Thursday, 8 January 2015

Rural Retention of Medical Doctors

On the invitation received from MoHFW, the undersigned along with Dr Ramesh Dutta, attended the meeting on Rural Retention of medical Doctors at New Delhi which was chaired by Health Secretary, GoI. MCI president was also present.

Agenda Note

1.      The Central Govt, in consultation with MCI, made the following amendments to its Post Graduate Medical Education Regulations to encourage doctors to serve in difficult/remote areas:

50% of the seats in PG Diploma Curse shall be reserved for medical officers in the Govt. service, who have served for atleast three years in remote and difficult areas.  After acquiring the PG Diploma, the medical officers shall serve for two more years in remote and/or difficult areas; and
Incentive at the rate of 10% the marks obtained for each year in service in remote or difficult areas upto the maximum of 30% of the marks obtained in the entrance test for admission in  PG medical courses.

2.      Thereafter, a draft notification was approved by the Ministry in June, 2013 to provide that one year rural posting at PHC will be mandatory for medical graduates for admission in PG courses from academic session 2015-16.  However, due to agitation by doctors against the proposed amendment in the PG regulations, the MCI was requested to keep the amendment notification in abeyance for publication till further orders from the Ministry.

3.      In July 2014,  with the approval of the Hon’bl HFM, it was decided to make the mandatory rural posting an integral part of PG course curriculum.  MCI was requested to furnish :
Revised PG Course curriculum
Draft notification amending PGMER, 2000
Roadmap for implementation of the scheme

MCI has now sought following clarifications:
Whether the Central Govt. envisages a PG degree course of 3 years or 4 years including one year rural scheme after completion of MD/MS course or during the course.
Whether the programme for PG course incorporating the rural posting applied to both govt. & private medical college?
During the 1 year posting that is proposed to be incorporated into the PG course, which authority shall pay stipend to the doctors during rural posting?

DISCUSSION IMA and Others, and outcomes

It was agreed that at the moment, Govt. will not go ahead making rural posting compulsory during PG entrance examination. IMA said, they will oppose if that happens.

MCI suggested that government may think of making one year rural training posting of pre and para clinical postings without increasing the duration of PG.

It was proposed that in pre selected PHCs, any post MBBS student who does one year rural training posting, he or she will get 10% extra marks to be added to his PG entrance  examination. Apart he/she will get a salary more than other places and in addition will also get an additional certificate of training in rural medicine and rural surgery

Some suggestions by IMA, not carried forward

1. Doctors who may like to work in Govt. area, may be given income tax exemption and high salary.

2. Local GPs may be given extra incentives to run a 2 hours OPD in these PHCs

3. Doctors posted in these PHCs may be given one year diploma in rural medicine and surgery.  The same was not accepted by the MCI.

4. A 2 years PG course may be started by DNB in rural medicine and surgery and out of these 2 years, one year may be in the  rural area and one year may be in the DNB recognized hospital.  As there was no representation from DNB, the same was not further discussed.

5. That all district hospitals may be made teaching hospitals and internship & DNB programme may be started, the matter is under discussion.

Some other suggestions and facts from the panel

1. Under the existing MCI Act, it is not legally possible to withhold the degree of a person for one year in the absence of completion of rural posting by him/her. So bond theory was not accepted.

2. To make PG entrance more difficult so that students are forced to go for rural posting for getting 10% extra marks.

3. Out of one lac only 6500 postings are without doctors. It is not that doctors do not want to go to rural areas. They do not want to go to these 6500 rural areas.

4. At any given time only 10% of the PHCs are without doctors

 5. In some states, they have incentivized by increasing the retirement age from 60 to 65 to post some specialists in rural areas.

6. In some states, hard area allowances are given and salaries are upto 1.5 lacs.

7. In  one state, 10 lac penalty bond has been kept in for not doing rural services after PG and  Rs 18 crore was the revenue. So this is not a solution.

8.  To have different fee structure, which means people who are ready to go for rural services will have a substantial subsidy in their PG educational fee by the Govt. But this was not again followed as the private medical colleges may not agree for the same.

IMA stand and offer

1. IMA will invite suggestions from its members through eIMA news

2. IMA will connect to its students through and

3. IMA will call representatives of IMSA India and have a discussion in Delhi along with MOH officials. MOH said that have no budget. IMA will call representatives. They will come of their own. IMA will support stay and food.

4. Every year  lac doctors appear in PG examination and only 25000 get admission. Remaining 75000 doctors at given a time start preparing for the PGs.

Final IMA Offer to students and government

Out of 75,000 doctors who are appearing for PG, if 10,000 are willing for a one year  positing in selected PHCs, IMA will get them five things

1. High pay scales

2. IMA certified (Non MCI) fellowship (one year) in Rural Medicine and Rural Surgery

3. 10% extra marks in their PG entrance examinations, by the government.

4. One year IMA certificate in "Community and Public Health ( this may help students who aspire further training abroad)

5. IMA will make ensure that government provides them free accommodation and security in these PHCs. IMA presumes that under the new MODI Jis promise basic free drugs and investigations will be available in every PHC.

Suggestions are invited. No final decision taken. 

Dr K K Aggarwal
Padma Shri, National Science Communication and
Dr B C Roy National Awardee
Hony Secretary General IMA

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