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Friday, March 10, 2006

Strong Medicine

This is the letter I wrote to Rashmi Bansal , editor of JAMMAG for here column in and The column is given below after my letter

Dear Mate,

I am a doctor from Tamil Nadu and a regular reader of your blog.

This mail is with reference to your column

WHile you have potrayed the situation very well, I differ from your column on one POINT.

Yes, the government does subsidise medical education, but that is also the case with IITs or government engineering colleges. In those cases, the ‘pound of flesh’ theory does not seem to apply!

The above line is CORRECT. But the subsidy is for the MBBS (undergraduate part) only.

Let me explain.

An engineering college, has many departrments and an administrative office. The administrative office deals with the pay and other functions.
The departments include, Mechanical, Engineering etc in an engineering college and Maths, English etc in an Arts college ( I have no idea about IIM)

The staff include
1. Professors
2. Lecturers
3. Lab Workers
4. Sweepers and Drivers
5. Principal etc

What is the purpose of all these staff... To teach the students......
Suppose students do not join for 5 years........ How much work do these people do..... (You can calculate)

Now come to the budget of the college.
The expenses are the costs involved in
1. Salary
2. Maintenance of the building
3. Papers / Lab articles etc

Now come to the income
1. Fees paid by the students.

Take IIT, IIM or even a government school. Obviously the fees paid is negligible and is about the 5 % of the expenses and the government spends 95 % as a subsidy.

Now come to an UNDERGRADUATE COURSE in a Medical College.

Medical College,as you may know is never a college alone (This is where we differ from the americal system of medical school).

By default, it is attached to a Hospital.

A medical college, should have the following departments
1. Anatomy
2. Physiology
3. Biochemistry
4. Pharmacology
5. Pathology
6. Microbniology
7. FM
8. SPM
9. ENT
10. Ophthal
11. Medicine
12. Surgery
13. Paediatrics
14. Ortho
15. OG
16. Radiology
17. Radiotherapy
18. Anaesthesia
19. Dermatology
20 Psychiatry

These 20 departments are must for a medical college. in addition you can have any number of more departments like Urology, Cardiology etc.

All these departments have
1. Professor
2. Assistant Professors
3. Staff Nurse
4. Pharmacist
5. Ward boy
6 Sweeper

in addition the college also has an administrative office. concerned with maintenance of hospital, DRUGS, Equipments etc

Now you see how the budget is used
1. Salary
2. Drugs
3. Equipments
4. Maintenance
5. Stationery

1. Fees.
2. Subsidy by the government.

Now comes the important point.

Of the 20 departments, I mentioned, only 3 - Anatomy, Physiology and Pharmacology are exclusively for Students.


Of the expenses invloved, the expenses that are invovlved towards educating AN MBBS STUDENT is the expense of the salary of the staff of the above 3 departments (out of the 20) and the stationery.


In short, government is subsidising, NO DOUBT, but 98 % of the subsidy is for HEALTH and less than 1.5 % is for Education.

But what will you hear. They will calculate the annual expenses and divide it by the number of students and tell that we are spending 22 lakhs for each doctor.

The truth is that EVEN IF A MEDICAL COLLEGE DOES NOT ADMIT MBBS STUDETNS, it will still have 98 % of its expenses for TREATING PATIENTS.

Now come to the Post Graduates..... The government does not even spend that 1.5 % (except for the PGs in the 3 departments I have mentioned).

In other words.....

Let me ask these simple question.

1. What will be the workload of a professor in IIM when students are on strike. Will it increase or decrease
2. What about when a Post Graduate Resident is on strike.

If there are NO STUDENTS JOINING in a course, will you run the course or shut it down. you will shut it down and bring the expenses to ZERO

If you are going to shut down KEM just becasue the PGs are on strike, will the patients allow you.

In other words, is the subsidy the government, WRONGLY AND INTENTIONALLY says that it is giving for Medical Education, a subsidy for educating students or for treating patients.

Treating the patient free or for money is not the theme of this article. I have written this to tell you that the subsidy which we are supposed to get is not for us doctors....... but for the patients

With regards

Original Article : Strong medicine By Rashmi Bansal
It's rare indeed when the word strike and the word 'justified' come up in the same sentence. At least in my dictionary.

BMC workers lay down their brooms. Bank employees lay down their pens. Airport workers lay down at the entrance. You wish someone would fire them from their jobs to teach them a lesson. But no, generally the government buckles under and grants them a Diwali bonus.

The strike by resident doctors in Maharashtra, currently into its 12th day, is different. For once, I feel the cause is justified, that the method adopted was the last one available.

What are the doctors on strike asking for? The right to some basic human dignities—as one doctor eloquently described the situation. (

“You work 24 hours a day… no fixed working hours, no fixed meal timings, less than four-five hours of sleep, emergency duties, five-six people staying in one small room, inadequate sanitary conditions, unhygienic food, constant stress, too many patients and too few equipment and facilities, inefficient supporting staff…”

The pressure from patients at the few government run hospitals is so high that it is not unusual for 2 doctors to see 300-400 patients in morning OPD, then look after ward patients and then go back to casualty filled with patients.

And although they may have cursed the system in private, residents continued fulfilling their duties, until the day that relatives of a patient who died beat up a doctor.

It was the proverbial straw that broke the camel’s already strained back. The match that lit the simmering discontent.

And now there is a raging fire.

A fire to not just get a few demands met, but to see some change in the system of medical education and public health as a whole.

Despite the boom in private medical colleges, it is an undisputed fact that government colleges attached to public hospitals attract the best brains and offer the best training. Students know that they will benefit from the exposure to a variety of cases that no private hospital can hope to attract.

The problems begin at the PG level, where the seats for specialisation are very limited. After a great deal of struggle, the MBBS graduates who get posts as ‘residents’ find that they bear the burden of the entire hospital’s functioning. Hospitals which attract hundreds of patients everyday not only from the city, but distant villages and talukas where there are no primary health care centers—let alone decent hospitals.

Yet the resident doctors take up the challenge, carry out their duties. For this they get paid, in Maharashtra, a sum of a little over Rs 8,000 per month. Which is around Rs 2,000 less than what is being earned by unskilled "Class IV" workers of the BMC (ward boys and sweepers).

Yes, the government does subsidise medical education, but that is also the case with IITs or government engineering colleges. In those cases, the ‘pound of flesh’ theory does not seem to apply!

A job well done needs to be rewarded with an adequate, if not lucrative stipend. Earning Rs 8,000 per month for a job that stretches 12-14 hrs a day is not adequate. Especially when you are in your late 20s!

Conditions cannot be so trying that people are turned off the profession of medicine. Which, if you ask me, is exactly what is slowly starting to happen.

The future of medicine

Medicine should not become a 'family business'—attractive only to those whose parents are already in the profession. It must continue to attract bright and idealistic young people. People who want to find a cure for cancer or rid humanity of its suffering. Sure, most of them will get hardened and cynical someday. But they need not get disillusioned too early.

In the past schemes wherein doctors were sent on ‘compulsory rural service’ failed. The trick is not to make such service a compulsion. If the government/ NGOs can provide basic infrastructure, medicines and some moral support, there are young doctors who will come forward to take up the challenge—at least on a short-term basis.

The current strike is sending quite the opposite signal to young doctors and even those contemplating a career in medicine. It is sending the signal that the system does not care about us, so why should we care about the system?

Yes, gradually you find more doctors opting for MBAs, for jobs in hospital administration and pharmaceutical companies. More doctors willing to give GRE and take up research instead of clinical jobs because it’s far easier to get a visa that way.

But speak to any of these doctors and there is a twinge of regret. The acknowledgement that ‘this is not what we slogged for’. The feeling that the word doctor minus the word patient is incomplete. Yes, we did the ‘practical’ thing, but in our heart we know it’s like cheating.

So rest assured that doctors are aware of the suffering being caused to patients. No doctor enjoys going on strike. The wounds must be deep for them to have taken this drastic action.

The bottom line is that the BMC can spend a little less on painting and repainting road dividers, or on repairing the mayor’s bungalow. Pay resident docs a little more money and a lot more respect. For a change, the healers need our healing touch.

Rashmi is an IIM Ahmedabad graduate and founder-editor of youth magazine JAM ( She can be reached at

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