Rural Service After MBBS

One year service in rural areas after a 5.5-year MBBS is a year too much to qualify as doctors?

In its zeal to produce more doctors to serve in rural areas the government is mooting the creation of a special medical course with reduced duration. It has also implemented the inclusion of one year compulsory rural service in regular MBBS courses. While the idea of serving in the rural areas is a good one the move is being resisted by certain quarters of the medical fraternity. 

Medical students have gone on strike opposing the expansion of the duration of the medical course which now becomes 6.5 years (4.5 years study+1 year internship+1 year rural service). Though some medicos are against the idea of serving in the rural areas sans any experience and specialisation after freshly graduating they are nevertheless willing to go ahead if the salary and facilities are bettered. But what the medicos have opposed to unanimously is the increase in the time taken to become a doctor. 

The general feeling is that the medical course in India is already lengthy. Usually a medico completes MBBS course at the age of 23-25. The duration of a post graduate degree is three years. Doctors with post graduation degrees are able to set up practice and support their families only when they approach or cross 30 years of age. They spend 2-3 years more than an engineer or other professionals. 

But the pressing need of the hour is to get more doctors to the rural areas as nearly 75 per cent of our population which is based in the rural areas do not get adequate healthcare. One of the reasons of this is the non availability and absenteeism of doctors there.

Is an alternative rural medical course a good one?

The other option is to fulfil the demand of rural healthcare by shortening the duration of the medical course and introducing a new course for rural healthcare. This is not a better alternative than having doctors with regular MBBS qualifications. Offering such a shortened medical course would be like reviving the old Licentiate Medical Practitioners (LMP) medical course. 

It is the considered opinion of many senior health professionals including Dr Ambumani Ramadoss, the former union health minister, that any attempt to shorten the medical course would make a mockery of the medical practice and end up generating more quacks.

Moreover, why should rural Indians be treated by less competent medical professionals? They have every right to be treated by full-fledged doctors who have studied for a full five and half years in a medical college. If a doctor posted in the rural areas has a post graduate degree it will be even better.

Nearly 75 per cent of the Indian population is treated by health professionals who do not have a proper degree from an allopathic medical college. The current doctor patient ratio is 1:1700 and the proposed plan could bring it down to 1:700, somewhat close to the recommended WHO ratio of 1:300.

The regular MBBS course was spread out over five and half years after much deliberation and debate. Even nurses have to study for four years before starting to work.
To meet the WHO target the sensible option is: effect an influx of qualified doctors in the rural areas.

More salaries and incentives to serve in rural areas

There is a point in the medicos’ grievance but it is also equally a legitimate demand to have these students pay back the state which spends Rs 20 lakhs on each graduate. Serving for one year in the rural pockets is one way of repaying their unsigned debt.

Of course, the doctors should be well rewarded for spending one extra year serving the rural areas. The health ministry has taken steps in this direction and is offering more salaries as well as 10 per cent extra weightage for each year of service in the rural area for post graduation courses. The extra weightage could go up to 30 per cent for a maximum of three years of rural service.

The good news is that fresh MBBS doctors have welcomed this move. In states like Kerala 407 doctors have signed up for rural service in a single day. Assam has notched up a figure of nearly 800 doctors for a single day. Along with the weightage for post graduation courses, a monthly salary of Rs 25,000 and free accommodation seems to have worked.

It is a different moot point altogether whether doctors should go after the completion of their MBBS course or later when they gain more experience in treating patients. But, if we want to deliver good healthcare to the rural population then more doctors must serve them. One year in the service of needy people is not going to be too much if the doctors are compensated well and appreciated for their dedication.