Why doctors are quitting Haryana government jobs?

Geetanjali Gayatri

Doctors are in short supply in Haryana. With legislators flagging the shortage of doctors in their constituencies in almost every session of the Vidhan Sabha, the ruling Bharatiya Janata Party-Jannayak Janata Party (BJP-JJP) government is having a tough time juggling postings across the state even as it tries to fast-track the recruitment of doctors.

According to the Haryana Civil Medical Services Association (HCMSA), there is a shortage of nearly 800 doctors in the state. The cadre strength is around 3,500. If that was not enough to deal with, doctors have been constantly and consistently quitting the Health Department — a trend that is fast catching on.

Reasons for leaving govt service

• Higher salary, more perks and increments in private sector.
• Pressure due to large number of patients, administrative work and shortage of staff.
• In addition to their regular duties, government doctors have to spend a lot of time in performing VIP duties and filing medico-legal reports.
• Working conditions in government healthcare centres do not match up to those in private hospitals.
• Time-bound promotions that depend upon the authorities.
• Class I officer status, but facilities are not commensurate.
• As soon as newly appointed doctors get admission in PG courses, they either resign or absent themselves from duty.

At the General Hospital in Panipat, for example, two newly recruited MBBS doctors have resigned while a third doctor, an MS (Ortho), worked for five months before choosing to not report for work. As many as 10 doctors absenteed themselves from duty since 2018 and three have resigned. This is one of the many general hospitals grappling with shortage as doctors are choosing to walk away from government jobs.

Joining and not reporting for work

More specialists are leaving their jobs as compared to MBBS doctors. However, the younger lot is quitting to pursue higher studies. There is no data available, but young doctors stop working as soon as they get admission to PG courses. The post remains blocked till their termination papers are prepared. This takes over a year. — Rajesh Khyaliya, HCMSA president

Realising the gravity of the situation, the Health Department constituted a three-member committee on May 5 this year. The committee, comprising the Health Secretary, the Chief Medical Officer Jhajjar, Dr Brahmdeep, and medical officer Dr Nishikant, has been asked to identify the reasons for the high attrition rate in the Health Department. For the HCMSA, it is a case of “too little, too late”.

HCMSA president Dr Rajesh Khyaliya says, “We have been raising the issue for several years now. The root cause is the few promotional avenues available to the doctors. Nearly 95 per cent of the doctors who join as medical officers get only one promotion during the service and retire as senior medical officers (SMO). Hardly 4 per cent get promoted to the rank of Civil Surgeon and higher designations. In 2015, the medical officers were given the status of Class I officers, but they don’t get the facilities or treatment as per their rank. It is very disheartening to see them struggling even before clerks for trivial issues.”

Meanwhile, no formal meeting of the committee has been held so far after its chairman was transferred about a week back. Sources maintain that the committee has sought a report on the total number of doctors who have quit their jobs in the past few years. Many senior doctors are opting for voluntary retirement while the younger ones are either quitting or absenting themselves from work.

According to the HCMSA, as per the Indian Public Health Standard (IPHS) norms, a total of 241 MDs (Medicine) are required in the state, but merely 50 are working. Of the 193 gynaecologists needed, only 95 are working; of the 231 anaesthetists, just 100 are on the job. The state requires 146 paediatricians, but has only 65; 143 surgeons are needed, but 75 are working.

Among the other reasons the doctors underline for the “disappointment” with government jobs are unsatisfactory working conditions, heavy workload due to the poor doctor-patient ratio, unsafe environment, lower salaries compared to private hospitals, VIP duties and the medico-legal cases that result in pressure from various quarters. The doctors also point out that the government pays 1.5 times more salary to the contractual doctors working under the National Health Mission (NHM) compared to regular doctors.

“There is an acute shortage of specialists in the department. Each time a specialist joins duty at a government facility, patients from adjoining districts also start flocking for treatment. Ideally, a doctor can examine around 100 patients a day as it takes time to diagnose, note down the patient’s history and then write tests and prescriptions. However, at government hospitals, the doctors are attending to 250-300 patients. This is a cruel joke on both the patients and the doctors,” Khyaliya points out. He says there is a need for at least 10,000 doctors in the government sector to smoothly run operations, but the present cadre strenth is barely 3,500.

A senior health official in Ambala explains, “Higher salaries in private hospitals, VIP duties, MLR duty, court evidence and the workload are some of the major reasons why doctors are leaving government jobs. At private hospitals, they have defined roles and get perks in addition to annual increments.”

While all these reasons hold good, pursuing higher studies or specialisation is another big factor behind youngsters quitting. “They get recruited and start working till the time their admission to post-graduate courses is confirmed. Once they get a seat, they quit or just absent themselves from work. This contributes to the growing shortage as well,” another senior doctor explains. An ENT specialist who resigned last year states, “I was posted in Naraingarh and had to resign after I got admission in a post graduation course. I applied for leave but could not get it even without pay. I was left with no option but to resign as I had to pursue my Masters degree.”

However, there are instances where doctors have joined duty, worked for a few months or a couple of years, improved their “market value” by working in the government set-up and switched over to the private sector. “The heavy workload in terms of patients visiting government hospitals makes the doctors way more experienced than they can ever be if they join the private sector. This experience increases their market value and also facilitates them in setting up their private practice,” a medical officer maintains.

“Some doctors leave their jobs to pursue higher studies while others start private practice after gaining experience and building an equation with the patients. Most of the specialists feel overburdened. Better salaries, an improved working environment, and formation of a specialist cadre are very important if the government wants to retain the doctors,” a doctor suggests.

Health Minister Anil Vij says, “We don’t have data of how many doctors have left in the last few years. We will need to compile it after taking information from various districts. A committee has been formed to ascertain the reasons for doctors turning away from government jobs and it will give recommendations to ensure we can retain them. We can only comment on the reasons after studying the report.”

(With inputs from Nitish Sharma in Ambala)

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