Dr Aviral Mathur, Senior Resident, Lok Nayak Hospital, Maulana Azad Medical College (MAMC), who was recently appointed as the new President of Federation of Resident Doctors' Association (FORDA), shares his views about recent issues related to the medical field.
Studying medicine in India has become increasingly difficult as a consequence of regular fee hikes in private colleges, the fierce competition, the violence that the medical community is at the receiving end of sometimes and the lack of timely stipend payment. On these matters, we sought the opinion of Dr Mathur, who seemed to get his words right for everything. He also emphasises how a work-life balance for doctors is very crucial and referring to the late payment of stipend for doctors, insists that they assert their rights by following “no pay, no work.”
NEET is a very competitive exam, what do you have to say to those who don't make it? What other options can they go for?
NEET UG witnesses more than 10 lakh applicants and although seats have increased, the number of candidates has increased too.
However, students have other options like Allied Medical Speciality courses, BDS and other general courses. Students can also choose AYUSH courses. I see so many people exploring Ayurveda and Homoeopathy as an option. I am amazed by the number of students joining these courses. Additionally, Bachelor’s and Master’s courses in related fields like Microbiology, Pharma and Physiology courses are also an option.
There are basically three kinds of students: The serious kind; the sincere kind who are unsure how desperately they want it and finally, the one that sits just for the sake of it and takes no interest in what they are studying, The first kind will not stop at anything less than MBBS, the second will qualify NEET but will have to settle for private colleges where the fees are exorbitantly high. The students who somehow manage to arrange for resources, take a seat there, so that is another option for students who are unable to make it to government medical colleges. The third kind go for shorter courses where they can get to the market early. If they pursued Math in high school, it opens up more fields for them.
Few students also opt for countries like Sweden, China and Ukraine to pursue their MBBS. And for that, they have started coming under fire, for example, the ordeal of students who came back from war-torn Ukraine. What do you have to say about that?
Like I said, there is the first adamant kind who will not settle for anything less and they will crack it. The second group who aren’t able to dedicate themselves as much land up in Sweden, Norway, Ukraine, China and Russia. This is mainly because of the high college fees for medical courses in private colleges here. In Russia, a student can pursue their entire course in Rs 10 or 20 lakh, as opposed to Rs 80 lakh or higher that it would take in India.
These students can complete their education there and when they come back, they have to clear only one exam known as the Foreign Medical Graduate Examination (FMGE) to become eligible to practise medicine here. Also, private colleges in India are in far off places, in the outskirts somewhere, so, for a fresh school pass out who grew up in a metropolitan, it becomes too difficult to adjust. There they prefer to get out of the whirlpool of spending too much and prefer foreign degrees. The mindset in India is that going abroad to study makes one an exceptional student, but that is not always the truth. This student who is going to Sweden or Ukraine could have very easily done their course here but unfortunately, that would cost them a fortune.
What about the quality of education? Which is better — Indian private colleges or foreign colleges?
That varies from college to college. There are many private colleges in India like Kasturba Medical College, Manipal and then Jolly Grant Medical College, Dehradun — these are really good private colleges for MBBS. The education system is good and they teach in a holistic manner with a very good patient footfall. Thus, while there are private colleges proving their worth, there are others that aren't even comparable to medical standards.
As for foregn medical degrees, I know quite a few students who returned with a degree from abroad and joined a government college for their PG course. So, their education must have been really good. However, I have noticed that these students are theoretically more sound and students from India are practically more sound.
What do you have to say about the Indian medical students from Ukraine who were initially promised assistance but are still stuck here? Do you think they can be integrated into government colleges?
To integrate them in the Indian education system might not be possible. The education systems are structurally very different in different places. ENT (Ear, Nose and Throat) is one subject that Indian students study from their third year onwards, while in Europe, they do it before third year, but then again in Russia it will not be taught until their fifth year. So this is a policy decision.
We trust the National Medical Commission to make a logical decision and they must have had deliberations before they made their decision.
Junior Doctors and others have had to face a lot of violence and harassment over the years. We have seen instances in the recent past as well. What steps have been taken by the government to ensure their safety?
It is basic to demand security in case you feel threatened. Such professional hostility is not conducive to a positive change and if you feel threatened while you are on your duty, you demand protection. All branches of any profession that deal with the public, witness this situation. Hence, we cannot demand a special act just for us doctors and instead, we are now demanding programmes and awareness campaigns by the government which can educate and sensitise people. So far, we have done this at the institution level and are in talks with the government.
What about the Supreme Court case, wherein, pleas were filed challenging NMC's circular on government college fee for 50% seats in private medical colleges? Is this really possible, what the NMC is proposing?
It should be possible, rather, it should be made possible. Pursuing a medical degree in India has become a deterrent for Indian students because of the high fees. This should be changed and we welcome this change. I personally feel this should be enforced and implemented pan-India instead of just certain parts.
Recently we saw protests at Osmania Medical College in Hyderabad, Telangana, regarding unpaid stipend for over seven months and similar situations were also witnessed in other medical colleges in the country over the years. What would you say is the root cause of this and what do you think can make the government a little more proactive?
Yes, I just had a conversation with someone about how the doctors at a Haryana college are receiving their stipends at an interval of three months. There is no difference between government or private colleges, both are doing this to their doctors and it is really unfortunate. I feel terrible as a resident doctor myself when I hear or witness these incidents. A resident doctor is already 25 years old and some of them are often older. At this age, working so much with each shift being 24 or 48 hours long along with paper work!
The basic needs that they look forward to is their daily sustainability and a good night's sleep. This issue prevents students from working hard as they are unable to reward themselves. The work needs to be in balance with the reward and this is basic for every human being. Not receiving one’s salary when they are working so hard can make the person mentally and financially sick. On off days, they cannot afford to go out. Few doctors have responsibilities at home or a student loan to pay back, so, this issue is of utmost seriousness.
When such incidents happen, we write letters to the head of the institutes for them to take the issue up with the higher authorities, however, if the head is not responsive we write directly to higher authorities like the ministries. When the higher authorities are also not bothered, we have no other option but to halt the work. During the NEET PG counselling last year, when doctors halted work and were on strike, the Supreme Court gave the ruling saying, “No work, no pay” and the salaries of doctors were deducted for going on a strike for their basic rights. Thus, there should also be a ruling that would say “No pay, no work”. That is what we stand for.
Like you said, the job of a doctor is very stressful with 24-48 hours shifts. How can young medical doctors cope with the stress of the profession? Do you have a message for them?
It is important for doctors to strike a balance between their social and professional life. I never advocate that doctors should take up a 24 or 48 hours continuous shift. I would advise them to always take time off, maybe go watch a movie, spend time with family and learn to unplug. It is very crucial that you unplug and rejuvenate yourself. I also recommend mindfulness, meditation, eight to ten hours of sleep and hanging out with friends.
A doctor taking a little bit of time off for himself or herself won’t affect the overall health status of a country. Infact, it is the government who should improve the infrastructure to incorporate more doctors. The issues you raised today are all linked together, a doctor is stressed and overworked because there are not enough junior doctors, there are no junior doctors because they went abroad to study, they went abroad because the fees are high and doctors here are prone to facing violence; and this overworked doctor, in reality, was the one that belongs to the first category of students who scored top ranks and worked the hardest to reach this place.
