Rural posting for doctors: Compulsory?

The Health Ministry and the Medical Council of India (MCI) are at loggerheads again.

Health Minister Anbumani Ramadoss had said on Wednesday:

The government had decided to make one-year combined rural posting mandatory for doctors seeking post-graduation from the next academic session.

Now the MCI says that compulsory rural posting of doctors was “not feasible” as it would lengthen the medical education course and disturb specialization schedules. MCI Chairman, Ketan Desai went on to say:

“MCI has already taken sufficient steps to increase the strength of medical practitioners in rural areas. Of the 130 medical colleges opened since 1997, 101 are in rural areas. It is mandatory for all new colleges to have a minimum 25 acres of land, which is not possible in urban areas such as Delhi and Mumbai.”

The health ministry wants doctors stationed at primary health centres, community health centres (at sub-district level) and district headquarters for four months each during rural postings. For this, they will get a monthly stipend of Rs 10,000. MCI’s argument is that doctors in rural postings do not get to hone their skills due to lack of infrastructure.

The fact remains that attempts to compel doctors to serve in rural areas have failed miserably. They are trained in tertiary care centres and then expected to perform in areas which barely have electricity and water. It is a state of disillusion as the young doctors are frustrated with their ‘learned helplessness’. If the infrastructure is improved, working conditions are satisfactory and the incentives (monetary and job satisfaction) exists, doctors will willingly serve these areas. To expect novices just out of college to completely shoulder the burden of the nation’s top priority is ridiculous.

As for MCI’s claim of opening medical colleges in rural areas, it is a sham. For the private owners have long since, converted the noble profession into a business. How many students who have been forced to pay through their nose for their education would choose to serve in rural areas, instead of logically ‘recovering’ their investment as soon as possible.

#respond

14 Comments

shruti_mohanty  on March 1st, 2009

Dear Anshu,
I agree with you regarding the unsatisfactory living conditions in the rural areas where the doctors are posted.minimum requirements like electricity and water supply is also not provided in some places.How can one expect to do service to mankind when we ourselves are not at ease.Both state and centre should work together to improve and provide basic needs before posting the doctors for serving.
With warm regards,
Shruti

Chetna Desai  on March 1st, 2009

Dear Anshu
Getting doctors to “Serve” in rural areas is a difficult task. Private colleges (Barring a few) do not really cater to the rural (and also urban) areas in the true sense of “serving”. The onus then falls on the Govt as in other service oriented sectors. Even in the Govt colleges, interns bunk the rural postings to devote “valuable time” for preparing for entrance exams…these issues are multifactorial and all need to be addressed for a logical solution if any. Another way out of this is to encourage private entrepreneurship in Health sector in the rural areas..with some sops that can be passed down to the poor. The good facilities that you mentioned for the doctors will be taken care of, at the same time patient care is also provided for. Maa Amrutamai institute, Muljibhai institute in Nadiad (gujarat) are some standing examples of these

Rakesh Biswas  on March 1st, 2009

One way to circumvent this problem of rural shortage of trained manpower would be to train people from the community as health assistants (which has been done in the past) and this time empower them with simple ICT tools such as email through which rural practitioners/health assistants can enter their patient details frequently on to mail boxes (that may serve as EHRs)and the patients could be helped informationally by a network of urban specialist practitioners (possibly a few committed and interested people without private practice and engaged in medical education).

One group that may have made some headway in this is:
http://www.firstcarehealth.in/servicedeliverymodel.asp

and they have also dwelt more on the problem here:

http://www.hindu.com/mag/2006/07/23/stories/2006072300080100.htm

sramji57  on March 1st, 2009

In indian constitution we can not force any one to do a job which is not specified in the beginning before going for any teaching or training. Further, if one has to do the specific work he/she must be provided with basis infrastructure. Merely building is not sufficient.
I do not know whether dr Ramdasso ever has worked at PHC. the best way to to shift MCI in a rural area and all the members to be asked to stay there.
A qualified person is worst than that of a dumb if he/she is not having the appropriate tool. So doctors to work in a rural area must be provided the infrastructure and tools for what they are supposed to do.
i feel that the best way to find a solution is that dr. ramdasso andDr. Ketan Desai must be posted at a PHC in Chhattisgarh or Jharkhand for one year. I am sure they will come with best solution.
Ramji

K7  on March 3rd, 2009

I find it surprising that many doctors and health care professionals get very emotional and start sob stories when it comes to rural postings. Need we remind them that 70% of India is rural and the same percentage of population is concentrated in the rural ares.The government is trying to ask Doctors and other health professionals to serve this 70%. I am no big fan of Ramdoss. But lets not hang him or the any organisation that tries to bring health care to the rural areas. Lets start off with finding out where the money came from to educate the docs who dont want the postings.Getting into med school by some crazy entrance exam or money does not absolve them from their societal responsibility. Neither are they a privileged lot. What the Government is simply asking is to go back and pay for the expenses that was incurred for the studies. Talking about tools, infrastructure and facilities. Doesnt life go on in the rural areas. Dont other professions do their work with scarce resources.The simple fact is that everyone wants to join the rat race. Spending a year in a rural area will put one behind in the race. So no ones wants it.I have had the chance to do community work as part of a public health project in gujarat. I dont know about Jharkhand or chattisghar. but i can say Gujarat has basic facilities. After interacting with the villagers i came to know one thing. They are not waiting for the angels in white coats to come and save them. neither are they crying like the angels for being neglected. what they are in fact doing is dying if they fall sick and dont get treatment or live happily if they are healthy. If only our hearts are as large as theirs.

Dr.Anshu  on March 4th, 2009

@ Kesavan.

There are some aspects which I want to focus on:
1. I feel we don’t emphasize social accountability enough in our teaching.
2. Doctors need to shove off that ‘superiority’ cloak off their shoulders. Once they talk to the common man, they will realize that they have many lessons to learn from them. Talking down to the rural people from a high pedestal doesn’t work. The doctors who are revered for their work in the rural areas, have without exception, seen eye to eye and understood the ground reality. The villagers will not reciprocate unless one behaves like one of them and shares their highs and lows.
3. Reducing a noble profession to a thriving business has played a huge part in this decline. When one treats one’s profession as an investment for the future, I don’t expect them to be socially accountable. I hardly see people who enter medicine to serve the people these days. Societal values have eroded considerably.

K7  on March 4th, 2009

Anshu,
I agree to all the aspects that you have mentioned. Business and service cannot go together i guess.In some countries societal obligations and responsibilities are state ordered.A few examples are Compulsory military training,living in monasteries and so on. As a friend has mentioned our constitution allows us to do what we want. So unless the individual chooses to do so nothing can change. As you have rightly pointed out there is so much we can learn from the rural people. I also disagree to the fact that many say that motivation levels will be down and docs will become out of touch with the world. I live in a small town and i never felt that way. In one way i find that living far away from the maddening crowd is healthy. You have also mentioned your rural experience to which i agree. In one of TS Sirs articles he had mentioned about the soft skills of doctors. I am continuously reminded about my experience when i was doing my internship. Tamil Nadu has some of the worst doctors i have seen in my small life.Many dont even know how to address an elderly man or woman. But do you think any curriculum can teach how one should talk to a patient or behave with them. I think it should have been taught by parents and their immediate society. The problem lies not in the education but in the selection process.When i recently saw some of the future doctors protesting in chennai over the rural postings i lost all hopes that they would be sympathetic to patients in any way. Jail in mates would have behaved better. Whatever,life goes on, for us and for the deprived.

Dr.Anshu  on March 4th, 2009

@Kesavan

Your mail inspires me to write about another topic vital to the health of India’s medical education system: how we select our students. Will write in detailed separate post soon.

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satish yadav  on February 8th, 2014

The mbbs course is already lenghen if rural posting will applied then it will so vast and there will be late for pg exam and mbbs student will feel helples

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