A medical mess
Bandhs, gheraos and peaceful demonstrations are quintessential features of the democracy for which India is acclaimed around the world. After protracted protests against the Citizenship (Amendment) Act and the three farm laws, India has again gained global media attention with thousands of striking resident doctors at New Delhi public hospitals facing off against police because of the inadmissible delay of NEET- PG Tips 2021. Further delay could lead to a paralysis of medical services across the country, as the Federation of Indian Medical Association (FAIMA) threatened to boycott all work, including emergency services, in protest against the crackdown on medical residents.
The alleged assault on the medics and FIR registration against them is deeply distressing as they were covered in rose petals by the government a year ago for being corona warriors. Resident physicians have been protesting since November 27 against the multiple postponements of NEET PG Counseling 2021 and the subsequent admission of a new batch of resident physicians to medical schools.
Resident physicians are crucial for the entire healthcare system, including Covid care. One public health expert has rightly said that nothing is truer in the medical profession than this ~ “Interdependence is a higher value than independence”. NEET-PG-21 counseling cannot tolerate delay for a variety of interrelated, interconnected and incidental reasons. It would be interesting to go into the genesis of the current unrest.
On July 29, 2021, the Union government issued a notification introducing two new bookings for undergraduate and postgraduate medical and dental courses, starting in the current academic year 2021-2022. Under the notification, 10 percent is reserved for the Economically Weaker Section (EWS) and 27 percent for Other Backward Classes (OBC) under the Indian Global Quota (AIQ). The National Testing Agency (NTA), Department of Education, organizes the National Eligibility-cum-Entrance Test (NEETUG) which is the entrance examination to all undergraduate courses (NEETUG).
The National Examination Council (NBE), Ministry of Health and Welfare, organizes the NEETPG, that is, the postgraduate examination for courses in medicine and dentistry in the country. The NEET-PG review was scheduled to take place in January 2021. But it was postponed to April 2021 and due to the evolving situation of Covid-19, still postponed to September 2021. The result of the NEET- review PG was released the following month.
The council was to start from the end of October itself. But counseling to PG courses could not begin as the notification regarding bookings for OBCs and EWS was challenged in the Supreme Court by some doctors aspiring to graduate. The petitioners also challenged the reasonableness of the annual income cap of Rs 8 lakh set by the government to determine the status of the SAP.
The case was heard by the Supreme Court on November 25, 2021. Asked about the justification for the income cap of Rs 8 lakh, the learned Solicitor General, Tushar Mehta, told the Supreme Court that the reservation was a matter of justice social, it could not be rescheduled and requested a four week deadline to review the annual income criteria of Rs 8 lakh for EWS applicants. He also said the review process would take around four weeks and until then PG Counseling would be kept on hold.
The government formed a three-member committee to review the SAP criteria with instructions to submit a report within four weeks. The next hearing is scheduled for January 6, 2022. However, due to clashes with police and the registration of FIRs against some protesting doctors, medical residents have called for the total closure of medical services in Delhi hospitals.
Calling it a “dark day” in the history of the medical fraternity, the Federation of Resident Doctors Associations (FORDA) said there would be a complete shutdown of all health facilities. In a press release, FORDA said, “We strongly condemn this brutal act and demand the immediate release of all medical residents. There will be a complete shutdown of health facilities… ”They also urged all state GDRs to join in the agitation. FAIMA has shown solidarity with them. The medical residents have insisted that the Department of Health give written assurance that the council will begin on a specific date. The case being sub-judicial, the department is faced with a dilemma. In addition, the next court date is approaching.
It should be remembered that the All India Quota (AIQ) program was introduced in 1986 on the instructions of the Supreme Court to provide homeless merit-based opportunities for students from any state aspiring to study at a good medical school in one of the states. The AIQ is made up of 15 percent of the total UG seats available and 50 percent of the total PG seats available in government medical schools. In particular, before 2007, there was no reservation in the AIQ system. In 2007, the Supreme Court introduced a 15 percent reservation for listed castes (SC) and a 7.5 percent quota for listed tribes (ST) in the AIQ scheme.
When the Law on Central Educational Institutions (Admission Reservation) entered into force in 2007, it for the first time provided for a reserve of 27% for CBOs. It has been implemented by all central medical education institutions such as Safdarjung Hospital, Lady Hardinge Medical College, Aligarh Muslim University and Banaras Hindu University. However, it was not extended to the AIQ seats in state medical and dental schools.
The 103rd Constitutional Amendment of 2019, provided for a reservation of 10% for the SAP category in all central educational institutions. The number of places in the faculties of medicine and dentistry has been increased over the next two years (2019-2020 and 2020-2021) to take into account this additional SAP reservation of 10% so that the total number of places available for the unreserved category is not reduced.
In AIQ seats, however, these benefits were not extended. On a petition filed by the DMK party, the Madras High Court ruled in 2020 that CBOs were entitled to reservations at AIQ seats and ordered the Union government to implement the same from of the 2021 academic year. The Union government, after careful consideration, made a conscious political decision and decided to provide 27% reservation for OBCs and 10% reservation for EWS in AIQ headquarters for all undergraduate and postgraduate medical / dental courses from the current academic year, 2021-2022.
Given the huge delay in the NEET-PG-21 Council meeting, the government could have taken the decision to implement these reserves as early as the next academic year 2022-23. But no democratic government that must seek popular support can be seen procrastinating and procrastinating on the highly emotional and inflammable issue of social justice, especially as the elections draw near.
The forgotten recommendations of the Mandal Commission were to be implemented by VP Singh as a countermeasure to save his government. Narasimha Rao’s government had introduced a 10 percent reserve for SAP, with the exception of 27 percent reservations for CBOs which were challenged in the Supreme Court in 1992. The Supreme Court in the famous Indra Sawhney case against Union of India confirmed the quota of 27 percent. for OBCs but canceled a 10 percent reserve for EWS. However, with the adoption of the 103rd Amendment to the Constitution, the reserve for the SAP was guaranteed by the Constitution.
Resident Doctors want NEET-PG-21 to start without further loss of time, which has been unreasonably and disproportionately delayed for multiple reasons, including the Covid-19 outbreak and the decision to introduce reservations for OBCs and EWS. The 2022-2023 academic session is only a few months away and given the severe constraints of infrastructure and faculty, approximately 90,000 PG students cannot be supported by a system intended for 45,000 students per academic year.
Besides great mental agony and affliction for the students, it will have a severe and debilitating effect on the teaching and treatment of the patients. To overcome the shortage of teachers, the Medical Council of India (now the Medical Commission) increased the teacher-teacher ratio from 1: 2 to 1: 3 compared to the 2018-19 academic session. The professors of the PG are already overloaded and the simultaneous conduct of two promotions, under the circumstances, is far from practical.
Moreover, the deprivation of much-needed medical care for patients, exacerbated by the looming Omicron threat, a possible brain drain and the financial losses to the nation cannot be measured in monetary terms. Indian medical education is acclaimed around the world. Indian doctors and paramedics are widely recognized for their professionalism. The whole nation is waiting with great hope and expectation for the Supreme Court to resolve the matter as we cannot afford the protracted protests from our doctors.
(The author is the former Additional Secretary, Lok Sabha and a member of the Delhi Bar Council. The views expressed are personal)