It is a well known fact that most young doctors passing out of medical colleges in the country are reluctant to work as government doctors and look out for more lucrative options in the private sector, where often the pay package is more and the work culture more corporate like. The situation turns grim when it comes to rural postings, which most youngsters are reluctant to join. Though different state governments have made rules from time to time, mandating rural postings for a certain period of time, the outcome is not very encouraging.
Gujarat is no different from the rest of the country when it comes to dearth of doctors for government hospitals. It was informed by the government in the state assembly that of 2,653 MBBS students who passed out from government-run medical colleges since 2020-21, 70% or 1,856 have not joined government-run facilities. These students get subsidised medical education in government colleges and in return they have signed a bond to serve for one year in the government-run health facilities – primarily in rural or remote areas.
At a time when the state government is planning to increase healthcare infrastructure at district levels, the shortage of medical officers (MO), who are generally these MBBS pass-outs, may affect the human resources availability, said experts.
The data, shared by state health department in response to questions by Kirit Kumar Patel, MLA from Patan, and Dinesh Thakor, MLA from Chanasma, also indicated that out of 1,856 doctors who have not joined service in government-run facilities, 70% or 1,310 are yet to pay the bond amount that stands at Rs 65.4 crore.
Senior health department officials said the bond system ensures that government-run health facilities get assured supply of health professionals. About five years ago, MBBS students had to sign a bond of Rs 1.5 lakh for the three-year service. During the Covid period, the system got an overhaul and currently the students have to serve for one year at a government-run facility chosen by the health department or pay Rs 10 lakh as bond amount. The postings are often in remote locations or rural areas at public health centres (PHCs) and community health centres (CHCs).
Out of the 872 graduating MBBS students, 57% did not join the service in 2022-23. The ratio was higher at 75% and 84% in 2020-21 and 2021-22 respectively. “One of the reasons for not joining duty and paying bond amount could be students opting for medical PG course. A procedure is already in place to recover the pending amount from the students who have not served the period,” said a senior health department official.
The numbers, however, indicated that some of the districts attracted relatively fewer number of doctors compared to others. In 2022- 23, out of 57 doctors assigned to Chhota Udepur with a predominant tribal population saw 34 not joining, whereas the arid Kutch region saw 43 out of 61 opting out. Experts said the trend forces the population in several such pockets to travel far to get basic medical procedures, increasing the burden of the hospitals in cities such as Ahmedabad and Surat. Doctors say one of the major reasons is unclear policy of the government and the fact that such appointments are seen as “punishment posting”.
Right from human resources to medicines, the junior doctors face issues, and some consider it a waste of time due to lack of learning curve, said a doctor.