Breaking News: NMC Asks States to do Away with Seat leaving Bond

New Delhi: In a move that is going to bring relief to thousands of resident doctors and medical students across the country, the National Medical Commission (NMC) has written to the Principal Secretary of Health and Medical Education of all States and Union Territories, asking them to review the seat leaving bond policy, and preferably do away with the same.

The direction comes after the National Medical Commission's anti-ragging committee held a meeting on 9th January 2024 to address the mental health concerns of PG medical students and recommended the State/UT to review the seat leaving policy in medical colleges and do away the same.

As an alternative, they recommended that the States may consider debarring the students for admission in their States for the next one year.

Mental health concerns of postgraduate medical students has been a major issue over the years. Since medical profession is one of the harshest professions in terms of time and effort involved, the doctors during their period of residency often get exhausted due to the workload. Resident doctors need to be present full-time in the hospital, day-in, day-out toppled with various night duties coming in rotation.

Despite efforts made by the government, the issue of mental health of medical students remained unaddressed over the years. Back in 2022, NMC took note of the issue and showing deep concern for the mental health and well-being of PG medicos, NMC had directed all the medical colleges and institutions providing PG medical training to address the issues faced by the PG medicos.

In this regard, the medical institutes were directed to take numerous steps ranging from ensuring adequate rest, weekly off, counselling for those who are under stress, arranging Yoga sessions on a regular basis, sanctioning leave when required, and respecting their dignity by providing a positive conducting working environment.

NMC had also asked the medical colleges to set up a committee to look into the complaints/grievances including anonymous complaints/grievances which may be submitted by the PG students either through mail or received in a drop box specially placed for this purpose.

Also Read: Give Weekly Off, Stress Counselling, Yoga sessions: NMC dictum to medical colleges to manage resident doctors' Mental Health

Back then, addressing the medical institutes, the President of PG Medical Education Board of NMC, Dr. Vijay Oza had mentioned that "A healthy and stress free resident doctor is critical not only for his/ her own well being but also for the well being of the patients he/she treats. All medical colleges/ institutes are therefore requested to take necessary steps for taking care of the mental health and well-being of the PG Medical Students studying/working with them."

The issue of the seat-leaving bond policy has also been a matter of concern for postgraduate medical students. Depending upon the State/UT where the resident doctor is pursuing his/her postgraduation, they need to pay a hefty amount of money for leaving their medical studies midway. State/UTs across the country implement such a condition to ensure that the postgraduate medical seats do not go vacant. However, several times such hefty seat leaving bond penalty causes financial strain on the students.

NMC Case Studies: I. A female student enrolled in MD (Pediatrics) at a Government Medical College in Madhya Pradesh for the 2022-23 batches faced mental harassment and grueling 36-hour duty shifts without rest. Distressed by the toxic environment, the student wants to resign mid-course. However, the college demands a hefty Rs 30 lakhs as a seat leaving bond. Poor father of the daughter has written to the Prime Minister for helping him as he can neither afford 30 lakhs of bond amount nor he can see her daughter who is a qualified doctor in mental agony.

Recently addressing the issue, the President of UG Medical Education Board (UGMEB) Dr. Aruna V Vanikar wrote Principal Secretary of Health and Medical Education of all the States/Union Territories across the nation.

Addressing the issue of mental health concerns of PG medical students across various institutes, NMC mentioned in the letter dated 19.01.2024, "National Medical Commission is in receipt of grievances/ issues pertain to the alarming levels of stress, anxiety, and depression faced by medical students specially the Post Graduate (PG) Medical students across various institutions. These mental health challenges are primarily due to inability of the individual to acclimatise with a different environment prevailing within their new colleges/institutions as compared to the one in which one has grown up or completed under graduate education." 

NMC Case Studies: II. In 2020, an MS General Surgery student at a Government Medical College in Madhya Pradesh faced adversity due to road accident of his father and subsequent hospitalization in emergency. Despite the genuine need for leave, the student, threatened by seniors to either provide substitute or resign, the student has to resign in mental stress. He deposited a hefty amount of Rs 30 lakh as seat leaving bond, derived from his father's superannuation. When attempting to rejoin, the college referred the case to the National Medical Commission (NMC). The Post Graduate Medical Education Board (PGMEB) approved rejoining, although he has rejoined after signing a fresh seat leaving bond but the college failed to refund Rs 30 lakhs deposited by the student as seat leaving bond from the student.

The Commission further highlighted how seat leaving bond conditions affect the students and mentioned, "A noteworthy impediment hindering affected students from seeking relief is the imposition of a hefty seat leaving bond. Such exorbitant amounts not only exacerbate the financial strain on the students but also act as a deterrent for seeking necessary mental health support from the family."

NMC explained how the number of PG medical seats has increased in the last 10 years. It further opined that the issue of seat going wasted is not of much significance now since the PG seats have increased by a huge number and they even remain vacant.

"The concept seat leaving bond, a common practice for medical students specially PG students, started with the aims to secure commitment, discourage abrupt resignations, address the issue of seat blocking and wastage of medical seats. However, in the last 10 years medical seats including the PG seats have increased substantially and even remain vacant. Therefore, the issue of seat being going waste is not of much significance in view of increased number of medical seats. Another issue of seat blocking is valid till the counseling is going on and after the session has started and last date of admission is over the negative effect of lower merit candidate being benefitted by leaving of the seat does not arise," the Commission added in its letter.

NMC Case Studies: III. A first-year MS (General Surgery) student at Government Medical College in Maharashtra, reported ill-treatment by seniors, forced menial work, and financial demands. Pressure to withdraw complaints is evident by the fact that a senior female resident accused in a ragging filed a complaint of sexual harassment against him. The poor first year student was so afraid of the toxic environment in the college that he left the seat by paying a hefty amount of seat leaving bond for which poor farmer parents have to sell their agriculture land.

Along with the letter, NMC has also referred to several case studies to point out how the issue of seat leaving bond policy affects the mental health issues of PG students. Referring to these, NMC mentioned, "The highlighted case studies underscore the challenges faced by students, particularly in terms of mental health issues and the payment of seat leaving bonds as given in Annexure. The case studies given in the Annexure are of those lucky one whose parents could support their wards by bearing the financial constraints but the unlucky one may commit to suicide in such mental health condition."

NMC mentioned that the resident doctors stand at the forefront of healthcare and they perform their duties in shouldering immense responsibilities in patient care, medical procedures, and facility management. Therefore, the Commission opined that their dedication to the well-being of patients is unparalleled, often involving long hours and diverse medical cases. 

NMC Case Studies: IV. First-year female PG student at Private Medical College in Telangana, reported mental harassment and restriction from going home by the seniors and college authorities. She wish to resign but cannot do so due to heavy seat leaving bond imposed by the college has expressed suicidal thoughts.

"The elimination of seat leaving bonds is a strategic move to prioritize the well-being of resident doctors, empowering them to provide optimal patient care. A supportive and stress-free work environment for resident doctors translates directly into improved healthcare outcomes, re-enforcing the symbiotic relationship between the well-being of medical professionals and the quality of patient care," opined NMC.

Therefore, NMC referred to the meeting of the Anti-Ragging Committee of the Commission on 9th January, 2024 and mentioned that considering the gravity of the situation, the committee recommended to the State and UT Governments to review the seat leaving policy in medical colleges/institutions and do away the same. "Committee also recommends that instead of imposing heavy seat leaving bond, State may consider debarring the student from admission in their State for the next one year," NMC mentioned in the letter.

NMC Case Studies: V. First-year female MD (Paediatrics) student at Private Medical College in Uttar Pradesh was under stress due to toxic working environment in the college. Her parents have to pay a hefty amount of seat leaving bond for the health of their daughter who later joined in Government Medical College next year. This exorbitant financial burden on parents raises questions about the fairness and appropriateness of seat leaving bond policy.

"On behalf of the National Medical Commission's Anti Ragging Committee I am requesting you to kindly review the seat leaving bond policy in Medical colleges in your State at your level and do away with the seat leaving Bond. Your efforts in this regard will go a long way in creating a supportive and nurturing environment for medical students. This, in turn, will foster their mental health and enhance their overall well-being leading to a positive transformation in the medical education system. An action taken report by your Government on this issue will be highly appreciated," it further added.

NMC Case Studies: VI. A female PG student pursuing MS (Obstetrics & Gynecology) at private medical college in Pune Maharashtra was under stress due to the persistently low clinical load in the department has made the difficult- decision to leave the course. It was because she has seen a good clinical load during her internship in Government Medical College. Her parents had to deposit a hefty amount as a seat leaving bond. This excessive financial obligation adds another layer of difficulty not only for the student but to the parents.

Also Read: Supreme Court calls for Uniformity in bond amount for vacating medical seats, details

Medical Dialogues had earlier reported that back in 2022 while considering a plea by a PG medical aspirant who had challenged the huge amount of security bond for vacating the seat, the Supreme Court had suggested that there should be a uniform security bond amount across the States. Although the bench comprising of Chief Justice of India D.Y. Chandrachud, Justice Hima Kohli and Justice J.B. Pardiwala had denied to grant any relief to the concerned student, it noted that the students who join the medical courses often come from humble middle class backgrounds and therefore, there should be uniformity regarding the bond amount for vacating the seats.

NMC Case Studies: VII. A female student from North East enrolled in MS (General Surgery) at a Government Medical College in Madhya Pradesh for the 2021-22 batches faced mental harassment due to ragging and toxic working environment has to leave the course by paying a hefty as a seat leaving bond. Aspiration of a Doctor from North Fast and her parents who has joined with great hope of better medical education went off and sent a wrong message for the medical education aspirants.

To view the NMC letter, click on the link below:

https://medicaldialogues.in/pdf_upload/nmc-seat-leaving-bond-230800.pdf

Also Read: Mental Health Concerns: Maha DMER Plans to Withdraw Rs 20 Lakh Seat Withdrawal Fees for Residents