Compulsory rural service for medical graduates in India
The Medical Council of India and government of India have decided to force newly qualified doctors to spend a year in a post in rural India after completing their internships, although the decision has been put on hold by the Medical Council of India. Medical students wanting to sit the postgraduate examination will have to serve this one year stint to be eligible for it, although the Minister of Health has said that this would not apply to students sitting the examination in 2015-16.This decision to enforce a year of working in the villages has created a stir across the country, with medical students and doctors protesting and striking against it.
Behind the decision is the need to improve the deteriorating rural health service in India. It is said that India lives in its villages. Health in rural India, where 70% of the population lives, however, is bad—there is a paucity of health services and infrastructure coupled with the lack of basic amenities. Is the decision to make a year in a rural post compulsory justified, or was it a desperate move to improve the acute shortage of doctors in these areas? What consequences will the decision have on the medical profession in India? And what effect will it have on medical students?
Medical students are being made the guinea pigs in this flawed experiment. Having completed their internship, and with little experience, they will have to serve in areas with few facilities. Spending a year in a rural village is a setback for medical students who want to specialise. Extending their already long medical course might cause them to give up on their aspirations and have a knock on effect on the quality of healthcare in the future.
In a country of more than a billion people, though, a mixed response to this potential change is not surprising. Some argue that doctors have a duty to serve the population. That’s right, but shouldn’t other sectors of society take some responsibility too? The quality of villagers’ lives would be improved greatly if they were provided with good quality drinking water, 24 hour electricity, and access to basic sanitation. Doctors are not needed to achieve these things.
Additionally, sending fresh medical graduates into the rural community puts the health of the villagers in the hands of relatively inexperienced practitioners. It also indirectly deprives rural areas of specialists because there are a finite number of jobs. On reflection, the decision will benefit nobody.
An exploration of alternatives is needed. The rural posting could be integrated into the postgraduate course, thus providing specialised care. Also, unlike undergraduates, postgraduates do not have to study for the postgraduate examination. The government should establish more medical colleges and hospitals in rural areas, which will attract more healthcare providers and services. Involving the private sector and non-profit organisations is essential for providing better coverage of services. Laboratory facilities at a rural level are also needed for rapid diagnosis and prompt treatment. Allowing new graduates to treat people without enough manpower and materials is a shortcoming of the administrative sector, not of the medical profession.
To provide a better healthcare system in villages, a better planned approach is needed. The policy makers should consult with the medical community. The decision to enforce a year of rural service needs to be reconsidered because the health of more than 70 million people and the future of medical students hang in the balance. I hope the temporary suspension of the policy by the Medical Council means that the policy makers are prepared to listen to doctors. It is time for them to wake up and act—or the future looks bleak.Sutanay Bhattacharyya, fourth year medical student
1North Bengal Medical College, Siliguri, India
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
- Express News Service. Doctors end strike after government puts rural posting “in abeyance.” Indian Express 2014. http://indianexpress.com/article/cities/delhi/doctors-end-strike-after-govt-puts-rural-posting-in-abeyance/.
- Joseph J. Rural postings: controversy in Indian specialists’ training. BMJ 2014;348:g54.
Cite this as: Student BMJ 2014;22:g1681