Ground Reports

Doctors threaten pan-India strike, Government constitutes panel, invokes ESMA

The delay in conducting admissions to the first-year postgraduate medical courses has rattled the junior doctors across the country. It is causing problems not only for those who are waiting for seats to be confirmed, but also for those who are already pursuing the degree.

By Rohin Kumar, 2 Dec 2021

Resident Doctors bodies have been consistent in written communication demanding the National Eligibility cum Entrance Test (NEET)-Post Graduation (PG) counselling be kicked off at the earliest, with the Union Government, Ministry of Health, National Medical Commission (NMC) and even the Chief Justice of India (CJI) has not yielded any significant breakthrough, forcing doctors to suspend all routine and non-emergency services including Out Patient Department across the country.

“We are severely understaffed and working at two-third strength. Soon, final year students will be having exams and would go on exam leave, which means only one batch of resident doctors would be managing the entire workload. This is totally unfair and unacceptable. We need a new batch of Residents as soon as possible,” Dr. Suvrankar Datta, General Secretary of Federation of All India Medical Association (FAIMA) told MoJo.

“We had been waiting for the Supreme Court verdict for a long time and even at the last hearing when the government asked the court for a four weeks time to respond to the query. Now the court has listed the hearing for January 6 of the next year. It is a tremendous delay as we don’t know when the verdict will be passed and NEET PG counselling will start. It is already now a one-year gap when a fresh batch of residents haven’t been inducted into the government system,” Dr. Dutta added.

The curious case of NEET PG

National Eligibility Entrance Test- Post Graduation, popularly known as NEET PG, is a qualifying and ranking examination in India, for students who wish to study various postgraduate Doctor of Medicine (MD), Master of Surgery (MS) and diploma courses, in government or private medical colleges in the country.

The Supreme Court of India is hearing a batch of petitions challenging the government and medical counselling committee notice issued in July, providing a 10 percent quota for the Economically Weaker Section (EWS) category in All India Quota (AIQ) NEET PG admissions. The petitions also argue issues like breach of the 50 percent quota threshold directed by a 1992 Supreme Court ruling, lack of study and justification on the EWS reservation criteria, and the government decision on EWS reservation in admission through NEET.

According to the legislation ratified by the Indian Parliament in January 2019, a general category student or candidate whose family income is less than Rs 800,000 per year is eligible per the EWS reservation. This income includes income from all sources i.e. salary, agriculture, business, profession, etc. for the financial year prior to the year of application. The students are opposed to this ‘wide-range’ of income consideration by the government in determining the EWS category for NEET-PG, as it is based on the theory of “excludes all” claim petitioners.

In October this year, when the top court asked the centre if they would like to revisit the EWS annual income slab, to which in an affidavit filed by the Ministry of Social Justice and Empowerment, the government said, the principle of fixing the income slab is rational and in accordance with Article 14, 15 and 16 of the Indian Constitution.

After the continued deliberations by the doctors, in the last hearing on November 25, the government informed the Court that it was willing to revisit the 8 lakh income limit set for determining EWS reservation category in NEET-PG, and sought four weeks time for the same

Indefinite strike till the demands are met

On December 1st, the Federation of Resident Doctors Association of India (FORDA) in a letter addressed to the Health Minister Dr. Mansukh Mandaviya intimated “withdrawal of all routine services by Resident Doctors in healthcare institutions across the nation from December 3rd onwards.”

FORDA categorically said, the Resident Doctors have waited patiently for a long time for concrete measures to be taken by authorities for fast tracking the Supreme Court hearing and expediting the NEET-PG 2021 counselling and admission process. Overburdened Residents are “physically and mentally distressed” observing the delay in on-going proceedings, said the letter.

“A delegation also met the Health Minister Dr. Mansukh Mandaviya with the letter of demands. The Health Minister assured the delegation that a decision would soon be taken within 02-03 days but there has been no progress yet,” said Dr. Rajendra Gupta, associated with FORDA.

After meeting with the union minister FORDA on November 27, had said that the protests would not be escalated further as of now and that the association would wait for a positive outcome of the proceedings. However, until the filing of this story, no “positive outcome” has been intimated hence, FORDA has said that it would be forced to suspend all routine services from December 3rd.

It’s an undeniable fact that government hospitals across the country are running short of skilled workforce. In answer to the Lok Sabha in 2018, the Ministry of Health and Family Welfare, referring to the National Health Profile (NHP) said, “There are 1,14,969 Allopathic doctors serving in the Government across the country and an average population of 11,082 is served by one allopathic doctor.”

While the government doctor (allopathic) to population ratio in states is more worrying. In Bihar, the government doctor (allopathic) to population ratio is 1:28391, 1:19962 in Uttar Pradesh, 1:18518 in Jharkhand and 1:16996 in Maharashtra, to name a few.

A significant part of this workforce is managed by Resident Doctors across the country. The pan-India strike could have unmeasurable bearings to public health considering the new COVID-19 variant Omicron already capturing global attention. Hence, FORDA warned, “With the possibility of future COVID-19 pandemic wave looming large, the situation will be disastrous for the healthcare sector with its bearing on the country’s population.”

Federation of All India Medical Association popularly known as FAIMA Doctors Association too said that with nationwide consultation of RDAs, FAIMA has reached to a unanimous consensus that the “RDAs and Junior Doctor Associations (JDAs) across the country will go on the complete shutdown of elective services from December 1st.” The protests would continue “till a written statement mentioning the date of judicial hearing or commencement of counselling is issued from competent authority.”

FAIMA earlier had also written to the Chief Justice of India (CJI) requesting to fast track the judgement on EWS-OBC reservation in All India Quota and expedite the admission and counselling process for session 2021-22.

Pan-India endorsements pouring in

The call for suspension of regular services by FORDA and FAIMA Doctors Association has been endorsed by various Resident Doctor associations spread across India. State Resident Doctors bodies in several states have already gone on indefinite strike and halted the elective services including OPD services December 1st, while the other RDAs including the ones in Delhi would completely halt non-emergency services by December 3rd.

Resident Doctors Association of Maulana Azad Medical College (MAMC) said, “This is very unfortunate that we have to adopt the method of protest to get our voice heard and even after meeting the Union Health Minister giving his verbal assurance of resolving the issue within 03 days, there has been no show of positive intent from the government.” MAMC Resident Doctors would be “boycotting all OPD and associated services from December 3rd.”

RDA Safdarjung Hospital, Guru Teg Bahadur Hospital,   too has called for suspension for all non-emergency routine services. The stir is not just related to the national capital but Resident Doctors in various states namely Chhattisgarh, Punjab, Tamil Nadu, Uttar Pradesh, Goa, Madhya Pradesh, Telangana and others have been staging continued protests, demanding expediting the NEET PG counselling.

Earlier, the Junior Doctors Network of the premiere doctors body Indian Medical Association (IMA) too had appealed to the government to protect their young colleagues from immense burnout and stress and that delayed hearings are costing careers of thousands of young doctors. They had also warned that if immediate measures are not taken to expedite NEET PG counselling, they would be forced to shut down elective services.

Centre revisits income limit, Goa prohibit strikes 

Soon after the government sought four week time revisit the income slab, the Ministry of Social Justice and Empowerment announced the formation of a three-member committee, comprising of Former Finance Secretary Ajay Bhushan Pandey, Member Secretary ICSSR Prof VK Malhotra and Principal Economic Advisor to the Indian government Sanjeev Sanyal.

The committee would review “the criteria for determining the economically weaker sections in terms of the provisions of the explanation to Article 15 of the Constitution” and will send its recommendations to the Union Government in the next three weeks.

Fearing the protests, the Goa government invoked the Essential Services Maintenance Act that prohibits protests. An order issued by Home Department, Government of Goa, dated November 30th, maintained that in the exercise of powers conferred upon it “by sub section (1) of Section 3 of Goa Essential Services Maintenance Act, 1988 and being satisfied under public interest it is necessary to do so, hereby prohibits strike in any form in all sections/units of Goa Medical College and Hospital with immediate effect.” Goa Congress condemned the decision, calling it “unconstitutional” and “undemocratic.

Soon after the government order, the Goa Association of Resident Doctors (GARD) called off the strike and instead, would be working with black arm bands as a mark of protest. “The lack of support from the government, which invoked ESMA, is disheartening. We had called for the withdrawal of only OPD services and other facilities, be it in wards, casualty etc would not have been hampered,” said Dr. Pratik Sawant, President, GARD.

According to the MoJo sources in the Ministry of Health, “The government is already prioritising the NEET PG case and a committee is formed to review the income slab. The committee is expected to submit its report before the winter leave and the court hearing is scheduled for January 6. So, it’s not like the government is not prioritising. If the resident doctors go on strike, the government might be forced to invoke special measures (possibly ESMA).”

Dr. Manish, President FORDA, met the Union Health Minister told MoJo, “The Health Minister said that the government would come up with a solution in next two to three days. He also said that the government would prepone the court hearing but what we have only got is ‘committee’. The meeting was a complete eyewash.”

“The elections are never delayed, not even the local body elections, but the government always delays hearings and decisions related to education matters. NEET PG counselling is one such case impacting thousands of doctors. The gross injustice doesn’t just stop here. Even the final year students working as Senior Residents are being paid the salaries of Junior Doctors. They are exhausted and need immediate support,” he added.

If the government invokes ESMA, what would be FORDA’s next step? “The government can do anything they want. However, we have not suspended the emergency services and only the routine services. In case they do something like that (invoking ESMA), we will understandably decide the next course of action.”