New Delhi: Dr Priyanka Singh, 26, a junior doctor in the radiodiagnosis department at Delhi’s Safdarjung Hospital—India’s oldest and largest government facility with 1,550 beds—was at the end of her tether when she joined a group of doctors on protest at the end of December 2021.
Through 2021, Dr Singh told Article 14, she had worked 58-hour and 72-hour shifts due to an acute shortage of doctors, brought about by a year-long tussle over affirmative action, involving the government, the Supreme Court and thousands of doctors waiting to begin post-graduation degrees.
The exhaustion and stress took a toll, worsened with the knowledge that a third wave could soon sweep in within days by the end of 2020, while India’s capital still healed from a vicious Covid-19 Delta wave earlier that year.
The third wave is now firmly on India, with 263,061 new cases on 13 January 2021, among the highest single-day rises since the pandemic began in 2019. On that day, Delhi reported 28,867 cases of Covid-19, with 40 dead on the previous day alone and 29.2% of all tests on 13 January positive for the virus.
The rapid spread of the third wave of Covid-19 is made clear by the test positivity rate (TPR). On 27 December, a TPR of 5% was reported in 3% of India’s districts—that had grown to 42% of all districts by 11 January, IndiaSpend reported.
The frustration and fatigue of junior doctors like Singh were exacerbated by the knowledge that about 45,000 qualified doctors were simply standing by to join hospitals. They had cleared a qualifying exam called the NEET-PG (National Eligibility cum Entrance Test-Post Graduation) in September 2021 but were waiting for the union government to start a process called NEET-PG counselling, the allocation of post-MBBS specialisations in government or private medical colleges in India.
So, it was music to Singh’s ears when on 7 January 2022 the Supreme Court— after six months since petitioners sought court intervention—directed the government of Prime Minister Narendra Modi government to proceed with the much-delayed counselling process for the 2021-22 batch so that the 45,000 doctors could get to work.
India’s shortage of government doctors is well-documented: Against the World Health Organisation norm of 1 doctor for 1,000 people, Delhi has an average of one doctor for 2,200, and India one doctor for 11,000.
Even after NEET-PG results were declared in October 2021, for the approximately 170,000 MBBS doctors who had appeared for the test, the delay in counselling was over quotas introduced by the Centre in July 2021 in the postgraduate medical seats pool, which has fewer than 43,000 PG seats.
Of these PG seats, about 26,700 are in government medical colleges and around 16,000 in private hospitals—24,600 seats for MD (doctor of medicine), 12,800 for MS (master of surgery), 2,038 for MCh (general surgery) and a little over 900 PG diploma seats. There are 2,400 postdoctoral seats.
MBBS graduates must complete a year of work in a hospital as junior residents before they can apply for post-graduation studies through the NEET-PG. Many of the 170,000 junior residents took time off from hospitals in 2020 to prepare, and finally appeared for the NEET-PG exam in September 2021, originally scheduled for January 2021, then postponed to April, and then September.
The Centre changed reservation policies to include two quota categories in the post-graduation pool. The split of postgraduate medical seats is such that 50% are allotted by the Centre, called the All India Quota (AIQ), and 50% by the state in which the hospital/ colleges are.
While states included scheduled caste and scheduled tribe (SC/ ST) and other backward caste (OBC) quotas in their 50%, the Centre had no quota in its allocation, except for SC/ ST. It was a Medical Counselling Committee announcement on 29 July 2021 that 27% of seats would be reserved for OBCs and 10% for the union government’s new EWS category within the AIQ that prompted doctors to petition the courts.
Dr Neil Aurelio Nunes from Goa and Dr Yash Tekwani from Chhattisgarh filed public interest litigations in the Supreme Court challenging the constitutionality of and manner in which the quotas were announced.
On 25 November 2021, the union government told the Supreme Court counselling would be further delayed by four weeks. The Federation of Resident Doctors' Association (Forda) called a protest on 27 November 2021.
As the protests continued into 2022, the Supreme Court upheld inclusion of the new quotas without any change for the batch of 2021-2022, but court proceedings on the bunch of petitions on the larger constitutional issue the income slabs created for the EWS category and overall reservations will continue in March 2022.
Counselling started on 12 January, but it will be weeks if not months before doctors can join work. Meanwhile, India is in the middle of its third wave. Numbers of Covid patients zooming and hospitalisation at a steady increase. At the time of publishing, Covid-19 wards at Safdarjung hospital were full, but over 200 doctors themselves were down with Covid-19, placing further stress on those on duty. In fact, hospitals also said there would be no quarantine for doctors exposed to Covid-19 contacts. The shortage is so acute that the government allowed the hiring of healthcare staff on daily fees.
Doctors Up In Arms
At the protest on 27 December, Dr Singh was dragged and hauled into a police van by Delhi Police. The manhandling of several of the agitating doctors on that day made national news.
The month-long protest had been called off for a few days, after government assurances to representatives of the protest, said Dr Anuj Aggarwal, 28, resident in radiodiagnosis department and general secretary of Resident Doctors’ Association (RDA) at Safdarjung Hospital.
Aggarwal told Article 14 that he and Dr Manish Nigam, president of Forda met Union health minister Mansukh Mandaviya and health ministry officials who assured them in four meetings—on 27 November and 3, 8, 17 and 28 December— that the government would “look into the matter”.
“We initially boycotted the outpatient services followed by Emergency services. The senior doctors were at work. We resumed our services when we saw patients suffering but resumed our strike on 17 December,” said Dr Aggarwal, adding that all they sought was that “the counselling be sped up”.
“But after what Delhi Police did to us on 27 December, we decided a complete boycott of health services,” said Dr Aggarwal. “We do not want to comment on the reservation policy changes.”
Minister Mandaviya, at the meeting with representatives of protesting doctors on 28 December, the day after police manhandled doctors, expressed regret and urged doctors to call off the strike.
The strike almost brought Safdarjung hospital to a halt. Resident doctor Dr Vinay Rathore in Safdarjung’s orthopaedics department said three batches of doctors work around the clock in government hospitals. The interns, the junior residents and the senior residents.
With no senior resident posted in all of 2021, Safdarjung for instance, was functioning without a large chunk of its about 1,800 resident doctors who are at the forefront of providing treatment in outpatient and emergency departments as well as in the specialist sections such as burns or orthopaedics or neurology etc.
As a result, “shifts for junior residents extended to more than 36-40 hours at a time during 2021, said Dr Rathore. “Sometimes we stayed for four days at a stretch,” Dr Rathore told Article 14.
For Dr Furqan Ahmed, 27, radiodiagnosis resident, the long hours had him questioning his career choice: “We were in a pitiable state, drained out. Every morning I would question my career choice. Did I choose medicine to join a protest? It is state negligence that pushes the cream of academics to leave the country. Similarly, even doctors are forced to move out.”
Dr Manish Singla, waiting for counselling, told Article 14, “The delay placed us under tremendous pressure.” Singla said he just “waited to hear from the government on allotment” while pursuing “courses on private and online consultation”.
Dr Devanshi Kaul, 26, junior resident in Safdarjung hospital’s anaesthesia department said the long hours amid a pandemic had led to serious mental health issues among doctors.
“Those of us working without seniors and the seniors waiting for their allotment were all overburdened,” said Dr Kaul. “We are mentally and physically exhausted. One set of juniors will now leave to prepare for their exams— and we don’t have any idea when the NEET-PG batch will finally join.”
According to Kaul, many doctors need “therapy” working long hours during two waves of the pandemic but find neither the time nor the energy to do so. “I was in critical care during the earlier Covid-19 surges, so I know up close what the condition was,” she said.
While doctors were annoyed that the changes in reservation policy were suddenly brought in mid-term, the delays leading to the protests, poor patients faced the brunt.
Jyoti (she used only one name), 35, reached Safdarjung hospital early December with a problem in her urinary tract. It was 20 days of running between departments, she told Article 14, with no one “attending to me in the name of a strike.”
Accident patient and daily wager Shyam Dev said he spent almost two weeks on a stretcher with a damaged leg since 3 December.
“When I went to the Emergency, they said take him to OPD,” Ashu Dev, his son, told Article 14. “When we came to the Emergency, the doctors literally tore the papers we had. We were told treatment would be only after an ultrasound. We could get no food for my husband since he had not been given admission.”
The young doctors holding the fort at critical departments amid the pandemic have waded into the third wave with little idea when their seniors will join, for the process to their placement has only just begun. They are still waiting for Delhi Police to apologise for the manhandling on 27 December 2021, as the union health minister promised they would.
(Samriddhi Sakunia & Hrishi Raj Anand are independent journalists based in Delhi.)