NMC to review bond policy: Chance to do away with penalties, lengthy processes? MBBS students across states, experts opine

With the ongoing agitation of MBBS doctors in Haryana against the state's bond policy, medical associations across the country have pointed out the flaws within the policy not just in Haryana, but in other states as well. The Union Health Ministry is reportedly creating guidelines to do away with the bond policy for doctors.

The bond policy requires doctors to work for a specified period of time in a state-run hospital after their graduation and postgraduation course is completed. Doctors who fail to do so have to pay a penalty (amount specified beforehand by every state and union territory) to the state or medical college. Doctors and medical students, however, state that the policy was formed when doctors were in deficit. "It was done to ensure that enough doctors join government jobs. But now jobs are in deficit. Many students get the required degree but are not able to secure jobs," said Dr Karan Juneja from Indian Medical Association (IMA) Junior Doctors Network Haryana.

Meanwhile, PTI reported that the effort to scrap the bond policy for doctors has been taken up by the Health Ministry following the recommendation of the National Medical Commission (NMC). The NMC, in its comments, stated that since the promulgation of the bond policy by the various states, much has changed in medical education in the country and therefore, it may be worth reviewing the merits/effectiveness of this policy by the various states, as per the report by PTI.

"The NMC submitted its detailed observations. In view of its observations and notwithstanding the observations of the SC upholding the legalities related to the bond policies of the state governments, the commission was of the considered view that medical students should not be burdened with any bond conditions and doing so may run contrary to the principles of natural justice," PTI quoted the person familiar with the matter.

What are the students and experts from the medical community going through currently? What are their present concerns? EdexLive talks to them to find out.

Karnataka
In accordance with the Karnataka Selection of Candidates for Admission to Government seats in Professional Educational Institutions Rules, 2006, MBBS students in the state are required to, upon the completion of the course, serve in any Primary Health Center or Primary Health Unit situated in rural areas in the state for a minimum period of one year, failing which, they have to pay a penalty of Rs 10 lakh to the government. "They have now increased the amount to Rs 25 lakh, which is a huge amount. Although one year of service is reasonable for learning purposes, the government has to increase the salary given during the bond period. We also have families to take care of and loans to repay," said Dr Jyothi Ramegowda, Chairman, IMA Medical Students Network. She added that an increase in salary amount will serve as an incentive for doctors to fulfill the bond conditions.

However, Dr Jyothi also highlighted that medical facilities in government hospitals in rural areas, where the doctors are posted during the bond period, are not up to the mark. "If a student has opted for a specialisation in gynaecology, it is difficult to practice because proper hygiene is not maintained in operation theatres in these areas. It is also possible for the patient to get infected. In some cases, proper washroom facilities are also not provided to these doctors," she added.

Rajasthan
Similar is the case with Rajasthan. "PHCs in such rural areas do not have the basic set-up for doctors to practice. By posting them in such areas, it is a waste of their skill and talent," said Dr Rajshekhar Yadav, state-level convenor of the United Private Clinics and Hospitals Association of Rajasthan (UPCHAR). The state government has reduced the bond policy period from five years to two years and the penalty to fulfil the bond condition has also been reduced from Rs 25 lakh to Rs 10 lakh (for the 2019, 2020 and 2021 batches). However, doctors continue to feel that the penalty amount is high. "Government should instead ensure that every doctor gets a job and scrap the bond policy," said Dr Rajshekhar. He informed that from the 2022 batch onwards, doctors have to serve for two years with a penalty of Rs 25 lakh, whereas the same for in-service doctors is five years with a penalty of Rs 80 lakh.

In fact, the Jaipur Association of Resident Doctors (JARD) have been protesting since October against the bond policy of the state, which they say is being "imposed" on them. In a letter dated October 3, they stated, "There has been a lack of transparency in the bond policy framed by the state government; several candidates after clearing the diploma posts will be appointed as senior residents that reflects a major flaw in the policy. Also, the resident doctors have been struggling without a five month income. The bond policy was supposed to start before the examination this year and is now six months late, which is a mid-period for all the resident doctors."

Consequent to this, several medical associations, including the Resident Doctors Association at AIIMS, Delhi, showed solidarity with them. "The PG batch 2019-22 resident doctors worked tirelessly during Covid-19 pandemic. Now, they have neither been posted for their service as per the bond policy nor have they been issued their degree certificate to avail other secondary options in their career," they stated in a letter dated October 11. With no guarantee of continuous employment and experience certificate, the government is forcing qualified doctors to occupy substandard posts, "causing a serious underutilization of human resources thus loss to the society," they added.

Andhra Pradesh
As per the AP Government Order MS 251, students who enroll for the course from the academic year of 2022-2023 should execute a bond, promising to serve the government for one year. They are required to join the service within 18 months of completing their courses. A rs 40 lakh penalty will be slapped on PG students and Rs 50 lakh on super-speciality medical students if they violate the conditions of the bond. However, doctors in the state opined that the bond service adds to the lengthy process of the completion of their medical education.

"We have to complete our MBBS, internship and PG, which takes about 10 and a half years along with preparation for the respective exams. Some even take up a super speciality course which adds another three years. After this, if we are being asked to serve a bond period, this will add to the lengthy process," said Dr Kartik Nagula, a member of the Junior Doctors Association. "Moreover, sometimes people come from other states like Kerala and if they are placed in peripheral districts with limited resources and infrastructure, they face problems with the culture and language. It is useless to have such knowledge if there is no resource," he added.

Assam
However, some doctors also point out that they are not against the concept of the bond policy. "The policy that Assam follows is good as it doesn't stop students from pursuing higher education if they want to. This is beneficial for the doctors and the patients as well," said Dr Syed Faizan Ahma, National Vice-President of All India Medical Students' Association. He stated that bond policies allow the opportunity to improve services in remote areas. As per the information obtained from the website of the Directorate of Medical Education, candidates must complete one year of compulsory rural service or five years of state health service after their MBBS course.

Moreover, all the PG degree/diploma candidates in Assam medical colleges after completion of their course shall work in secondary and tertiary care government hospitals of Assam for a period of one year. "This policy is also not compulsory. If students wish to get 50 per cent state quota in PG seats, then they must fulfill this condition after their MBBS course. It is a good step as it doesn't tie up the students. The government has not stopped students from pursuing higher education in the name of the bond policy," said Dr Syed. The bond policy must exist, but it should work towards the benefit of both the doctors and the patients.

On the other hand, students of the Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS) in Rohtak continue to protest against Haryana's bond policy. Dr Karan informs that the state set the worst condition for the policy with respect to the hefty amount and the IDBI Bank's intervention. The students are expected to meet the CMO today, November 25, to discuss their demands.