Can't Specify Daily Working Hours of Doctors: Ministry official

New Delhi: Considering the heavy patient load in the medical college hospitals across the country, there cannot be set a daily working hours limit for the resident doctors, stated a senior Health Ministry official.

Speaking to Education Times, the official referred to the provision of paid leaves, and weekly offs in the newly released Post Graduate Medical Education Regulations (PGMER), 2023, and said that the concerned Head of the Departments in medical colleges will have to ensure that the doctors do not get exhausted due to work, nor should the lives of patients be put at stake.

Medical Dialogues had earlier reported that the final Post-Graduate Medical Education Regulations, 2023 (PGMER 2023), which were published in the official Gazette on 29.12.2023, lay down the rules and regulations regarding admission, counselling, and other details related to the postgraduate medical courses.

Clarifying that all Post-graduate students will work as full-time resident doctors, the regulations further mentioned that they will work "reasonable" working hours and will be provided "reasonable time for rest in a day".

The new regulations have also specified that post-graduate medical students will get a minimum of 20 days of paid leave (casual leave) per year. Apart from this, under these new regulations, doctors will also be allowed weekly holidays.

"Subject to exigencies of work, post-graduate students will be allowed one weekly holiday," mentioned the regulations. Further, the resident doctors will be given maternity leave and paternity leave as per Government rules and regulations. There are also provisions for a total number of 5 paid academic leaves for the PG medicos.

Further, the new regulations have introduced uniformity in the stipend paid to the PG resident doctors in a particular State/UT. In this regard, PGMER 2023 mentioned that the PG medicos who are pursuing degree, diploma or super-speciality courses should be paid a stipend at par with the stipend being paid to the PG students of Government institutes, in that particular State/UT.

Also Read: 20 days of Paid leave, weekly offs, reasonable working hours for PG medicos: NMC PGMER 2023

Apart from this, NMC has also made it mandatory for the college to provide appropriate residential accommodation to post-graduate students. However, it will not be mandatory for the post-graduate students to stay in the hostel.

Reacting to the new regulations and especially the provision of a uniform stipend paid to the residents in a particular State/UT, a senior health ministry official informed Education Times, on the condition of anonymity, "The regulation on stipend parity as per government guidelines was already existing even at the time when the Medical Council of India (MCI) was the regulatory authority. But some private medical colleges ended up hoodwinking the system, forcing students to pay back the stipend through tuition fee hike and other miscellaneous expenses. While the current regulations will enforce the rules, implementation can be a challenge as students tend to get victimised in the process."

The official further explained that since stipend is a state subject, the amount will be different in different States. It can range from a little over Rs 1 lakh- as in some States of the North to Rs 40,000 in some southern States. Therefore, the parity should be at the State level, where the residents in the private medical colleges should get equal amount of stipend as paid in the State medical colleges. However, a uniform stipend policy across the country is not possible, which the students have been demanding for a long time, explained the official.

In respect of the provision of paid leaves, the Health Ministry official claimed that maternity/paternity leaves will also mean that the tenure of the training period shall get extended as PG medical courses are not a regular job. 

Referring to the weekly holiday, 'subject to exigencies of work', the official added that this provision seems justified keeping in view the interest of the patients, medical emergencies and life and death situations. He explained that considering the high patient load in medical college hospitals, even the number of hours on a daily basis, which has not been specified in the PGMER 2023, cannot be defined.

Further, the official opined that the rights of the doctors must be balanced along with the healthcare of the patients. He added, "It should be the responsibility of the Head of Departments (HoDs) in medical colleges to ensure that doctors do not go into burnout phase, nor should patients’ lives be at stake."

Opining that balance also holds the key while providing accommodation to the resident doctors, he highlighted how some of the premier medical colleges are bursting at the seams and they are not equipped to offer accommodation to all the PG medical students. In this regard, the official added, "In such cases, the PG residents can be provided house rent allowances, barring doctors engaged in emergency services, who can be offered on-campus accommodation."

Commenting on the matter, the president of the Postgraduate Medical Education Board (PGMEB) of NMC, Dr. Vijay Oza told ET, "If it is an emergency duty or extended hours of work, doctors will have to be within permissible distance of the hospital." He also mentioned that medical colleges will have to face penalties in case of non-compliance of the regulations. 

According to Dr. Oza, the newly released PGMER 2023 will help the HoDs take on an empathetic approach towards the more sensitive PG medical students who could be less resilient to the challenges.

The issue of long working hours faced by Resident Doctors: 

The Medical Profession is one of the harshest professions when it comes to the time and effort 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. The Supreme Court in 1990s had directed the Central Government to form a Uniform Central Residency Scheme defining base for all functioning of resident doctors.

Consequently, the Central Residency Scheme was introduced in 1992 and it 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. Under this scheme, it was mentioned that the duty hours for the resident doctors would not exceed 12 hours at a time. It had also offered them with 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.

Previously, NMC had taken cognisance of the issue of the mental health of PG medical students. In this regard, earlier, the medical colleges had been directed by the Commission to ensure 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.

Medical Dialogues had earlier reported that last year there were reports that NMC was 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.

Finally, the PGMER 2023 was notified in the official Gazette on 29.12.2023, and addressing the issue of resident doctors it mentioned, "All post-graduate students will work as full-time resident doctors. They will work for reasonable working hours and will be provided reasonable time for rest in a day."

Several doctors expressed their disappointment over the fact that the working hours for the PG doctors have not been defined by NMC. Earlier, speaking to Medical Dialogues, the president of the Federation of Resident Doctors Association (FORDA) Dr. Aviral Mathur had explained the necessity for a bracket regarding the weekly working hours for the resident doctors. Dr. Mathur had also mentioned that the issues of working hours, maternity leave, and other important issues would be raised by FORDA to the appropriate authorities.

Also Read: All PG medical students to work as full-time resident doctors for reasonable working hours: NMC PGMER 2023