Stipend Disparities Mar MBBS education in India, Will NMC intervene?

Thereafter, efforts were also made to standardize the process of counselling- leaving little freedom in the hands of private institutes to admit candidates to the MBBS courses.

The new entity the National Medical Commission (NMC) is also making several efforts to standardize the process of medical education across the country. It includes its efforts towards NExT or the National Exit Test, which is the upcoming common exit exam for the MBBS graduates, as well as the recently released MBBS internship guideline, that for the first time spelled out the entire journey of a medical student during internship and what outcomes they are expected to learn.

However, the biggest pinching line that is yet to be addressed remains the issue of MBBS stipend across the country. While the role of MBBS students have taken a major leap in the COVID era, with young medicos being put in COVID duties, the corresponding remuneration to them for their services is marked by severe disparities.

Also Read: MBBS internship only at Medical College where medico is studying: NMC releases fresh guidelines for Compulsory Rotating Internship

Severe disparities in MBBS internship Stipend across India

The issue of uniform stipend is not at all a new one. Severe disparities exist in the payout to the MBBS medicos depending on their states as well as institutions.

• Karnataka pays its medical graduates an amount of Rs 30,000 as a stipend and additionally it has recently started paying another 10,000 rupees to those interns who have joined COVID duties. Previously, the intern doctors in the State used to get Rs 20,000 which was revised last year.
• West Bengal Government hiked its stipend for MBBS interns in 2020 by Rs 4,425 and now the intern doctors in the State receive an amount of Rs 28,050 per month for their MBBS internship.
• Until July 2021, the Central Government used to pay its intern doctors an amount of Rs 23,500 per month, which has been recently revised as 26,300 in most of the Central Government institutions and hospitals across the country.
• However, the stipend amount was much lower in states like Rajasthan, Uttarkhand even a few days ago. Rajasthan MBBS interns were the lowest paid across the country as they were receiving an amount of Rs 7,000 (per day 233 approximately) per month. It was finally revised recently to Rs 14,000 per month after the intern doctors decided to go on strike.
• Uttar Pradesh MBBS interns were also one of the least paid across the country as they were getting an amount of Rs 7,500 per month (Rs 250 per day). It was revised back in January, this year to an amount of Rs 12,000 per month.
• The stipend of the Uttarakhand MBBS interns was revised only this week to Rs 17,000 per month after around 330 medical interns across the State raised their voice for being the lowest-paid interns (previous stipend Rs 7,500) across the country.
• Interns doctors in Madhya Pradesh also raised their voice seeking an increment in their stipend and finally it was revised to Rs 12,000 from Rs 10,000 per month back in June 2021.
• The Stipend of Tamil Nadu Intern doctors got last revised back in 2018 and they started getting Rs 20,000 per month (Previous stipend Rs 13,000) with a yearly increment of Rs 600. Currently, Tamil Nadu intern doctors are getting Rs 21,800 per month. Although they sought an increase along with the resident doctors in the state, and decided to go on a strike, the issue is yet to be resolved.
• Bihar Government had increased the stipend of the MBBS interns back in 2017, when it was increased from Rs 12,000 to Rs 15,000 per month. Pointing out the severe disparity of stipend paid to the MBBS interns at state government institutes and central government institutes around 850 interns doctors in the State had recently threatened to go on strike.
• Currently, Himachal Pradesh and Haryana are paying an amount of Rs 17,000 per month to its MBBS interns.
• MBBS interns in Andhra Pradesh got their stipend revised back in 2020 (Previous stipend Rs 15,817) and currently, they receive an amount of Rs 19589 per month.
• Gujarat medicos currently get an amount of Rs 18,200 per month after they got an increment of Rs 5,000 in April 2021.

NMC Draft Regulations for Compulsory Rotating Internship:

The National Medical Commission (NMC) has recently released the Draft Regulations For Rotational Compulsory Regulations, 2021, one of the most comprehensive documents on the elements of MBBS internship.

The new guidelines outline the various aspects of MBBS internship ranging its goals, objectives, and duration to eligibility, stipend and what shall entail in the training of a medico during the internship adding that "The goal of the internship programme is to train medical graduates to fulfill their roles as doctors of first contact in the community."

However, regarding stipend, the council has noted that all the interns shall be paid stipend as fixed by the appropriate fee fixation authority applicable to the Institution/university/ state. This has caused a major reaction from the medical fraternity asking the apex regulator to take this issue in their own hands

Uniformity of the Stipend - the Need of the Hour:

The Commission had invited comments and suggestions from various stakeholders regarding the Draft Regulations and had asked them to submit their responses before August 7, 2021. Responding to the invitation, various doctors' associations have already written to the Commission pointing out the aspects of the regulations that they think need improvisation.

When NMC asked for feedback, the Indian Medical Association wrote to the apex medical education regulatory body stating its objections regarding several aspects and also raised its voice regarding the need for a Uniform stipend policy.

IMA had opined that although section 6.3 of the draft regulations demand uniform skill development and talks about the uniform testing by NEXT exam, the issue of stipend is still under the control of the private medical colleges and states.

Mentioning that the issue of stipend of MBBS interns should not be left to the "whims and fancies of private medical colleges of the state", IMA stated in the letter, "IMA demands there shall be a uniform scale of stipend and working conditions of the interns shall be formulated in the regulations."

Although NMC is yet to respond to these suggestions, the recurring strikes by MBBS interns across the States complaining against the disparities in the stipend amount point towards the fact that uniform stipend policy is what the country awaits.

Recently, when Medical Dialogues approached several doctors' associations regarding the issue, they also voiced the same opinion. 

While commenting on the matter, Dr. Manish, President of FORDA said, "I agree with the concept of Uniform Stipend Policy. In fact, not only for the MBBS interns but across the country, there should be a uniform stipend for the PG residents also. As the working hours are more or less same, the amount of stipend should be same also for the doctors working in the same designation."

Dr. Rakesh Bagdi, President of FAIMA, also agreed to the notion of uniform stipend and said, "Central Government has recently revised the stipend of intern doctors to Rs 26,300, whereas the stipend of the intern doctors in States like Rajasthan, Uttarakhand got revised a few days back after the students started protesting. This kind of uneven distribution of stipend is not acceptable when all the doctors after studying medicine for 5 years are putting in the same amount of hard work, and serving their duties towards the patients.

Dr. Bagdi also raised the issue of the Foreign Medical Graduates and added that "these students after pursuing their education abroad clear the FMGE test and only then get enrolled for an internship. So, they should also be paid the same amount for their share of the hard work. Now, after the introduction of NExT, all the MBBS graduates would have to clear the same exam as well. So, there shouldn't be any disparity regarding the stipend amount as well."

Speaking about the matter, Dr. Karan Juneja, IMA-JDN National Secretary referred to a recent survey conducted by Indian Medical Association Medical Students' Network, Uttar Pradesh. In the survey, in response to the question "Do you think, by not mentioning about uniform stipend in the draft is injustice?", 88.3% people voted for "yes".

"There is a need for increased expenditure on healthcare and proper implementation of uniform stipend by the administration. Timely well-paid uniform stipend is the need of the hour and there is also need of proper training in modern medicine clinical subjects and family medicine so that we get professionals who can heal all and lead the nation as Indian medical services officers hopefully," added Dr. Juneja.

Also Read: Give uniform stipend, working conditions for all MBBS interns across the country: IMA to NMC

( With inputs and research work from Barsha Misra and Sanchari Chatterjee)