People start streaming into the outpatient ward before sunrise, even though doctors will start seeing patients only after 7.30 am. By noon, the doctors would have seen a hundred patients. Even the outpatient surgery wards are full, and patients are attended to by doctors on multiple 24-hour shifts. This is a recurring pattern in all government hospitals in Tamil Nadu.
The state is touted to have one of the most resilient public healthcare systems in India, but the doctors running the system are overworked with long shifts, spread thin and cannot get the government to fill the vacancies. Many finish a 24-hour shift only to stay back for emergency cases, paperwork and teaching responsibilities—pressures that pushed them to announce a strike on March 5.
Coming just three months after the nurses’ strike, the nascent doctors’ strike at Chennai’s Rajeev Gandhi Government General Hospital was quickly snuffed out. Talks with Health Minister Ma Subramanian failed, and the doctors were refused permission to conduct a strike on the hospital premises. But doctors say they have only postponed the strike.
Among the key demands by the Federation of Government Doctors' Associations (FOGDA) are the creation of additional posts in the government hospitals, revisions to pay structures and promotion policies, and the restoration of doctor posts that were removed in 2018.
Tamil Nadu has 1,48,217 doctors registered with the state medical council. Of these, 21,567 work in the public health sector. According to the 2011 census, the state had a population of 7.21 crore. Population estimates of 2023 place the figure at around 7.69 crore.
Around 65.1% of TN households use government healthcare, according to
The National Family Health Survey 5 (2019-2021). At the same time, the burden on tertiary care hospitals has increased sharply. Between 2021-22 and 2024-25, patient load in the tertiary healthcare sector rose by 49%.
With increasing patient load and no creation of additional posts, doctors are struggling to handle their responsibilities and feel the government has been unresponsive to their demands.
What are the demands?
One of the central demands relates to the review of Government Order 354, passed in 2009, during the Dravida Munnetra Kazhagam (DMK) government under the then chief minister M Karunanidhi. The order introduced a time-bound promotion system for medical officers, replacing promotions based solely on vacancies.
As per the order, doctors are eligible for promotions after 10, 15 and 17 years of service, along with corresponding pay revisions. However, doctors say the policy has not been periodically reviewed as promised by the government at the time. Periodic reviews are meant to increase the number of posts or the pay and promotional possibilities of doctors based on workload.
“Following strikes by central government doctors, provisions were made for promotions after four years, nine years, 13 years and so on. When we took out a similar strike, the GO was passed but in a diluted form, giving promotions after eight years, 15 years, 17 years and so on. Along with the GO, we were also promised a periodic review of the provisions and promotions on par with the union government doctors," Dr A Ramalingam, convenor of FOGDA, said.
One way to get a promotion was when a vacancy opened up in higher postings. However, the National Medical Council, in 2019, relaxed the minimum standard staffing requirements by the GO 4D (2). Following this, around 1,500 promotional posts were removed, which meant that there were fewer posts to be promoted to.
The association demanded the recall of this 2018 order that reduced around 1,500 doctor posts. They are also calling for the creation of new posts to address growing patient loads in government facilities.
Doctors say that the introduction of new health schemes, along with preventive care against vector-borne diseases and vaccinations, in addition to seeing patients, has increased their workload tremendously. Doctors want the government to pay the Rs 3,000 stipend it had announced for the increased workload.
“The demands go back to around 2017. When we protested in 2019, then opposition leader MK Stalin assured us that once he came to power, the demands would be implemented. These measures would not place a significant economic burden on the state,” said Dr Shanthi Ravindranath, secretary of the Doctors’ Association for Social Equality.
Shanthi maintains that staffing shortages have significantly increased the workload of doctors across the public health system.
“The current number of posts is based on a population which has not been revised in almost two decades,” she said. “After the COVID-19 pandemic, more people are turning to government hospitals, partly for economic reasons. Even the Health Minister has spoken about increased footfall in government hospitals. But the number of doctors, nurses and paramedical staff has remained largely the same."
Overwhelming patient load
While the state’s overall doctor-to-population ratio stands at one doctor per 486.7 people – well above the World Health Organisation’s recommended ratio of one doctor per 1,000 people – the majority of these doctors work in the private sector. The public health system, which handles almost two-thirds of the state’s healthcare needs, is managed by just around 14.6% of registered doctors.
Doctors working in government hospitals say the result is an overwhelming workload.
“In the surgery outpatient ward alone, we see around 100 to 150 patients every day,” said a general surgeon at Government Medical College and Hospital in Sivaganga district. “We have 22 doctors in the department, and each doctor typically sees around 30 patients between 7.30 am and 12.30 pm.”
Beyond outpatient consultations, the doctor also performs surgeries and teaches medical students as part of his responsibilities.
“Since this is a medical college hospital, we also have to teach undergraduate students. In addition, there are paramedical courses like lab technician, operation theatre technician, and radiology courses. We take classes for those students as well," he explained.
Government doctors also have to pull 24-hour shifts, often multiple 24-hour shifts in a month, depending on the availability of staff. “At present, we have 22 doctors in our department. Eight months ago, we had only 13,” the surgeon said. “Now we do about two to three 24-hour shifts a month. When we were fewer in number, it was three to four such shifts every month.”
Each 24-hour shift is compensated with around Rs 300 and a day’s leave. However, doctors say the leave often becomes nominal.
“If emergencies come in after the 24-hour shift ends, we have to attend to them. There are also reports to complete and administrative work. Many times I end up leaving the hospital only around noon on what is supposed to be my off day,” he said.
Doctors in understaffed specialities such as obstetrics and gynaecology may have to perform such shifts six to eight times a month.
Structural issues within the health system
Doctors also criticise the government’s approach to expanding medical colleges. According to them, several district headquarters hospitals have been upgraded into medical colleges without a corresponding increase in staff strength.
“When a hospital becomes a medical college, then the campus expands and the number of beds increases,” a doctor at Salem government hospital said. “But, instead of increasing the number of doctors and nurses, the government often redeploys staff from existing hospitals.”
This transfer of doctors and nurses from other facilities to fill positions in the newly upgraded institutions leaves gaps elsewhere.
Recent regulatory changes have also influenced staffing policies. In 2025, the National Medical Commission relaxed the minimum faculty requirements for government medical colleges. Doctors say the state administration has cited this change to maintain existing staffing levels without creating new posts.
Concerns about staffing shortages extend beyond doctors. Nurses and other healthcare workers in Tamil Nadu have also staged protests in recent years over understaffing and increasing contractual employment within the public health system.