Docs leave ailing hospitals

For when it comes to salaries these doctors get little more than what arts and commerce teachers are paid see box. Says Dr Bharat Dalvi, who recently resigned from KEM after 21 years of service, 8220;There is a discrepancy between pay-scales in private and public sectors the world over, but it is only here that a senior doctor cannot afford even a one-bedroom flat in Mumbai after putting in years of service.8221;

Said Dr Ranjit Nagpal, a consultant at Jaslok Hospital, 8220;When I joined KEM 30 years ago, hospitals like JJ, KEM in Mumbai and AIIMS in Delhi were considered the best.Today, a VIP will rather go to Breach Candy or Jaslok where there are state-of-the-art facilities. Public hospitals barely fulfill the minimum requirements of health care, and have no desire for progress.8221;Regulations like the one introduced in 1985, stipulating that only post-graduates can join as lecturers, deter fresh graduates who could earlier do their post-graduation simultaneously. Says Dr Nagpal, 8220;Most young doctors opt for super-specialisation in their fields. But when government hospitals do not have the necessary equipment, doctors feel that their knowledge is being wasted and opt for private hospitals.8221; Having spent the best years of their career in a government set-up, most doctors are hesitant to quit as they feel it is too late to establish a private practice.

Says Dr Dalvi, 8220;Complacency sets in as full-time doctors are taken as permanent staff. There is no check on honoraries at all. Some honorary doctors visit hospitals just once a month!8221; He suggests that a contract system be introduced for some posts, and doctors be allowed to practise privately after completing six years of government service. Incidentally, fiveIndian states have already permitted private practice by government doctors. It8217;s the same story with promotions. Unlike in the private sector, upward mobility here depends on the years of service put in, not necessarily efficiency.

Lecturers and half the number of associate professors and professors are appointed by the Public Services Commission, and the remaining 50 per cent seats are filled by departmental promotions. In the last nine years, there have been no promotions in Maharashtra. A post meant for a reserved class candidate remains vacant even when an open merit candidate is available. In the years 1977, 81, 84, 85 and 87, almost every government doctor was randomly transferred within the state. Most of the transferred staff quit. The beneficiaries of this trend were private medical colleges, which these doctors joined, and at higher salaries to boot.

Dr Sharma says this exodus is not restricted to Mumbai alone, but applies for institutes like the AIIMS, Delhi, Christian Medical College, Vellore, Kasturba Medical College, Manipal, Shrichitra Institute of Medical Sciences, Thiruvanathapuram, and the Sanjay Gandhi Post-graduate Institute, Lucknow, among others.

Unless the state government upgrades the pay structure or introduces new rules permitting private practice, it seems as though government doctors will continue to move in the direction of the more lucrative, better equipped private institutions.