'Junior Doctors forced to work 36-hour shifts at AIIMS Bhubaneswar, AFMC Pune': Doctors demand Immediate NMC, DGHS action

New Delhi: Highlighting violations of duty hours regulations for resident doctors at All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bibinagar and Armed Forces Medical College (AFMC) Pune, the National Medical Commission (NMC) and Directorate General of Health Sciences (DGHS) have been urged to investigate the issue and take strict disciplinary action.

Writing to the Director General (Health) of DGHS and the NMC Chairperson, National President of United Doctors Front (UDF), Dr. Lakshya Mittal, referred to the Uniform Residence Scheme of 1992 (dated 5 June 1992), and the Postgraduate Medical Education Regulations (PGMER) 2023, which mentioned that the woking hours for the junior residents should be "reasonable" and must include adequate rest periods, with an upper ceiling to prevent physical and mental exhaustion.

Doctors undergoing Junior Residency during the period of Postgraduate medical education complain of long duty hours, low pay, almost inhuman working conditions, lack of basic necessities, and even lack of a clear structure of what is expected. The Government introduced the Central Residency Scheme 1992 after the Supreme Court took note of the issue 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.

The Central Residency Scheme specifically provides the maximum number of duty hours done by a resident doctor. In particular, it says, "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."

Also Read:86 percent Medicos Suffer Mental Health Strain Due to Exhaustive Duty Hours: UDF, Medical Dialogues Survey

However, allegedly, these rules remained only on pen and paper and the resident doctors continued working without proper rest. Meanwhile, NMC in 2023 published the PGMER 2023 in the official Gazette. While it did not specify the upper ceiling of working hours for the resident doctors, these regulations said, "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."

Referring to these rules, Dr. Mittal, in the letter directed to NMC and DGHS, mentioned, "However, junior resident doctors at AlIMS continue to be subjected to continuous duty hours ranging from 24 to 36 hours, in blatant disregard of these norms. This not only amounts to institutional negligence but also poses serious threats to the physical and mental health of resident doctors and compromises patient safety."

UDF had filed Right to Information (RTI) applications seeking to know the real scenario regarding the duty hours of resident doctors. Dr. Mittal informed that the responses received from the institutes, providing details of duty hours of resident doctors, clearly reflected the pattern of duty hour violations. "This is not a matter of isolated incidents but reflects a systemic disregard for national regulations governing medical residency," he mentioned in the letter.

At AIIMS Bhubaneshwar, the RTI revealed that the duty hours for Assistant Professors, Associate Professors, General Duty Medical Officers, Non-Academic Junior Residents, and Senior Residents range around 208 hours per month. They get 4 days off per week and while the doctors get a 24-hour shift strictly, it extends to 30 or 36 hours in clinical departments, depending on the patient load.

The RTI revealed that at the General Medicine Department of AIIMS Bibinagar, the first sem Junior Residents of the January 2024 and July 2024 batches get 24-36 hours of duty for 2-3 days per week. They also get night shifts for 2-3 days per week.

In the case of AFMC, Pune, the junior residents of the clinical departments get a 24-36-hour duty for 4 to 5 days per month. The RTI also revealed that the duty hour extends to 30-36 hours in all clinical departments.

For the Department of Anaesthesiology and Critical Care, the RTI revealed that "The dept doesn't generally list 24 hours duty for residents, 32-36 hours duty is scheduled once a week, however resident is given off for 1-2 hours for ablution and freshening up, depending on the case load."

Referring to these RTI responses, UDF President Dr. Mittal has urged NMC and DGHS to initiate a fact-finding investigation into the duty hour policies currently being followed at AIIMS, take strict disciplinary action against the officials responsible for implementing and overseeing these violations, direct AFMS to comply strictly with the Uniform Residency Scheme and PGMER guidelines and submit a compliance report, issue a broader advisory or notification to all medical colleges and institutes reiterating the legal and ethical mandate of compliance with prescribed duty hours.

"The well-being of our resident doctors must not be sacrificed to systemic inefficiencies. Long and exploitative duty hours have been directly linked to burnout, mental health crises, and even suicides in medical colleges across India," he added in the letter.

Speaking to Medical Dialogues regarding the issue, Dr. Mittal said, "We have officially raised serious concerns with the Ministry of Health and the National Medical Commission regarding blatant violations of resident doctors’ duty hours at premier institutions like AFMC Pune and AIIMS Bhubaneswar. RTI responses have confirmed that junior doctors are being forced to work up to 36-hour shifts without adequate rest—directly contravening the Uniform Residency Scheme, 1992, and NMC’s PGMER Guidelines, 2023."

"This is not just a matter of administrative failure—it’s a question of human rights, mental health, and patient safety. The system’s inefficiencies cannot come at the cost of young doctors’ well-being. UDF demands strict disciplinary action, immediate compliance audits, and a nationwide advisory to prevent such exploitation," he added.

Medical Dialogues had earlier reported that earlier this year, the Central Government had introduced a review meeting to introduce modifications to the Central Residency Scheme in 1992. One of the modifications that the Government was planning to introduce is to fix the duty hours of resident doctors to 48 hours per week, a long-pending demand raised by the members of the medical fraternity, especially those working as junior and senior resident doctors in the medical colleges.

While the Director General of Health Services, Dr. Atul Goel had informed that no final decisions were made during the meeting, the National President of United Doctors' Front (UDF), Dr. Lakshya Mittal and Chief Patron of FAIMA Doctors Association informed that the DGHS had agreed to modify the rules to clearly mention the fixed duty hours as 48 hours per week.

Also Read: Will 48-hour work week for doctors become a reality?