Budget Dreams

Respected Sh Arun Jaitely ji

Medicos Legal Action Group Trust seeks your indulgence to go through our prayer for the upcoming budget 2018-19 on behalf of doctors of the country. There is an urgent need for innovative intervention in the field of healthcare failing which the situation is fast slipping out of hand.

Problems;

1) There is severe shortage of infrastructure and posts for MBBS Doctors to work in rural or urban area Primary Health Centers (PHCs). Total vacancies for MBBS doctors wanting to work in PHCs are about 2700 and total MBBS graduates who pass out 60000 plus every year. About 24000 take up postgraduation, 2700 join rural service , similar number join other Government jobs and the remaining about 50% of MBBS graduates remain unemployed seeking to go abroad for better opportunities, or change their profession or remain underemployed and used as human resource fodder by large medical establishments for years with no advancement.

2) Lack of Specialist Doctors in rural / semirural / small towns in private and Government service.

3) Corporatization and Commercialization of medical education and medical practice

4) There is cadre of Foreign Medical Graduates who are unemployable because they have not cleared the exam held by NBE. A similar army is now sought to be created by introducing Exit Exam for MBBS graduates through the NMC Bill.

Solutions

1) There is an urgent need to increase the number of Primary Health Centres in the country from the current 28000 approximately with simultaneous increase in number of posts for MBBS doctors to work in these PHCs from the current 30000 approximately. This needs additional funds with an annual outlay of Rs 10000 crore to be earmarked for atleast a 150% increase in both infrastructure and human resources for rural / urban primary health care. This focus on primary healthcare will give dividends many times over that given by establishing new AIIMS surrogates.

2) The lack of specialists Doctors can be tackled by appointing those with training and experience but not the requisite qualification in area of need. These Designated specialists should be authorized to provide specialist care. Today thousands of physicians and surgeons with years of training and experience in superspeciality and speciality fields are being denied right to work in the speciality concerned by the MCI as well as the courts through their judgments. A procedure of distinguishing Designated vs qualified specialist may be incorporated giving an appropriately higher pedestal to those who have training as well as qualification in the concerned speciality or superspeciality. This may even reflect in the salary structure of the two cadres. However permitting an MBBS or MD/MS with adequate training and experience to practise in the particular speciality will ease the dearth of specialists felt acutely in some areas.

3) There is also urgent need to give tax benefits to Small and medium Healthcare Establishments that set up in areas of need. Giving benefits only to hospitals with more than 100 beds has not given the desired benefits to the nation.

4) There is also urgent need to free small and medium healthcare establishments (SMHCE) of upto 50 beds from irrational statutory requirements both in urban as well as rural areas. Yes it is ideal if all nursing homes and hospitals have a 10 KV solar power generator or a path all around the building for a fire tender to go around but small set ups do not permit luxury of so much space to fullfill such requirements. Redundant laws not applied even in Government buildings, courts which have footfalls of 10000 persons per day are unnecessarily imposed on small 250 sq yard houses where medical services are being provided to maybe 10 patients per day. These are stifling and forcing closure of SMHCEs in the country which allows healthcare to shift to corporate hospitals.

5) Investment into Government medical colleges has to be increased to prevent commercialization of medical education because if medical education is commercialized there is no way medical profession will not be commercialized.

6) Those who have graduated in modern scientific medicine either in India or abroad and have not cleared the licentiate exam need to be permitted to work in hospitals under supervision till the time they are permitted independent practicing rights.

We understand that some of the issues raised and their solutions suggested do not relate to Ministry of Finance or may require other ministries to be involved. However Budget is what sets the tone for the path chosen by the Government towards issues facing our country and signals in the budget can bring about a systematic change even from other ministries which is what we want.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
Sco 1066-67 , Sector  123 New Sunny Enclave Mohali
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