After a gruelling two years of the COVID pandemic, medical teachers from the Grant Medical college in JJ Hospital, Mumbai, went on strike starting January 5th. For over two months, they demanded regularisation of their services and the implementation of the 7th pay commission, which would mean standardised salaries and timely promotions.
The situation in medical colleges and hospitals that are run by the Maharashtra government point to discrepancies in budget allocation and implementation for medical colleges, when other central and BMC run hospitals provide better working conditions for medical practitioners and teachers.
The working conditions coupled with the depleting perception of medical education in India has led to a shortage of medical practitioners in the public healthcare sector.
The strikes point to gaps that have larger implications for medical education in Maharashtra.
What do doctors want?
The 7th pay commission, established by the central government, was supposed to be implemented nationwide in 2016 but has not been implemented in Maharashtra yet. Post-COVID, this has been a major setback for medical teachers and doctors who are struggling for deserving services.
Those on strike described how, even after putting in hundreds of hours during the pandemic in hospitals where they have been working for 4-5 years, many younger doctors have still not been established as permanent employees and continue to be employed in ad hoc arrangements. This deprives them of salaries appropriate to their work, timely increments and leaves. Regularising medical work would allow them these.
Despite many appeals, most medical teachers have not been made permanent employees in hospitals, citing issues about a halted supreme court judgement. So far, only 700 teachers across all the state hospitals have been absorbed into these government institutions through earlier regularisations, points out Dr Sachin Mulkutkar, HOD of Physiology Department in the Grant Medical College of JJ Hospital and head of the Maharashtra State Medical Teachers Association (MSMTA).
“The decision to make employees permanent is entirely a political decision, and it only requires a nod from the Cabinet Ministry,” said Dr Sachin.
Salaries are still remunerated according to the older 6th pay commission. Additionally, state government hospitals also get some grants and allowances in the form of PG allowances and academic allowance recharge, which have also remained the same since 2008. In sharp contrast, in central institutions like AIIMS, PG allowances and academic allowances have increased tremendously. “We didn’t demand a hike during the COVID-19 pandemic, even though our doctors did some extraordinary work, but now that things have started opening back up, we urge the state to review this,” Dr Sachin added.
Dr Amit Lomte of JJ Hospital also points out, “Private hospitals offer job security, high salaries, and promotions every 3-5 years. Even BMC hospitals fare pretty well, due to allocation of large budgets; State government hospitals should work similarly to provide equal perks to all doctors. This will make the medical profession more appealing to the youth and mitigate the shortage of doctors in the long run.”
More hospitals but no doctors
Government colleges are infamous for their mass transfers of doctors to other rural government hospitals. According to the doctors, tertiary care institutions in the state are facing a huge resource crunch. New hospitals are being made in rural areas without recruiting new doctors. “Doctors are just being moved around from one hospital to another,” said Dr Amit, which he feels “is not the solution to filling gaps in the medical labour force”.
“The state government is assigning budgets for building new hospitals, but they’re not assigning a proportionate amount to recruit new doctors,” he added.
Paucity and misuse of funds
In this year’s civic budget, the BMC allocated Rs 4,700 crore towards healthcare for a little over 70 municipal hospitals, and multiple PHCs, while the state budget for healthcare this year is Rs 12,500 crore for over 3239 state PHCs, CHCs, Sub-Divisional Hospitals all combined. Doctors in BMC hospitals are getting paid 3-4 times that of state government hospitals. Evidently, state government hospitals are not adequately funded.
A CAG report in 2020 found that the state misused funds that were meant to upgrade medical colleges to increase intake in postgraduate courses. 11 government medical colleges (GMCs) were part of the central financial assistance scheme that has been running since 2012 that was meant to upgrade GMCs.
Rs 195 crore was allocated to this scheme, out of which the GMCs had spent Rs 177 crore. The target was to create 692 more post-graduate seats when in reality only 79 seats were created in 8 years.
Funds for research also elude the government hospitals. “State-funded medical hospitals have no grants for research, none,” said Dr Sachin. “In private colleges and some central institutions like AIIMS, there is a grant of at least one lakh per academic publication.” Research is heavily incentivised in such institutions to cultivate a culture of innovation, which is imperative to open new frontiers of scientific knowledge.
In 2017, the Indian Council of Medical Research (ICMR) could not name a single research intervention in the public sector in terms of drug, vaccine or a diagnostic test in India. Which points to a glaring issue at hand – the lack of funding for medical research.
According to Dr Amit Lomte, regularisation of medical staff has been in the talks since July of 2021, with authorities affirming that changes will be made. Most of the paperwork is also done, everything now only depends on the decision of the ministry. T P Lahane, who was the Director of the State Medical Education Department before the current Director Dr. Deelip Mhaisekar was appointed in 2021, was also involved in the process. But in Dr Amit’s words, “We are simply being given false promises for years now.”
In March when the protests were at their peak, the doctors had demanded a time bound assurance of demands being met. Upon which the Medical Education Department issued a letter notifying that the MSMTA representatives will meet with the Chief Minister to discuss the issue. It was said that six non-compounding increments will be provided to public healthcare practitioners and soon the same rule will also apply to the Medical Teachers Department.
“So far no demands have been met. Medical teachers continue to work ad hoc and remuneration remains low,” said Dr Amit.