Sunday, April 20, 2008

The resident doctors strike and the commercialisation of medical education

The newspapers have been full of articles about the recent medical students and residents doctors strike in Maharashtra ( which has just been called off). Reading about this strike makes me cry - but not because I think doctors should not go on strike ! Let me explain.

Medical students are going to be the doctors of tomorrow. They enter medicine because they want to help other people ( and yes, they also make money in the process, and I think it's perfectly justified for them to do so !) . Sadly, the conditions under which they work are so miserable, that their resentments and grievances keep on festering; and when they find no one is willing to listen, the only option they have left is to go on strike. Now this is not something which future doctors do lightly. Doctors have a conscience, and the fact that patients may get hurt when they go on strike is a major deterrent for residents. The major focus for residents and students is their education and they want to complete this as expeditiously as possible so they can get on with becoming doctors. Also, it's possible for the government to take punitive action ( such as cancelling their registrations), so going on strike can have serious repercussions . It takes a lot of guts to go on strike !

The tragedy is that these strikes seem to have become regular affairs - and they fail to achieve their purpose. I remember going on strike 20 years ago; and these seem to happen every 3-4 years. The strike is called; the newspapers report this; the politicians and bureaucrats promise to take corrective action so that the strike is called off; but nothing happens, so that the residents are forced to call for another strike after a few years.

The trouble is that it's a very uneven and unfair battle. Residents come and go, because once they complete their training and become doctors, they move on. Unfortunately, government bureaucrats remain forever, so they are formidable opponents, whereas residents are unarmed and inexperienced in these confrontations. Also, the media usually supports the government, because they highlight the adverse effect these strikes have on the poor patients who avail the services provided by government hospitals, which means the public is full of sympathy for the poor suffering patients - and they have little compassion for the suffering medical residents. Unfortunately, there is little unity amongst doctors, so practising doctors do not provide the stroking residents with any support. The biggest tragedy is that the medical professors and teachers , who are supposed to nurture the next generation of doctors, also fail to support them with the result that the strike fizzles out very quickly, and never achieves its purpose.

What was the reason for the present strike ? The medical students and residents were agitating over the fact that the number of recognised postgraduate posts for specialistion in medicine in the government hospitals in Maharashtra has been progressively declining because the government has not bothered to upgrade the teaching facilities; employ the required professors; or get the needed recognition from the Medical Council of India. The authorities have promised to "look into the matter" in order to settle the strike, but it's very unlikely that they will do anything more than paying lip service.

The reason is simple. Along with the declining number of government postgraduate seats, there has been a corresponding increase in the number of private medical colleges in Maharashtra , which are now mushrooming all over the place. These private colleges offer "recognised" medical training for which they charge a fat fee, which means they are extremely profitable to run. And the vast majority of these are owned by politicians in the state. 8 cabinet ministers in Maharashtra own their own medical colleges today ! Not only are these highly profitable ( which is how rich politicians become even richer) - they are also a great way of providing favours for sons of influential and well-connected businessmen and doctors. This is the real reason why there is absolutely no political will to try to improve the sad state in government medical colleges today. After all, if ministers are spending all their energy on getting recognition for their own private medical colleges, why should they care about what happens to the seats in government medical colleges ( which offer serious competition for them ! )

All of us are silent bystanders. Today, it's the medical students and residents who are suffering. Tomorrow, it will be all of us who will pay the price for our inaction and lethargy, because the quality of the doctors which are being turned out is going to drop dramatically as a result of this privatisation of medical education. I guess we will get what we deserve - and we only have ourselves to blame !

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