG students to learn or practice their specialized skills. Further, if we increase the PG course duration by one-year, it will unnecessarily lengthen the study duration which is already more than nine years – five and half for MBBS and three for PG, not to mention the years spent between the two for PG entrance test preparation. The seemingly ever-declining interest of school students in medicine as a career option will only be further bolstered by such measures.

Another idea is to start 50-seat MBBS medical colleges at district level by upgrading the existing district hospitals and train the students mainly as general practitioners (GPs) in a way to make them more suitable for the local needs. This will address the uneven spread of medical colleges in the country, bring more doctors in the system and encourage the medical students to learn more about the diseases/problems at the local level. If necessary, these seats may be reserved for meritorious students within the district so that they continue to serve locally. A major concern in this regard is finding enough teachers for these medical colleges. However, it should not be much of a problem for clinical subjects, as district hospitals already have necessary doctors. For the non-clinical subjects like Anatomy, Pharmacology etc one teacher might be assigned to 2-3 adjoining district medical colleges with travelling/accommodation allowances etc. The conduction of supervised video lectures from experts all over the country may also be probed and adapted depending on results and response.

For achieving the same, a substantial amount of the financial budget needs to be allotted and expended for a complete makeover of the medical facilities, thus popularizing the desire of doctors all over to happily serve wherever they are posted. This should not be too much of an ask, especially when we have been spending almost twice the money allotted to the health sector for minority welfare, around 20 times for the agriculture credit scheme and much larger amounts for urban development and loan waivers. However, it remains to be seen whether these old political gimmicks are finally abandoned and the real problem at hand is dealt with once and for all amidst innumerable promises.