Mandatory rural service

Facts v/s myths

Its adverse impact on health system

Brief overview of the health system

Tertiary

Secondary

Primary

Brief overview of the health system

Teaching hospitals

CHC, Area Hospitals, District Hospitals

PHC, SC

MCh/DM

MD/MS

MBBS

MD/MS

MBBS

MBBS

What is Mandatory rural service?

• AP medical registration act (Act no 10 of 2013)

– One year of rural service is mandatory for registration under AP medical council

What is its relevance?

• To address shortage of doctors in rural areas

• To overcome reluctance of the doctors to serve in rural areas?

• But today

– 3000 MBBS doctors pass out each year (in Telangana)

• (more than 3 times the number of PHC’s in Telangana)

– Doctors are ready to serve in rural areas

• 16,000 applications for 1100 posts of CAS!!! (Dec 2013)

The big question??

• Then why is the Govt still insisting to impose mandatory rural service on junior doctors?

– To use junior doctors as cheap alternative to permanent employees (doctors)

IMPACT ON PUBLIC

Impact on public

• With mandatory rural service, the govt tries to fill up all the vacancies with fresh batch of inexperienced doctors every year.

• Permanent recruitments will be done on ad hoc basis or even not at all.

Impact on public

• Doctors assigned to particular area should

– Get familiar with the patients and their health status

– Get familiar with the basic health parameters (drinking water supply, sanitation etc)

– Develop cordial relations with the patients (mutual trust is very much essential between the doctor and the patient)

• It takes a few months to establish ourselves as a trustworthy doctors among the general public.

Impact on public

• But, with temporary appointments, people lose faith in the entire public health sector.

• This drives them toward alternate options (RMP etc)

Impact on public

• Risk of driving doctors away from tribal and rural areas.

• In early 2000’s, a scheme was introduced to offer reservation (30 % in clinical and 50 % in Non Clinical subjects) to an MBBS graduate if he serves – 2 years in tribal health centers– 3 years in rural health centers– 5 years in urban health centers

• Because of this scheme, we are one of the very few states with no vacant PHC

PG reservation scheme in AP -Its positive impact on rural health

Increase in MBBS seats

Decreasing vacancies in PHC’s

Impact on public

• The PG reservation incentive encouraged the doctors to reach out to the most remote areas.

• If the mandatory rural service is imposed on every one, the above said scheme will lose its relevance.– Doctors will move towards urban and peri-urban

areas

– Rural and tribal PHC will suffer lack of doctors

Impact on public health

• If there is no vacant PHC, then why are the services poor in rural areas?– Failure of the supervisory system of the govt

– Absence of adequate para medical staff

– Inadequate infrastructure

Without addressing the core issues, will posting the doctors on temporary basis help to improve rural health services?

Impact on public health

• Financial burden by temporary MBBS doctors at PHC

– 2900 x 20,000 = 580,00,000/ month (72 crore/ year)

– Is it not appropriate to allocate this amount to address other issues which need immediate action

• Recruiting paramedical staff

• Providing infrastructure etc

IMPACT ON MEDICAL STUDENTS

Impact on medical students

• Medical education is the most toughest and lengthiest of all.

– It takes an average of 12 – 15 years to become a superspecialist.

– Adding one more year is nothing but to snatch away one more year of stress free life.

– Puts a brake to academic life

– Discourages merit

Impact on medical students

• Risk of losing entire life’s hard work

• Chances of medico legal tangles that will scar one’s entire career

Risk of losing entire career

• All these medical students DO NOT have license/registration to practice independently.

• Yet, they are posted in hospitals without qualified superior.

• Treating a patient without registration amounts to medical negligence

– Equal to attempt to murder

• Is this fact unknown to higher officials?

• If not, are the medicos being made scapegoats just to entertain political ambitions

If public money is spent ?????

IMPACT ON PARENTS

• WHY BOND WHEN WE ARE EDUCATING OUR CHILD?

• HOW MUCH DIFFICULTY FOR A MIDDLE CLASS PERSON?

• HOW MUCH DIFFICULTY FOR CLEARING OUR LOANS?

• WHY THEY ARE USING OUR CHILDREN AS A CHILD LABOUR?

Conclusions

• All the vacant posts at all levels of health care should be filled on permanent basis

• Provision should be made to identify and fill up vacancies on a regular basis

• NO MORE BOND SYSTEM IN THIS TELANGANA