When Dr Manish Arya (30) and seven batch mates graduated from the paediatrics department of the state-run Grant Medical College in 2009, only Arya and two others chose to continue working at the public hospital.
Five opted for private practice, and now, two of those who stayed back are also thinking of moving to the private sector. Public hospitals are undeniably the best training grounds for doctors because of the sheer number of patients that go there, but very few medical graduates choose to stay back after completing their studies.
“I want to super-specialise. To do that I need experience, which one can only get in a public hospital,” said Arya. But once they’ve gained this experience, doctors move to the private sector for its higher salaries and more manageable workload.
At KEM Hospital’s psychiatry department, to cite another example, only one of the four resident doctors stayed back last year. Dr Sangeeta Ravat, professor, and head of the hospital’s neurology department, said that during her 16-year stint there, only one student has opted to stay on.
“The offers from the private sector are so lucrative one really has to believe in the nobleness of the profession to remain attached to a government hospital,” said Dr N N Ramraje, president of the state and city chapters of the Maharashtra State Medical Teachers’ Association.
Although doctors at public hospitals are now paid salaries recommended by the Sixth Pay Commission, on average, these are still much less than what private practitioners can earn.
In a public hospital, for teaching as well as treating patients in the Out Patient Department (OPD), a professor with at least 10 years in medical practice, gets a monthly salary ranging from Rs 90,000 to Rs 1.2 lakh.
In the private sector, a doctor with half that experience can easily earn Rs 2 lakh to Rs 3 lakh a month. “Money, by and large, is the main reason most young doctors opt for a private job,” said Dr Atul Goel, head of KEM Hospital’s neurosurgery department.
Dr Sachin Mulkutkar, associate professor at Grant Medical College, joined the hospital in 1997. For 12 years, he was not a permanent employee, so he took half the normal salary and was not eligible for allowances or leave.
“Had I switched to a private medical college, I would have become a professor by now, earning more than Rs 1.20 lakh a month,” said Mulkutkar, who now earns half that amount in the government hospital.
The OPD of surgery at Sion Hospital sees 150 to 200 patients every day. There are six to seven doctors who handle this workload. At KEM’s neurology department, the patient numbers are similar but there are only four doctors to see them. The same departments at any private hospital see a maximum of 10 to 15 patients in a day.
“Besides the shortfall of doctors, our government hospitals do not have enough nurses and peons, which forces resident doctors to do work such as arranging bottles of blood and changing drips,” said a senior doctor who did not wish to be named.
Besides money, transfers also deter doctors from staying on in the public health system. For instance, a senior woman doctor working as associate professor in the medicine department at JJ Hospital was transferred in November 2008 to a small village near Nanded town.
She has been on medical leave since, and has stopped reporting to work, said another senior doctor. Last year, another doctor from the paediatrics department resigned after he was transferred to Latur. He now works as a professor with MGM Medical College in Navi Mumbai.
“We have made repeated representations to the government to make the transfer policy more viable and logical,” said Dr Ramraje of the medical teachers’ association.
Some doctors also find the government system far too politicised. At civic-run hospitals, doctors complain of political considerations interfering with promotions and postings.
“I moved out of the public hospital not because of money but because of the unhealthy work culture,” said Dr Reshma Dhillon Pai, a gynaecologist with Jaslok and Lilavati hospitals.
“If you are a doctor working with a state-run hospital, chances are, you will be spotted in Mantralaya more often than in your cabin,” said another doctor who did not wish to be named.
Lack of teachers
In Maharashtra, 184 of the 1,173 lecturer posts in the 14 state-run medical colleges-cum hospitals, or 16 per cent of the total posts, are vacant. At Mumbai’s JJ Hospital, six posts of professors, 46 posts of associate professors and seven posts of lecturers are vacant.
“In the past 14 years, medical seats have reduced drastically because there aren’t enough teaching staff,” said
Dr Ramraje. The government’s process of filling these vacancies is so slow that for a job advertisement that was out in 2006, exams were conducted only in 2008 and the results are still awaited.