November 06, 2010

Revenue Recovery Looms Over Rural Posting Defaulting Doctors

Doctors who have not served the one-year Compulsory Rural Service (CRS) will have to pay the government at least Rs. 30 lakhs each, according to National Rural Health Mission (NRHM) officials.

Plans are under way to also cancel the Medical Council Registration of these doctors.

These punitive measures are being chalked out to make sure that students who complete the MBBS/Medical PG degree/DNB or Diploma from government-run medical colleges serve in the rural areas to fulfil a contractual obligation to the government.

Primary reports show each defaulting doctor has to pay not less than Rs. 30 lakh, which includes the bond amount and the amount spent by the government on each doctor during the course of studies and the interest on this amount.

In Kerala last year, 528 doctors were sent for CRS out of which 201 have discontinued without giving proper reasons. “We have sent notification to 160 of them asking them to resume service. Notifications for the rest are in process. And if they don’t turn up, revenue recovery by the government will happen without any compromise,” says a senior official at the NRHM in Trivandrum.

Students are given admission for MBBS, only after they sign a contract with the government for serving in rural areas for one year soon after completion of their course. There is also a provision to discontinue their service if they get admission for higher studies but they should resume service after the course.

But the practice now is that many of these doctors refuse to do rural service but join private hospitals or go abroad soon after the completion of their course. Also, junior doctors go on leave for preparing for PG admissions. This creates a dearth of doctors to attend to the poor and needy in the rural areas.

One of the reasons the doctors give for not taking up rural service is the low remuneration.

“It has become a regular practise by the doctors to not take up the rural service. These young doctors complete their MBBS at an age of 23 or 24 when students in other professional streams like engineering start earning at 22. By the time these engineers are 24 or 25 they become rather settled in life with a good job in hand and probably even a marriage, whereas an MBBS student has to go for higher studies. It makes it difficult for them to take up another year of rural service due to their personal commitments. Hence the defaulters,” says a senior doctor from Trivandrum Medical College, who doesn’t want to reveal his identity.

The NRHM now offers Rs. 15,000 per month as salary for the doctors who take up rural service. Also, they can avail 20 casual leaves and one leave every week. In addition to all this, doctors who are posted in interior rural areas such as Attapadi and Parambikulam are given an extra allowance of Rs. 3,000 to Rs. 5,000.
Pay-back Time

The students who pass out of government medical colleges owe it to the government to pay back in some form. “I think the government is right in their decision. The rural posting is the government's way of reclaiming the money that they spend on each student in a government medical college. If you look at the figures, a student in a government medical college pays an annual fee of around Rs. 12,500 as against about Rs. 5 lakh paid by a student in a private medical college. The rest of the amount is borne by the government,” says a student of Jubilee Mission Medical College & Research Institute, Trichur.

One year of rural service is not much in terms of a junior doctor’s pay-back to the government. Besides, a doctor who does rural service gets preference when he or she applies for PG courses.

“There is also another side to this story. Most of the students who get into the government medical colleges are repeaters at the entrance. Hence, most of them would be 24 to 25-years old when they graduate. And then they have their PG to do. So, obviously, they don’t want to ‘waste’ another year in rural service.”

“But rural service is a humanitarian service that a doctor owes to the society and there shouldn't be defaulters. Even we (students of private medical colleges) have something called ‘community service’ wherein we will have to visit rural areas on a regular basis,” he adds.

Reasons To Bunk

A house surgeon at the Alappuzha Medical College has a different take on the whole issue. “Though I would not support this practise by doctors, we have valid reasons for doing this.”

He blames the government’s erratic administrative behaviour for doctors being in a precarious situation. “It’s the government that decides who will be posted where and when the posting must be made. Most of the time what happens is that no decisions will be made by the time we complete our course. The next thing we would like to do is to go for a PG or take up a posting somewhere we will be paid a decent salary. But we can’t take up a job because we will be waiting for our rural postings,” he says.

“The rural posting comes when we least expect it. It becomes practically impossible for us to plan our lives with such erratic behaviour from the government.”

Another issue that he points out is that two batches complete their courses at nearly the same time with the results of the previous batch coming late. And there are rumours that the NRHM doesn’t have enough funds to pay the doctors of two batches if they get posted at the same time. “The latest batch would get a posting at a later time and no one gives us any assurance when this posting happens. Hence it becomes most likely that some of us would try to evade the rural posting,” says he.

But the officials at the NRHM office near the General Hospital here wouldn’t buy these arguments. “It’s not true that the doctors can’t choose where they would like to get a posting. We give postings strictly on merit basis. Those who pass the course with top ranks can choose where they’d like to do their CRS. Obviously, those who come last in the rank list will be left with not many options,” says a top official at the NRHM.

He says the department doesn’t delay postings. “Doctors usually complete their course by October-November every year and we send them posting notifications by December or by the end of November itself. There is no question of them having to wait for long. If there are late postings, it is only because some of them would have papers to clear and they finish the course after the others,” he adds.

He also rubbishes the rumours that the NRHM is running out of funds. “I’m not aware of anything like that. The NRHM is a fully state-run institution funded by the central government. We currently pay Rs. 15,000 for each doctor, Rs. 3,000 extra for those posted in ‘difficult rural areas’ and Rs. 5,000 for those posted in ‘most difficult rural areas’. And we have always been prompt in paying the salaries. About the pay being less, I’ve no comments. It’s the state government that decides the remuneration,” he says.

Doctors who go for rural service don’t have many good experiences to share. Most of the time, the senior doctors would dump all the responsibilities on the junior doctors. This is also a reason for some of them not returning once they get a chance to step out to do a PG course.

Having listened to all sides of this issue, Yentha believes that it’s a matter of professional ethics Vs practicality. The government’s decision of revenue recovery is something that can be justified in many ways and yet, one can’t be oblivious to the issues raised by the doctors.

A senior doctor of Trivandrum Medical College says: “Someone taking up medicine as a career has to be aware of these professional hazards rather than running away from responsibilities.”

Unlike in other professions, an irresponsible medical practitioner puts the life of common man at stake. Medicine is a profession where one’s priority should be the welfare of the people rather than any personal benefits.

An excerpt from the modern version of Hippocratic Oath: I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

Link: Original Article


புருனோ Bruno said...

How much does Government Spend for a doctor

See here

How does compulsary Rural Service work in tamil Nadu

See here

Anonymous said...

an article should be based on facts and not concoctions. The author has really failed to present the real scenario . For someone totally ignorant of kerala govt health services , nothing more could be expected. Projecting crs as a panacea for the kerala health sector surely sheds light on authors ignorance



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