When I was doing my medical house surgeon-ship in Mangalore a few years ago, Karnataka government was planning to implement compulsory rural service for house surgeons in the state. This news was not taken in a positive light by the doctors which eventually led to numerous protests by doctors across the state, and I was one of them. Before you start grilling me, let me admit that I was a different person back then, and had other aspirations.
Now, coming to the present scenario, I’d like to believe that my values and ambitions took a drastic change. However, I still feel there are some valid reasons for doctors to refuse working in rural areas. Here are some of them:
- Medical Education Curriculum
The design of medical education in India is simply not for healthcare in villages. The training is primarily geared towards tertiary care, which basically means a multi-specialty hospital setup with numerous specialists. The only subject which gives an emphasis on rural healthcare is community or social medicine, where we had a two-month long rural posting, and it wasn’t enough.
In a nutshell, the government wants to send a doctor trained to work in a multi-specialty hospital, to a rural hamlet in the middle of nowhere. How does that make any sense!
- Lack of Infrastructure
Now, for a minute, let’s assume that all doctors are enthusiastic to work in rural areas. It is still the responsibility of the government to build adequate infrastructure for the rural clinic setup. However, the reality is far from what it is supposed to be. Every other day, I hear about inadequate medical facilities, lack of staff and absence of basic amenities for the staff in the Primary Health Centers (PHC) across the country.
- Corruption in MCI (Medical Council of India)
Ah, the good old friend of all problems in India. There is massive corruption across the Medical Council of India(MCI), the governing medical board of the country. Addressing the issues of MCI will be an entirely different blog, and a bigger story to analyse before telling. Let me leave it for another day!
- Lack of Career Prospects
Studying medicine is not easy. It takes a significant amount of time to start a full-fledged career. An average medical student takes at least 10 years to gain financial security, and practicing in urban areas helps to achieve that objective. On the contrary, working in rural areas doesn’t really help one make money.
Does this mean that most doctors are money sucking, apathetic, and narcissistic neanderthals? Of course not. I know many private doctors who frequently conduct regular health camps in remote villages and many of them also move out of their comfort zone to help people. In fact, a cross-sectional survey that was conducted among 226 medical students across India showed that many of them felt that it is essential to give priority to public health as it would help change ‘India’s Rotten Health System’.
If the government really wants doctors to work in villages, they can start by introducing a course module in the MBBS curriculum to stress upon the problems at the grassroots levels and improve the medical infrastructure in villages. Unless the students are exposed to that world, I doubt they would care about its challenges and prospective solutions.
- Azhar, G. S., & Jilani, A. Z. (2009). Future of Community Medicine in India.
- Kar, S. S., Ramalingam, A., Premarajan, K. C., & Roy, G. (2014). Do Medical Students Prefer a Career in Community Medicine?