Rising disaffection within the medical students community in Maharashtra (pop. 96 million) has aroused fears of a decline in the number of post-secondary students entering the states 13 government medical colleges. During the past one year, medical students have struck work on six occasions causing great inconvenience to the public, as they provide OPD (out patient department) services in government hospitals as part of their study programmes. Moreover postgrad students provide in-hospital free treatment to the public.
Nevertheless once again on April 14, the Medical Association of Resident Doctors (MARD) struck work for six days protesting a decrease in postgraduate medical seats in government medical colleges which have been reduced to 411 this year from 653 last year.
This capacity reduction is the result of the state governments Directorate of Medical Education and Research failing to maintain a faculty-student ratio of 1:1 for postgrad programmes as mandated by the Medical Council of India (MCI).

On April 20, the strike was called off following verbal assurances by health minister Dilip Walse-Patil that faculty vacancies in government colleges will be filled up soon. We have made it clear that there is no intention to reduce the number of seats. But we had to follow guidelines of the Bombay high court which has asked us to maintain MCI guidelines after we challenged them in court. We are now awaiting the final judgement and hopefully the Maharashtra government and MCI will sort out this issue soon, says Walse-Patil.

Following the end of the latest strike called by MARD, termination notices which were issued to around 100 resident doctors in Nagpur who participated in the strike have (predictably) been withdrawn. We agree that the public is affected by our going on strike. But we do so only after all negotiations with the government fail, says Ravikant Singh a spokesperson of MARD.

The root cause of the frequent strikes and turmoil within the medical students community is the reluctance of medically qualified faculty to accept teaching positions in government colleges which offer poor salary packages and abysmal infrastructure.

Every year 60-70 faculty flee to teach in private medical colleges where they are offered much higher remuneration and emoluments. This annual exodus skews the teacher-pupil ratios mandated by MCI and prompts the state government to reduce the annual intake into postgrad programmes. Every year an estimated 10,000 MBBS students write the entrance examination for admission into postgrad medical courses, of whom only 411 are admitted into government colleges.
Against this backdrop its hardly surprising that there is constant disaffection in the ranks of medical students, medical interns, medical teaching staff and MARD on varying issues — students protesting against the internship period being extended to two years, teaching staff demanding higher pay and the reduction of intake in postgraduate programmes.

This constant turmoil within the medical fraternity hits the poor, obliged to patronise government hospitals, hard. With doctor-patient ratios in government hospitals touching 1:1,000, a decrease in the number of postgrad seats means less doctors on duty. If the postgraduate education intake is not increased, government hospitals will soon be reduced to primary healthcare centres, warns Dr. Shailesh Mohite, general secretary of the Teachers Welfare Association.

Moreover in the longer term the supply of specialised medical practitioners into the national pool — which is already running dry given the average 60:100,000 doctor-patient ratio countrywide — will go from bad to worse.

Vidya Sunderesan (Mumbai)