All Talk and No Action Monday, July 28, 2008

The recent brouhaha against Health Ministry's petition promoting Compulsory Rural Stint for medical students merits attention and sound debate.

At first glance, I felt it was the right thing to do and why should all the wannabe docs refute such a noble proposal? Is 365 days too much to offer your country which subsidizes your education?

Its said, about 8% of primary health centres in rural areas do not have any doctors ! If this young force lent their assistance for a year, it would greatly reduce the burden on the already cracking health infrastructure.

When these young doctors work under such dire conditions, their learnings and observations can lend a great insight into the health care system and the requirements to provide basic health care to rural areas.

Moreover, their stint in the hinterlands would come in handy later on - they would have learnt to function with limited professional help and medical supplies, thus helping create a sound judgment.

Yes, all of the above and a lot more can be said in favor of a compulsory stint in rural areas.

However, when we look at the other side of the coin, the situation appears dismal !

The Health ministry wants all the students to go in for a compulsory internship for 2 years (1 in a rural area of their choice), only after which shall they be given their official doctoral degrees.

Now, most medical students hail from middle class families. Such a compulsion would mean they would end up getting their MS/MD only when they turn 32/33...Follow this up with paltry remuneration they are offered in their initial years. Making a 5.5 years' course (inclusive of 1 year of internship) into a 6.5 years course would only add fuel to the raging discontent amongst medical students.

Just how does one manage taking care of one's family, meeting financial demands and clearing off educational debts?

Moreover, if we were to put our minds to the situation - how do we expect 23 year olds to face the pathetic, almost non existent infrastructure in most rural areas? If we want these people to learn and have an impressive take home, shouldn't the government be working on the basics at least?

Also, if we were to question the commitment of the government, what explains the penalty of 3/5/15 lakhs for students who want to do away with rural stint? Only a select percentage can afford such exorbitant penalty. What about the majority? Why should they alone suffer? Also, why should graduates with foreign university degrees be spared the rural stint?

Rules should apply to all.

I feel to make the initiative successful a mix and match of the following could be used -

  • Increase the Stipend of interns
  • More credits for students who come out with executable solutions/innovations to solve health care issues
  • Instead of the suggested 2 years, break the existent 1 year into various weeks of working in cities, towns and most affected rural areas
  • For better performance and encouragement, senior doctors or guides should spend a week/two with these interns. This shall ease away the fears of the fresh graduates and provide them an understanding of what's expected from them.
  • Tie-Ups with foreign medical universities, preferably, with countries which have similar health care set up. Our graduates could intern with them, study and learn how these countries deal with health care problems and help infuse fresh ideas in our decaying system
  • Adoption of a cluster of villages - In this case, the government could target the worst affected villages first instead of pseudo villages. While a group of interns work there, the government could build up clinics, mobile vans, sanitation camps across the village
  • Tie Ups with private sector for establishment of clinics, medical supply and so on
All the above is achievable with participation and commitment from all quarters. Instead of making scapegoats of our young doctors, lets partner with them to set up a "healthy" health care system.


11 comments:

Mitesh said...

hey..this is good..there are many doctors which suffer after becoming one...cmon doctors have their own families to care ...govt is responsible for the doctors not going...by increasing the span of internship they are discouraging the future generation to go in the field..now as in there are few docs..and in future d no wil only go down..

india unbound said...

@All Talk and No Action

I agree with most of your points. However i feel the solution lies in liberalising the medical education sector.

This will help in improving the dismal doctor to population ratio. Unless we do this we will have to resort to such unimaginative solutions which look good on the surface but wont solve much in the long term.

However I disagree with Mitesh above that youngsters would be discouraged as despite this compulsory two year stint in rural areas, we still see lakhs of students competing for few thousand Medical seats.

And since the Govt is subsidising their Medical education, students should not crib much in giving their two years for a noble cause.

Mitesh said...

i agree to it...but these lines look good in books..lets think about the student who works..i mean pratically..wasting one in rural areas is not at all good..the term for studies has also been ncreased..i mean it ws 4 and half years + one year internship..which has risen to 5 and a half + two years internship...and after that in todays competing world...can a person who is only MBBS can survive..i suppose no...and the time duration for PG course has also been increased by one year..so when does the person start earning bread...ya i understand noble cause is good..but not at the expnse of own remaining hungry..govt is giving subsidies..i know..but after the increasing the term...the no. of students appearing for medical line has fallen by 23%...and dats this year..and in at the end we need food and shelter nt the people..ok i may be sounding selfish...but with the prices growing..u have too...ya i dont say they shouldnt be sent rural.but think bout the students and their families too..six months in college and six months in rural areas is fine

india unbound said...

@Mitesh

I am really sadden by the fact that according to you rural stint is a "waste of time". Infact medical students should take it as a challenge and a good learning experience.

And since our Govt. spends lakhs of rupees on each medical student, the least that such students can do is work for two years in Rural areas.

And no medical student will remain hungry because of working in rural areas. This is an exaggeration.

And even if there was a decrease of 23% in applications to medical studies, we would still have lots of candidates for our medical colleges.

Mitesh said...

sorry to say..but the time by which a student leaves the college he is 26..just a plain MBBS...so when does he sette down..when should he setttle..when shoul he free his retiring father from his burden..either he must leave further studies..or his father must suffer...in medical field there is no way a student can earn like in commerce courses..and by the way medical is the toughest field after iit....come on..if the govt is spending so much...y not spend t on rural areas..y giving permission for private colleges...who take hugeamount of feess..my dear in a pvt college the fees is no less than 1.5 to 2 lacs per year..afte spending so much when will the student recover...u cant deny dat...i didnt say rural stint was waste of time..but the duation set by the govt is a waste..one year..split na..six months in college and six months in village..y to increase the duartion of the course...from yrs the docs have studied for the old duration y to increase the duration..time matters my friend
and it takes at least two years to set up ones practise and infact to start to earn..

india unbound said...

@ Mitesh.

If Medical students settle at the age of 28, it would not be the end of the world for them. The increase in the duration of course is justified under the current circumstances.

As I said, this is the least they can do after becoming doctor on Government's subsidy.

And all the doctors/dentists earn a lot after some initial hiccups for the simple reason that their is a shortage of doctors in our country. So I dont feel sorry at all for our medical students. Infact, I am saddened by their insensitivity.

Mitesh said...

my dear friend..make ur statistics clear...at 28 the guy is only MBBS...and at present there is no value for that...he can only be a teacher..usme bhi usko 4 saal lag jaeynge...aur medical students ki chodo...enng students...govt unpe bhi to kharcha karti hai..to un logon k liye govt companies me internship kyu nahi hai...unke to bade ache campus selection ho jaate hain..and they get packages...y do they not work for people...and its not insentivity...jus see..how many people commit sucide every year....aur jo insentivity ki baat kar rahe ho to sorry..apno ko marte dekh duossroon ki madat karna kitaabo me acha lagta hain...enng get jobs by the age of 22 rather...y??? do they not think of the rural people..and under current circumstances changing the sylabus is important and not increasing the duration...

All Talk and No Action said...

Hmmm...

Nice thoughts from both of you...

However, I seem to agree more with Mitesh here...

Yes, working in rural areas is a necessity. However, in this case, I feel the govt is making a scapegoat out of all medical students.

Before coming out with senseless policies, it should first get the basic health care infrastructure in place !

Also, its easy for us to harp about social responsibility. However, we do have to think about doctors who cannot start making a decent living before they are 33/34...

This could lead to a larger menace...of Docs indulging in malpractices later on to make easy and quick money.

india unbound said...

@All Talk and No Action

Building Infrastructure is not an easy task. It takes time. In my first reply, I have suggested a possible solution and I agree that compulsory 2 year stint in rural areas is not a long term solution. However, what can be done till we have proper medical infrastructure or enough doctors ?

Should we leave the rural areas deprived of any medical facility just because our doctors will take more time to "settle"?

As far as medical malpractices are concerned, I have been hearing about kidney rackets since I was a kid and then there was no compulsory rural stint. I just hope that this policy of our Government is not unnecessarily blamed and maligned to defend or justify the greed of some doctors .

@ Mitesh

Engineers are doing their best in making India a superpower. If required I am sure Engineers wont hesitate to do rural stints.

Mitesh said...

enng will be doing..but the docs are doing it dude..sitting in an office and working on programs and machines is easy but handling humans is not dat..since last sixty years govt is making infrastructure...so wat do u say about dat...is the two year stint is going to solve problems....two years may be a small time for u..but to a medical student it is more than a gem...and the students are working hard..but to enroll everything upon just one branch is not done...so anyways who is going to look after the settlement..is d govt gonna do..normal life expectancy of a human being is 65 to seventy years...and if he spends half d life studying and serving..when will he fufil his dreams for wich he has worked hard...survived the torture and all...dat means..a blooody thankless job..then y the hell to do it..

Mitesh said...

and by the way on the kidney rackets..i have been hearing buildings falling bridges falling..due to poor enng...so who is dat gonna account for..no good enng available...all going abroad to serve foriegn companies...y...are there not enough jobs in india..then y people go US UK to get MS...serve india na..serve people...docs are also researching...giving their lives and everything and make india proud...so its both ways dude