48-hour work week on cards for resident doctors? Policymakers Claim Matter under consideration

New Delhi: The long-pending demand of young doctors, which has never been able to see the light of day till now, of having a 48-hour work week might become a reality soon. In fact, the doctors may also get one day off in the week along with this.

While this may seem like a distant dream to many young medicos, an official from the National Medical Commission (NMC) recently informed a leading Daily that the Commission is planning to bring regulations that will ensure that medical students get weekly off, they are provided reasonable time to rest and their working hours do not exceed more than 48 hours in a week. The matter is currently being considered by the Commission.

This comes at a time when recently a 27-year-old second-year PG anesthesiology student at Sree Mookambika Institute of Medical Sciences in Kanyakumari committed suicide by injecting herself with a muscle relaxant in her hostel room alleging harassment by seniors and professor. Her colleagues came out to inform that the doctor was severely overworked and was working as much as 20 hours a day. 

Also Read: 5 Points about Central Residency Scheme all Doctors Should know

Medical Profession is one of the harshest professions when it comes to the time and efforts involved. The period of residency requires the full-time presence of the doctors in the hospital, day-in, day-out toppled with various night duties coming in rotation.

Moreover, despite efforts made by the government, the issue of mental health of medical students has remained unaddressed over the years. Doctors undergoing Junior Residency During the period of Postgraduate medical education complain of long work hours, low pay, almost inhuman working conditions, lack of basic necessities, and even lack of a clear structure of what is expected. 

Even though there have been efforts in the past to address the long working hours, doctors complain that policy has remained limited to the paper only.

Central Residency Scheme, 1992: 

Back in the 1990s, The Supreme Court bench took cognisance of the exploitation that occurs of young doctors in government institutions and directed the formation of a Uniform Central Residency Scheme that would set up a defining base for all functioning of resident doctors in the country. Taking note of the same, the government formed a scheme in the year 1992.

This scheme addressed several issues including the number of duty hours done by a resident doctor, the issue of weekly off, accommodation of residents, leave travel concessions, etc.

With respect to the number of duty hours required to be done by a resident doctor, the rules specify that "Continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time. The junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch subject to the condition that the working hours will be flexible as may be decided by the Medical Superintendents concerned keeping in view the workload and availability of doctors for clinical work."

Allowing one day off in a week, this scheme states, "Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation."

However, these resident-friendly rules remained only on paper, and resident doctors are still found doing at least 70-80 hours of duty a week. In case of a high workload, the duty hours can further be extended. The situation is worse for clinical branches, where certain weeks the work hours can even reach 100 hours.

Commenting on the situation, Dr. Karan Juneja, National Standing Committee member of IMA JDN told Medical Dialogues, "There should be a stress buster for such heavy workload pressure. Doctors should be given proper counseling services to ensure their good mental health."

When asked about his weekly working hours, Dr. Juneja, who is a Pathology PG Resident, explained "Doctors generally don't get weekly off and they have to work during the night as well. Apart from the hospital duty, there are several other pressures such as file work, reporting work, thesis work, etc."

NMC Intervention: 

Last year, NMC took cognisance of the issue of mental health of postgraduate medical students. Showing deep concern for their mental health and well-being, back then the Apex Medical Regulator directed all the medical colleges and institutions providing PG medical training to address the issues to PG medicos ( resident Doctors).

For the same, the medical colleges had been 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.

Further, the institutes had been directed by NMC to constitute 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.

The NMC directions came after the Commission received several grievances from Post Graduate (PG) Medical Students (Resident Doctors) stating that they were under stress and depression due to long working hours, no weekly off, non-sanctioning of leave during emergency, etc. This issue was also flagged in print media and was also raised in the Parliament.

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."

New NMC Policy on Cards for Doctors? 

Despite the NMC directions, the situation of PG resident doctors has not improved much and on top of that several ragging cases have been reported over the years.

Amidst this situation, the Apex Medical Commission is planning to introduce new rules to ensure that PG medical students do not have to work more than 48 hours a week and are given weekly off and proper time to rest.

Indicating this possibility, an NMC official told Live Mint on the condition of anonymity, “We are trying to fix that every medical student should get weekly off, provided reasonable time to rest, and not exceed their working hours for more than 48 hours per week. The regulations are likely to be out by next month, as at present it is still in consideration."

Further addressing the recent incident of ragging at the Tamil Nadu-based medical college, the Apex Medical Commission official added, “Regarding the suicide by a 27-year-old girl in a medical college in Tamil Nadu, we conducted an emergency meeting and directions have been given to the college to submit the report by Thursday. Besides this, state medical commission and NMC officials are also inspecting the medical college at their level to collate information from students, faculty and staffers."

“If mental health of the medical students is not good, they will not be able to treat patients and one single misbehaviour or harassment from faculty, friends and staff can affect their mental health and can push them towards taking the wrong step," said the official.

While commenting on the possibility of a new policy ensuring weekly off and 48 working hours for doctors, Dr. Karan Juneja added, "If such a policy gets implemented it is undoubtedly a very welcome move. However, it needs to be ensured that it is done by DGHS and it reaches all the nodal centres ensuring proper implementation of the rule across the country."

"Central Residency Scheme was introduced with great efforts by the doctors. However, it has not been properly implemented. Several hospitals even take money from doctors to appoint them as non-academic JRs. So, apart from all the workload and stress, it also creates an issue of monetary burden on them. In fact, the situation of the recreational rooms for the doctors remains pathetic. Sometimes, they do not even get access to the bathroom. All these issues need to be addressed. When foreign countries talk about paternity leave, menstrual leave, we are so overburdened that it is affecting our mental health," he further mentioned.

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