August 12, 2021 2:26:08 pm
Resident doctors in six government medical colleges went back on strike on Thursday, a day after they had resumed only emergency and Covid-19 duties following an assurance from Deputy Chief Minister Nitin Patel, who is also the state Health Minister, that their demands would be looked into by a committee.
The doctors have revised their demands, seeking that their residency period of one year after completion of the three-year post-graduate education be counted as part of the compulsory medical bond service on lines of Maharashtra.
What issues are the doctors facing?
As the second wave of Covid-19 brought with it an uncontrollable surge of cases burdening hospitals, the Gujarat health department on April 12 issued a Government Resolution (GR) stating that for final year postgraduate students (resident doctors) who took admission in 2018, the residency period would be extended by three months and would be counted as part of bonded service in a 1:1 ratio, that is, one day of residency duty equals one day of bond service.
Residency is a year-long specialised training after three years of the post-graduate programme. It is also mandatory if one wants to apply for teaching positions.
In Gujarat, students admitted through state quota seats are also mandated to serve a year-long medical bond period as rural tenure, which is separate from the residency period. However, as per the GR, residency service came to be equated as bond service.
The GR also stipulated that those who have completed necessary academic requirements are appointed as specialist PG doctors for medical bond service for 11 months as Class-1 officers at district and taluka-level hospitals, where they have to work for a year as part of their bond conditions at a salary of Rs 80,000 per month. For this service, one day of duty will be counted as two days of bond service.
However, on July 31, the Gujarat health department issued a second GR revoking the April 12 one and stipulating that the medical bond service period will be counted on par with non-Covid times of 1:1 ratio. The new resolution was to be deemed effective starting August 1.
This change in the provision resulted in protests by Junior Doctors’ Associations (JDA) in six government medical colleges — Ahmedabad, Vadodara, Surat, Rajkot, Jamnagar and Bhavnagar. After making representations to their college administrations with their demands to reverse the decision on August 3, resident doctors went on an indefinite strike on August 4 until their demands were met.
The Government Resolution
The April 12 resolution did not set a clear deadline on the special exemption provisions it had formulated, and for how long the same would be applicable.
As the state has repeatedly reiterated through Chief Minister Vijay Rupani and Deputy CM Nitin Patel, the special provisions were brought into effect to encourage resident doctors to chip in during the Covid surge. Since there are fewer patients now in hospitals, their services are required to be regulated as per normal pre-Covid times.
Notably, for those who were admitted in post-graduation courses in 2017, a similar GR with 1:2 ratio was implemented in July 2020, and since the GR remained effective throughout the year, the earlier batch did not have to deal with a sudden change in norms. In case one does not wish to serve the mandatory bond period, they can forfeit an amount of Rs 40 lakh to relieve themselves of the bond conditions.
During the second wave, however, the government had halted the option of forfeiture of the bond of post-graduate and superspecialty practising bonded doctors, resulting in the doctors moving court.
What are the other issues plaguing doctors?
Another grievance is that resident doctors had to forgo time to prepare for higher studies as they were involved with Covid-19 duties, which they had agreed to owing to the incentives the April GR had provided.
Apart from demanding 1:2 bond service duty, the resident doctors also demanded they be paid in accordance with the 7th Pay Commission.
A contention of the resident doctors on strike has also been that their rural postings, as part of medical bond at primary or community health centres, stymie one year of their career as they graduate with specialised degrees and the same cannot be put to any use at primary-level health centres. Due to this, they are demanding that they be allowed to serve their bond period at tertiary centres or medical institutes.
After Nitin Patel said on August 10 that genuine issues would be addressed if the strike was withdrawn, the doctors have come forth with only one demand — that their residency period be equated with the medical bond service period.
Why are only six medical government colleges involved in the protests?
The clause of a mandatory bond service in post-graduate medical education is valid only for the six government colleges. Newer medical colleges by the government are set up now through the Gujarat Medical Education and Research Society (GMERS), which are self-financed institutions with fees running in lakhs per year, as against the six government medical colleges where the fees are heavily subsidised.
Why is it critical to resolve this strike?
Around 2,000 resident doctors, 1,150 intern doctors and over 500 senior resident doctors had joined the protests. They had found support and solidarity from the Indian Medical Association Gujarat chapter, Ahmedabad Medical Association and the Gujarat Medical Teachers’ Association. Political opposition leaders, mainly from the Congress, had also extended their support. Despite Nitin Patel repeatedly saying medical services and treatment will not be affected by the strike, planned surgeries had to be postponed at some of the government medical college-affiliated hospitals.
Resident doctors also complained that while they were ready to come to the negotiating table, government authorities did not give them time as they were busy with celebrations for the completion of five years of the Chief Minister Vijay Rupani-led government in Gujarat.
Additionally, as a third wave of infections looms large, it is imperative for the government to resolve the issues. The health department, as it is, is short of staff; there are several vacancies in sanctioned posts, especially at health facilities, including at district and sub-district hospitals. The government submitted to the Gujarat High Court in July this year that there are as many as 1,000 vacancies, and “there is a dire shortage of specialists in the district and rural areas”.
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What is the government saying?
Talks between resident doctors and the government are underway. Earlier this week, the government threatened resident doctors with coercive action, and even cut off access to hostels in Vadodara and Jamnagar. On Tuesday, it justified its actions, saying the protesters were no longer students but specialist doctors. The government has urged doctors to report to their designated sites of deputation and mark their attendance.
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