Mental health, Well-being Woes: What are the Five Issues that Resident Doctors Are Fighting For?
New Delhi: Representatives of the resident doctors recently highlighted their demands before the National Task Force of the National Medical Commission (NMC), which is currently considering the issues affecting the mental health and well-being of medical students including the resident doctors.
The Task Force, which will submit its recommendations soon, recently held a meeting with the stakeholders including the undergraduate and postgraduate medical students, faculties and the parents of medical students to discuss the issues.
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. 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.
During the meeting, the representatives of the resident doctors' associations across the country highlighted the issues and the requirements to make the residency period better for PG medical graduates.
Also Read: Responses Pour in for NMC Task Force Meeting on Mental Well-Being of Medical Students
Here are the five things that the resident doctors in India are currently fighting for:
Leave/Vacation for PG Students:
One of the major objections and concerns raised by the resident doctors is regarding their inability to avail leave during the period of residency. Due to the huge work pressure in the hospitals where they undergo residency, they fail to avail the leave benefits. The resident doctors allege that because of this, they do not have any work-life balance as they do not get time to spend with their families.
Medical Dialogues had earlier reported that the newly notified Post-Graduate Medical Education Regulations (PGMER) 2023 specified that post-graduate medical students would get a minimum of 20 days of paid leave (casual leave) per year. Apart from this, these new regulations further mentioned that the resident doctors would also be allowed weekly holidays, maternity leave and paternity leaves as per the Government rules and regulations.
While this move was welcomed by the resident doctors as it specified a minimum number of leaves granted to them, due to the immense pressure in the medical institutes, the doctors still complain of being overworked, which ultimately affects their physical and mental health.
Raising this issue, Dr. Prajwal R, a 3rd PG Student and a representative from RDA, PGIMS Rohtak, informed the NMC in its recent meeting about the requirement of granting vacation to the resident doctors. He said that giving vacation to the PG students will allow them to visit their families or do something they like which ultimately helps them mentally.
In his written representation to the NMC National Task Force, he wrote, "Medical students endure tremendous pressure and stress as they juggle academic responsibilities, clinical rotations (including night duties and emergency services), research commitments, and personal obligations. The demanding nature of medical education often leads to burnout, anxiety, and depression among students, impacting their overall well-being and academic performance. It is needless to say to what an asset PG medical student, who work as full-time resident doctor in the institution they are serving and they contribute significantly to the health care system of state across the nation."
"The initiation of vacation to PG students would go long way in relieving mental health of PG students and allow PG student to spend quality time with family and loved ones who travel long distance for pursuing medical education, additionally enable him to improve the understanding of medicine and it would reflect on overall wellbeing of patient care," he further mentioned in the letter.
Moreover, in the meeting, the president of the NMC PG Board, Dr. Oza had clarified that 20 days of leave mentioned in the regulations is the minimum number of days of leave that should be granted. However, it can be much more in any specific institute.
Regulation of Duty-Hours:
Resident doctors in medical colleges often complain of being overworked and sleep-deprived due to long duty hours. 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 the 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 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.
Recently NMC addressed the issue of working hours for the resident doctors and in this regard, the PGMER 2023 mentioned that all post-graduate students will work "reasonable working hours" and they will also get "reasonable time for rest in a day".
Therefore, no specific duty hours were mentioned by NMC in its regulations. Recently when the NMC National Task Force asked the stakeholders to submit their responses regarding the issues they faced, a doctor referred to the PGMER 2023 as vague and unjustified. Seeking clarity, the doctor from Jharkhand mentioned that apart from hospital duty, the resident doctors also need to do academic work. Therefore, the doctor suggested that the NMC regulations should specify an eight-hour daily duty and a maximum of 48 hours weekly duty.
Highlighting the issue of unjustified working hours, a first-year ENT resident claimed that in their college, the working hours are excessively long i.e. 14 hours on regular days. She alleged that the duty hours get extended up to 38 hours on duty days and the students do not get off even on Sundays, as they are required to work until noon or later for camps. As per the PG medico, while the NMC guidelines advocate for giving the resident doctors a day off weekly, the rule does not get implemented and those requesting leave face criticism.
"We lack time for eating, sleeping, and health check-ups. Raising concerns is dismissed with the excuse that this is typical for postgraduates, and NMC guidelines are not strictly followed," said the doctor.
Good Health:
Resident doctors have time and again highlighted that they remain sleep-deprived and do not even get time to eat or undergo health check-ups due to the long duty hours. Apart from this, they are always exposed to possible health hazards as they are the first line of contact with patients suffering from numerous ailments.
Highlighting the requirement of good physical health for the residents, Dr. Aviral Mathur, the president of the Federation of Resident Doctors Association (FORDA) recently mentioned in his written submission to the NMC National Task Force that the resident doctors should be granted Risk Hazard allowance "for damages/ diseases contracted in the line of duty and a provision of a mandatory health service card to them."
During the NMC meeting, Dr Mathur also urged the authorities to ensure that CGHS/DGHS facilities are also extended to resident doctors.
Also Read: From Ragging to Stipend issues: Here's what was discussed at NMC Task Force meeting today
Salary/Stipend:
One of the major issues that the resident doctors face is the inadequate amount of stipend they receive. While the residents in the government medical institutes comparatively get better salaries, the PG medical residents undergoing residency in private medical colleges often complain about not getting a proper stipend. Sometimes they allege that even though they are paid on paper, a huge amount or the full amount is later retracted by the institute.
Medical Dialogues had last year reported about the glaring disparities in the amount of stipend paid to Undergraduate and Postgraduate medical students across the country. As per the data regarding the students admitted through the National Eligibility-cum-Entrance Test Postgraduate (NEET-PG) examination 2022, which is available on the official website of the Commission, there were glaring disparities in the stipend paid to the Junior Resident doctors across the country.
The data revealed that the minimum amount of stipend (Rs 20,000 or less than Rs 20,000 per month) is paid to the resident doctors pursuing their postgraduate medical education in medical colleges located in States like Karnataka, Punjab, Rajasthan, and Uttar Pradesh.
Meanwhile recently releasing the final Post-Graduate Medical Education Regulations, 2023 (PGMER 2023), which were published in the official Gazette on 29.12.2023, the National Medical Commission (NMC) introduced uniformity in the amount of stipend paid to the PG medicos in a particular State/UT.
The Commission specified 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. However, despite the NMC directive, residents from several private medical colleges complain of not getting enough stipend.
After the Supreme Court took cognisance of the issue of stipend paid to the medical students, NMC recently gave a deadline to the medical colleges to submit the details of the stipend paid to their UG Interns, Post-Graduate Residents, and Senior Residents or PGs in Super Specialty for the financial year 2023-24.
NMC provided a similar annexure for the details of the stipend paid to the medical students for the academic year 2024-2025. Further, in this regard, the Commission had directed the concerned colleges to update these details on the website of the institute every month (by 5th of every month). The colleges had been asked to submit the complete statement to the NMC at the end of each financial year.
Also Read: Uniform Stipend for all PG Medicos in a particular State, UT: NMC
Freedom from Bond:
Another issue that often troubles the resident doctors is the imposition of bond conditions- both service bond and seat leaving bond. While the seat-leaving bond is imposed on the students to discourage them from discontinuing their medical course and the consequent 'wastage' of medical seats, the service bond was introduced to ensure the availability of doctors in rural areas.
Earlier this year, the Apex Medical Regulator NMC had already directed the State/UT governments to reconsider the seat leaving bond conditions for the PG medical students.
The Anti-Ragging Committee of NMC had recommended the State/UT to review the seat-leaving policy in medical colleges in an attempt to address the mental health concerns of PG medical students. Earlier,t as an alternative, NMC had recommended that the States consider debarring the students for admission in their States for the next year.
This issue of the seat-leaving bond was raised during the recent NMC meeting. Dr. Rohan Krishnan, the National Chairman of the Federation of All India Medical Association (FAIMA) pointed out how the issue of the seat-leaving penalty puts pressure on the medical students and opined that there should be a free exit.
Also Read: Breaking News: NMC Asks States to do Away with Seat leaving Bond
Earlier, the Supreme Court had suggested that there should be a uniform security bond amount across the States. The top court bench comprising Chief Justice of India D.Y. Chandrachud, Justice Hima Kohli and Justice J.B. Pardiwala had opined that the students who join the medical courses often come from humble middle-class backgrounds and therefore, there should be uniformity regarding the bond amount for vacating the seats.
Regarding the imposition of service bonds, Dr. Aviral Mathur mentioned in the NMC National Task Force's meeting that during the District Residency, the doctors are catering to the district hospitals. Therefore, he pointed out that DRP is substituting the bond service to some extent and suggested that considering this fact, the tenure of the bond service should be reduced.
In a written representation to the Task Force, Dr Mathur highlighted the requirement of "Formation of an Indian Medical Services cadre, who will better understand & be solely responsible for the bureaucratic and administrative decisions and redressal of complaints BOND FREE MEDICAL EDUCATION- A pertinent issue which has been the cause of contention and protests in many states recently. There should be a uniform policy decision on the same."
Meanwhile, in the meeting, NMC Secretary Dr. Srinivas clarified that NMC is not in favour of bonds. However, pointing out that this is a State issue, he mentioned that NMC cannot enforce it. He also added that NMC recommended to the Ministry that the bond should be removed.
