Resident doctors, medical interns and final-year medical students have once again been put on COVID-19 duty after the Prime Minister’s decision last week — a move that the medicos have been protesting since last year. It was also announced that the National Eligibility and Entrance Test (Postgraduate) has been postponed and that the exam will not be held before August 31. This is the second extension of the NEET-PG entrance exam after it was slated to be held in January 2021.
When the Union government announced that resident doctors may be ‘utilised’ until fresh batches of PG medical students join, the Karnataka Association of Resident Doctors (KARD) termed it as a “black day for resident doctors of India” and said the measures were “unscientific, irrational, unwarranted and uncalled for.”
The resident doctors — those who are currently pursuing their post-graduation — have been staffing COVID-19 wards since the last year. These junior residents, especially those who have finished their final year and are continuing to be kept on for COVID-19 duty, are questioning why they cannot be promoted to senior resident doctors, and paid on par with their peers in other states. Various federations of resident doctors have raised this issue across the country as well.
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— Karnataka Association Of Resident Doctors (@karnatakarda) May 3, 2021
Dr Dayanand Sagar, the president of KARD, tells TNM that they are getting their stipend on time, but are not considered for a risk incentive or an allowance despite work in COVID-19 wards for the last year.
“Many resident doctors on COVID-19 duty are testing positive for coronavirus. As per Union government guidelines, anyone who is exposed to risk is entitled to a risk incentive or allowance. That has not been considered yet,” he says.
According to Dr Dayanand, Karnataka has one of the highest tuition fees in the country, which they are paying. He says they are considered as students, but their education is not taking place during this duration.
Incidentally, since health is a state subject, the stipends are decided by the state and not by the Union government. Junior residents receive a stipend of Rs 45,000 in Karnataka. However, in some states and in central government institutions, this is nearly double. These are people, Dr Dayanand points out, who have families to take care of and are in their late twenties.
Additionally, medical interns (final year MBBS students) and junior residents haven’t been given a separate place to stay. Currently, some stay in crowded hostels with common bathrooms or are at home, exposing their parents to the risk of contracting the disease in the process.
Dr Dayanand says they need recognition for their efforts, as many like him have already worked as junior residents for three years. Their final exams, however, have been pushed for now.
“We worked as junior residents for three years. We should now be promoted as senior residents, but they are not doing that. That is exploitation. That is forcing someone to work even if they don’t want to, beyond their tenure. Whether I voluntarily work or not should be my decision. They have our degree certificates and other original documents, so we have to work. If they extend the tenure without taking my consent, that is exploitation,” he said.
He adds that at least provisionally, it must be declared that junior residents have completed three years of work, and be made senior residents.
While those like Dr Dayanand are being made to work despite completing their three years, doctors such as Dr Sharon Fredrick are waiting to enter the system.
Dr Sharon is a NEET-PG aspirant, who took a year off to prepare for the exam in order to take it in January. Now, with the exam being pushed to August 31, there are many like him who are ready to enter the system and are available as trained doctors but can’t, because the exam has not been held.
“Hospitals would have got at least 50,000 junior residents on board. Instead, they are keeping final year post-graduation students like bonded labour and extending their term,” he says, terming the move ‘illogical’.
The Union government said that individuals who provide a minimum of 100 days of services in COVID-19 management will be given priority in upcoming government recruitments and a “samman” (Prime Minister’s Distinguished Covid National Service Samman) from the Union government. For medical interns, Solicitor General Tushar Mehta had told the Supreme Court that there could also be an incentive by way of grace marks in the NEET-PG exam.
“The government is threatening students saying if they come for a 100-day COVID-19 duty now, on a contractual basis, they will give us samman and that may help us get some grace marks in the exam. It can be misused. Every day, the government, through their illogical decisions, is playing with our lives as well as depriving patients of quality healthcare,” says Dr Sharon.
Dr Dayanand questions if all medical interns and resident doctors who have been on COVID-19 duty for the last 400 days or so would even be considered for this.
Dr Sharon adds that extra marks would create an uneven playing field because not every state is witnessing the same intensity of cases. “This would lead to a disadvantage to those who belong to states that don’t need extra resources,” he states.
He adds that many students have financial commitments and took a year off to study for the exam, but it has now been pushed by over a year-and-a-half. “They [the government] are not even consulting with the stakeholders and arbitrarily deciding things. It negatively affects patients as well,” he says.
“If the NEET-PG exam was held earlier this year and doctors were allowed to join as junior residents, it would have elevated a lot of stress, at least in tier-one and tier-two cities. A lot of those places are not staffed because a lot of students took leave for final year exams, which, too, is not happening currently,” he adds.
Final year MBBS students, the government said, can be roped in for teleconsultation and to manage patients with mild COVID-19 symptoms. “They have had zero clinical exposure. Expecting them to manage mild COVID-19 cases is cruel. The attitude is that they are just used to fill manpower requirements,” Dr Sharon says.
It is important to note that final-year MBBS students are currently not being paid for this, and it is unclear if they will be provided allowance.
The previous batch of medical interns, who worked for a year after finishing MBBS, were thrown into COVID-19 duty just a month into their internship, which is when the pandemic began.
For interns like Dr Gayathri, who completed the internship in February 2021, payments were only released once every three to four months. “There were interns who could not afford to get it four months late as they had to send money back home,” she says.
“We were never given any risk or COVID-19 allowance. There were announcements, but there was no number on it,” she says, adding they did not demand it as it was a crisis. But now, it has been over a year.
Additionally, at the beginning of the pandemic, interns who tested positive for coronavirus were given quarantine facilities, but that, too, was gradually discontinued. Day scholars, who live at home, still do so with the risk of infecting their parents, she adds.
Now, since completing their internship, these doctors have no idea on the way forward.
“They [the government] don’t let us know what they are going to do to us. Because they have our certificates with them, they can do whatever they want. It has been four months since we completed the internship, but we still have no idea on what next,” she says.