Severe Disparity in Stipend: Kerala House Surgeons Write to Government Seeking Intervention

Requesting the Government to support them in their cause, the MBBS interns in the Self-financing medical colleges are also planning on holding a token strike next week regarding the matter, a student actively participating in the agitation dropped the hint while speaking to Medical Dialogues.

The doctors in a letter directed to the Health Minister of the State, Veena George have submitted how there is a huge discrimination in the stipend paid to the house surgeons of the Government Medical Colleges with the ones under control of the Private management.

When the medicos belonging to Government medical colleges get paid Rs 25,000 per month, the interns in the Private medical colleges of the State get paid any amount from Rs 3,500 to Rs 12,500.

They have also approached several students' bodies including Indian Medical Association-Junior Doctors Network (IMA-JDN) in this matter. Requesting for their solidarity, the students in a letter dated 11.08.2021 mentioned, "Most colleges have barred providing food to the house surgeons citing cover protocol but at the same time refuses to pay the students their rightful stipend amount so that they may procure food for themselves. Many students are overworked and do not even have enough money in hand to afford basic necessities."

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The 2016 batch MBBS students of 23 Private medical colleges have referred to a Government Circular in this regard. In that circular dated 22.01.2016, the Kerala University of Health Sciences (KUHS) had instructed the self-financing colleges of the State to grant stipends for the interns of UG and PG medical courses at par with the interns of the Government colleges.

However, the direction remained in pen and paper and due to the lack of implementation of the order, the medicos belonging to the Self-financing medical colleges deal with a huge disparity in the amount of stipend paid to them when compared with their colleagues in the Government medical colleges.

In fact, there is difference in the stipend that is mentioned in pen-and-paper and the amount that is actually paid to the medicos. As per the data presented by the medicos in their letter (a copy of which is with Medical Dialogues) to the Health Minister, Thrissur-based Amala Institute of Medical Sciences pays probably the highest amount its interns, i.e. Rs 12,500 per month.

However, in several other medical colleges including the Pushpagiri Medical College, Mount Zion Medical College, and Al Azhar Medical College, there is a difference in the amount that is mentioned in the paper and the actual amount that the medicos receive.

Among these, the medicos belonging to the Al Azhar Medical College are one of the least paying house surgeons as they get an amount of Rs 3,500 per month as their stipend (Stipend on paper Rs 8,500 per month).

Reportedly, the erstwhile Medical Council of India (MCI), now National Medical Commission (NMC) had in a public notice in 2019 had directed that all the students pursuing their compulsory rotating internship from their parent institutes would be paid an amount of stipend on par with the stipend paid to the State/Central government medical colleges. However, this direction was never published as a gazette notification. In fact, such a stand by MCI became weaker once the NMC replaced the earlier Apex medical body MCI.

The issue apparently became more problematic with the recent draft regulations by the Apex medical education regulatory body, NMC. Medical Dialogues had recently reported that the National Medical Commission recently issued the Draft Regulations For Rotational Compulsory Regulations, 2021.

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

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 apparently further complicated the matter as now the Private institutes seem to have autonomy over the decision regarding the amount paid as stipend to the MBBS interns in the respective colleges.

Speaking to Medical Dialogues regarding the issue, an intern doctor at a private medical college said on the condition of anonymity, "We work equally as the doctors in Government medical colleges, we have received the same education as them and yet there is a severe disparity in the amount of stipend paid to us. Only the amount paid by the Institutes run by the Christian Management is around Rs 10,000. The rest of the medical colleges are paying a meagre amount starting from Rs 3,500, which is around Rs 100 per day."

"Although several Students' Bodies including KSU, ABVP and IMA-JDN have extended their solidarity to us, the issue is yet to be resolved. We have tried for several times to reach out to the Health Minister in Kerala. However, the Government is unwilling to interfere in the matters of the Private medical institutes," he added.

When asked about their future plan of action, the MBBS student said, "Although we do not want to get involved into any kind of violence, we are planning on holding a pre-strike as a token protest in front of the Government Secretary as the Government is unwilling to provide support to us regarding the matter."

"If the Government pays attention to our problems and help us solve the same, then it will be for the best. Otherwise, we will be forced to arrange strike in all the private medical colleges," he added further.

Meanwhile, IMA-JDN has extended its support to the MBBS students belonging to the Private medical colleges in Kerala. "IMA JDN ardently stands in solidarity with the oppressed interns/house surgeons of #Kerala & demands that the issue be resolved at the earliest & rightful demands of Kerala drs be heard by the concerned authorities," the association mentioned in a Tweet.

While commenting on the issue, Dr. Arjun, associated with the IMA-MSN, Kerala, said, "The MBBS interns in private medical colleges are afraid to reveal their identities as this might result in strict action against them by the management of the private medical colleges."

Opining that the NMC Draft Regulations have further complicated the matter, he said, "the Draft Regulations have mentioned that the fees would be fixed by the fee fixation authority of the Institute, University or State. Now, the fee fixation authority of the Private medical colleges would be at liberty to pay any amount of stipend to the MBBS interns."

K.V.Babu, a public health professional based in Payyannur seems to have a similar opinion regarding the matter. Speaking to The Hindu, he opined that draft regulations dated April 21, 2021, of the NMC on the issue of internship and stipend are vague and give ample opportunity for the private managements to deny stipend to MBBS interns.

"I have responded to the public notice inviting suggestions on draft regulations of the NMC. I have suggested that the provision on stipend be redrafted that the students of private medical colleges be paid stipend on a par with the amount being paid to the interns of the State/ Central govt. medical institutions," he further added in this context.