Doctors' Association for Social Equality

VIJAYAWADA: Working for a minimum of five years in rural areas would be made mandatory for all doctors who complete the undergraduate course in future, according to Minister for Vaidya Vidhana Parishad and Hospital Services Vanama Venkateswara Rao.
The Minister made a surprise check of a couple of wholesale drug establishments in One Town and a blood bank in Governorpet on Tuesday.
Talking to reporters later, Mr. Venkateswara Rao said the healthcare sector was badly neglected by the earlier Government.
He said the Government would soon issue a notification for the recruitment of 700 staff nurses.
Notifications had already been issued for the recruitment of 534 specialist doctors, 135 dentists and 450 paramedical staff.
The process of recruitment would be completed by November-end.

Trauma care centres

The Government had earmarked an additional 40 per cent of the budget for healthcare to provide emergency treatment for poor patients.
The Government had earmarked Rs. 5,000 crores for providing healthcare to the poor under a health scheme. The Government had also released Rs. 72 crores for establishing ten trauma care centres along the national highways.
The Minister warned of stringent action against the manufacturers and distributors of substandard or spurious
He said the minimum sentence for dealing with spurious drugs was three years. Manufacturers and distributors caught dealing with spurious drugs would be blacklisted permanently, the Minister said.

Source: The Hindu ( http://www.hinduonnet.com/2007/10/17/stories/2007101761350500.htm )

Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Manas Kaushik et al.
High-end physician migration from India
High-end physician migration from India
Manas Kaushik,a Abhishek Jaiswal,b Naseem Shahb & Ajay Mahalc
a Departments of Nutrition and Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston
02115 MA, United States of America. Correspondence to Manas Kaushik (e-mail:
mkaushik@hsph.harvard.edu).
b All India Institute of Medical Sciences, New Delhi, India.
c Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA.
Bulletin of the World Health Organization 2007;85:XXX–XXX
Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una
traducción al español. ة ل 􀑧􀑧􀑧 ة العربي 􀑧􀑧􀑧 ي ن ەذەالترجم 􀑧􀑧􀑧 ة ف 􀑧􀑧􀑧 صەالخلاص 􀑧􀑧 ة الن 􀑧􀑧 ل ل اي 􀑧􀑧 ة ەذەالكام 􀑧􀑧􀑧 .المقال
doi: 10.2471/BLT.07.041681
(Submitted: 23 February 2007 – Revised version received: 11 June 2007 – Accepted: 25 June 2007)
Objective To examine the relation between the quality of physicians and migration among
alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period
1989–2000.
Methods In a retrospective cohort study, data on graduates of AIIMS were collected from
entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American
Medical Association and informal alumni networks. The data were analysed by use of 2x2
contingency tables and logistic regression models.
Findings Nearly 54% of AIIMS graduates during 1989–2000 now reside outside India.
Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53–2.99) as students admitted under the affirmative-action category.
Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients
of awards (95% confidence interval: 1.04–1.76). Multivariate analyses do not change these
basic conclusions.
Conclusion Graduates from higher quality institutions account for a disproportionately large
share of emigrating physicians. Even within high-end institutions, such as AIIMS, better
physicians are more likely to emigrate. Interventions should focus on the highly trained
individuals in the top institutions that contribute disproportionately to the loss of human
resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.
Introduction
The migration of skilled professionals from developing to developed countries has long attracted
attention from researchers and policy-makers.1,2 The literature on the subject encompasses a vast area, including assessments of the implications of skilled labour migration for equity and efficiency in economic outcomes, examinations of the links between growth in international trade and trends in international migration, and optimum strategies to address losses to sending countries due to
Page 1 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
emigration.3,4 Migration of medical professionals has attracted concern in light of their impact on
health policy goals.5–7 In a seminal 2004 report, the Joint Learning Initiative (JLI) devoted an entire
chapter to international flows of doctors and nurses, and their potentially harmful effects on the less
well off in developing countries. As the report points out, “while the absolute numbers may not be very
large, the outflows can be ‘fatal’ for disadvantaged people in source countries”.8 The world health
report: working together for health, also reached a similar conclusion.9
Considerable information exists on the “push and pull” factors operating in different countries
and the number of doctors migrating from India to other countries, particularly towards Europe and the
United States of America.10,11 However, much less is known about the quality of medical professionals
who migrate, compared with those who remain. The issue of the quality of professionals emigrating is
important both for destination countries where these physicians eventually practice,12,13 but also for
source countries. While the number of physicians emigrating is one dimension of the human capital
involved in migration,14 simple head counts are insufficient if the individuals who emigrate are
academic leaders or better-skilled physicians than those who remain. This set may include institution
builders who are trainers, professors in medical schools, or physician leaders who influence positively,
by example or collaboration, the quality of health services provided by others who remain in the
country. By adversely affecting the training, leadership, and possibly even managerial capacity, the
emigration of high-quality medical professionals adversely affects the health system in a way that
cannot be captured in statistics on the numbers of migrants among medical professionals.
Among developing countries, India is the biggest exporter of trained physicians with Indiatrained
physicians accounting for about 4.9% of American physicians and 10.9% of British
physicians.10 We assess the relation between physician quality and emigration with information on
graduates of the All India Institute of Medical Sciences (AIIMS), India’s top ranked medical school,
over the period 1989–2000. Because there are no readily available objective measures for assessing the
long-term academic or leadership potential of newly trained physicians, we used several indicators of
quality. First, we compared overall emigration rates among AIIMS graduates to those for medical
schools in India as a whole, on the assumption that acceptance into an exclusive institution on the basis
of their performance in medical admission tests is an indicator of both greater academic preparedness
for medical school and overall ability.15 Related to this point, we also inquired whether students
admitted under an affirmative-action quota, whose scores in the AIIMS entrance examination were
generally lower than those of other entrants, have a lower likelihood of emigrating. Finally, we
Page 2 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
considered whether individuals who received academic awards at the time of graduation from AIIMS
were more likely to emigrate.
Methods
AIIMS admits students through an objective exam, in which 45 students from a typical pool of 30 000
applicants (0.15%) are selected. We assembled a cohort of AIIMS graduates who entered AIIMS from
1989 through2000, and extracted information on their state of residence at the time of entry and
whether admission was made under the affirmative-action programme from entrance-exam
notifications and national newspapers where exam results are published.
We identified the country of residence, gender and year of graduation for AIIMS graduates
from published16 and online alumni directories,17 with follow-up contacts with individual graduates and
their classmates for whom information was not accessible in these directories. We ensured consistency
of this information with physician registration data in the United States of America, where many
AIIMS graduates migrate. With the exception of two inconsistencies (which we addressed), our
information on country of residence, gender and year of graduation matched exactly with information
on residence available from the American Medical Association data set. However, the American
Medical Association data set does not include information on physicians who are currently enrolled in
graduate programmes (e.g. masters and doctoral courses) and research positions, for instance, and
constitute an important avenue for migration of new graduates. Moreover, there is a lag of 1–2 years in
updating American Medical Association data sets even after physicians join residency programmes.
Thus, we believe that our data set is more up to date than the American Medical Association database.
Information on academic awards received by AIIMS graduates for the years 1989–2000 was collected
from convocation booklets (graduation records) published annually by the institution.
At least 11 of the 45 students are admitted to AIIMS each year under a distinct admission track
for two population subgroups: scheduled castes and scheduled tribes that are considered particularly
deprived under the Indian Constitution. Some 800 castes (of a total of 3000 in India) are categorized as
belonging to scheduled castes, with another 250 groups designated as scheduled tribes.18 The defining
criterion for these groups includes economic and social deprivation, more fully described in an Indian
government commission report.19 Students from these groups whose scores exceed this minimum
become part of the general pool, irrespective of their social background. While we were unable to
obtain admission scores for the entire group 1989–2000, we were able to do so for a group of 394 new
students from 1998 through 2006. Our data show that the affirmative-action group had a mean score of
Page 3 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
56.5 (standard deviation = 4.5), whereas the general group (excluding affirmative-action candidates)
had a mean score of 69.4 (standard deviation = 3.8), out of a maximum of 100. Thus, we used
admission under affirmative-action category as a proxy for lower academic preparedness and ultimately
lower quality.
The use of entrance examination marks, or admission under the quota, as an indicator of quality
is problematic as entrance examination scores might not truly reflect ability among socially
disadvantaged people and the decision to emigrate might be based on social networks and economic
ability that can vary across different admission categories. We also used the receipt of academic awards
as a distinct proxy for quality, and compared emigration rates among award recipients and nonrecipients.
In general, because physicians practicing at AIIMS and other public institutions are shielded
from medical malpractice suits by virtue of working in the public sector,19 malpractice suits are
probably not a good indicator of quality, since some AIIMS graduates end up at public institutions.
Furthermore, the onerous nature of the Indian legal system discourages such suits.20 The use of clinicalvignette-
based standardized examination, such as United States Medical Licensing exams, in assessing
physicians, even for residency positions, is discouraged. In the absence of available and accepted
indicators of physician quality, particularly of international medical graduates, most of whom emigrate
soon after graduation, we believe that academic achievement can be used as an indicator of quality.21
We compared emigration rates among groups for alternative indicators of quality, using
proportions and multivariate logistic models for assessing the relative likelihood of migrating. Because
some individuals might have better access to, desire for, and information about opportunities for
migration, confounding might occur. If this propensity to migrate is randomly distributed across
individuals, our results will be unaffected. However, if this propensity were positively correlated with
academic performance,4 it would bias the magnitude of the relationship between emigration and
graduate quality upwards. Other elements of heterogeneity (patriotism or closer family ties) may bias
the relationship in the opposite direction. We sought to partly address such concerns by using
information on the region of origin of AIIMS graduates and their gender in a multivariate regression
analysis to potentially control for such biases.
A total of 564 students graduated from AIIMS during 1989–2000. We could not obtain
information on either the affirmative-action status or province of origin for 136 graduates. This left us
with a sample of 428 individuals. Of this, 21.2% belonged to the affirmative-action category, very
Page 4 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
close to the proportion admitted under affirmative action (22.5%). We used this sample to assess the
proportion of graduates emigrating by gender, region of origin, and affirmative-action category
(Table 1) and used multivariate logistic regression to assess the likelihood of emigration (Table 2). The
dependent variable in all of the four regression specifications in Table 2 took the value 1 if the
individual resided abroad and was 0 otherwise. For explanatory variables in multivariate regressions,
we included sex, time since graduation, the square of time since graduation and indicator variables for
region of origin in all models. The main difference in the four regression models used in this paper is
the indicator of quality used: an indicator variable indicating whether admission was under the
affirmative-action category or not (model 1), the logarithm of entrance exam scores for students for the
years they were available (1998–2000; model 2), an indicator variable for any award received
(model 3), and indicators, respectively, for exactly one award and for receiving more than one award
(model 4).
Because the information we possess is on the current residence of physicians, some individuals
in our sample might have returned after a stay abroad, whereas others may have moved both back and
forth. If so, the correct interpretation of dependent variable is that it reflects the cumulative probability
of net emigration of graduates. In fact, the number of returning migrant doctors from AIIMS appears to
be miniscule. For AIIMS graduates during the years 1996–2000, for which we have more detailed
information, only one of the emigrating AIIMS graduates returned to India and that was for just 1 year.
Results
Nearly 54% of AIIMS students who graduated during 1989–2000 now reside outside India. Of the total
alumni emigrating in this group, 85.4% emigrated to the United States of America with no significant
gender differences in the proportion emigrating. This conclusion is in line with our preliminary
examination of AIIMS alumni records showing that roughly 730 out of a total of 1440 AIIMS
graduates, dating all the way back to the early 1960s, reside abroad, suggesting emigration of at least
51%. Of the 428 students in our sample, 52 received at least one award, with some receiving more than
one, amounting to a total of 116 awards. Only one student of 87 (or 1.2%) in the affirmative-action
category received an academic award at the time of graduation, compared to 15.2% in the general
category, supporting the argument that this category may reflect a lower level of academic skill.
Table 1 presents cumulative emigration rates of AIIMS students graduating during 1989–2000
by gender, admission and award category. Among graduates over this period, we find that students
from the general group are nearly two-times more likely to be residing abroad (95% confidence
Page 5 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
interval: 1.53–2.99, P < p =" 0.436).">1. Grubel H, Scott A. The brain drain: determinants, measurement and welfare effects.
Waterloo, ON: Wilfrid Laurier University Press; 1977.
2. Bhagwati J, Wilson J. Income taxation and international mobility. Cambridge, MA:
MIT Press; 1989.
3. Bhagwati J, Hamada K. The brain drain, international integration of markets for
professionals and unemployment. J Dev Econ 1974;1:19-42.
4. Stark O. Rethinking the brain-drain. World Dev 2004;32:15-22.
5. Mullan F. Doctors for the world: Indian physician emigration. Health Aff 2006;25:380-
93.
Page 8 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
6. Vujicic M, Zurn P, Diallo K, Adams O, Dal Poz MR The role of wages in the migration
of health care professionals from developing countries. Hum Resour Health
2004;2:3
7. Chanda R. Trade in health services. Bull World Health Organ 2002;80:158-63.
8. Joint Learning Initiative (JLI). Human resources for health: overcoming the crisis.
Cambridge,MA: Harvard University Press; 2004.
9. The world health report 2006: working together for health. Geneva: WHO;
2006.
10. Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;353:1810-
8.
11. Astor A, Akhtar T, Matallana M, Muthuswamy V, Olowu F, Tallo V, et al. Physician
migration: Views from professionals in Colombia, Nigeria, India, Pakistan and the
Philippines. Soc Sci Med 2005; 12(61):2492-500.
12. Salsberg E, Grover A. Physician workforce shortages: implications and issues for
academic health centers and policymakers. Acad Med 2006;81:782-7.
13. Kindig DA, Libby DL. Domestic production vs international immigration: Options for
the US physician workforce. JAMA 1996;276:978-82.
14. Grubel H, Scott A. The international flow of human capital. Am Econ Rev
1966;56:268-74.
15. Julian ER. Validity of the medical college admission test for predicting medical
school performance. Acad Med 2005;80(10):910-7.
16. Bhatnagar V, Sahni P, Agarwala S, Sahni P, Agarwala S. The Aiimsonian directory.
New Delhi, India: The Aiimsonians; 2003.
17. Government of India. The Constitution of India. New Delhi, India: Law Ministry;
1996.
18. aiims-usa.com [Home page on the internet]. Newton, MA: Aiimsonians of America,
Inc.; c. 1999-2002. Available at: http://aiims-usa.com/
19. Pande R. Can mandated political representation increase policy influence for
disadvantaged minorities? Theory and evidence from India. New York: Columbia
University, Department of Economics; 2000.
20. Bhat R. Regulating the private health care sector: the case of the Indian Consumer
Protection Act. Health Policy Plan 1996;11:265-79.
21. Das J, Hammer J. Money for nothing: the dire straits of medical practice in Delhi,
India [World Bank Policy Research Working Paper]. Washington, DC: The World Bank;
2005.
22. Dambisya YM. The fate and career destinations of doctors who qualified at Uganda's
Makerere Medical School in 1984: retrospective cohort study. BMJ 2004;329:600-
1.
23. Ihekweazu C, Anya I, Anosike E. Nigerian medical graduates: where are they now?
BMJ 2005;365:1847.
Page 9 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
24. Bhatt RV, Soni JM, Patel NF, Doctor PS. Migration of Baroda medical graduates,
1949–72. Med Educ 1976;10:290-2.
25. Hagopian A, Thompson MJ, Fordyce M, Johnson KE, Hart LG. The migration of
physicians from sub-Saharan Africa to the United States of America: measures of the
African brain drain. Hum Resour Health 2004;2:17.
26. Rosselli D, Otero A, Maza G. Colombian physician brain drain. Med Educ
2001;35:809-10.
27. Akl EA, Maroun N, Major S, Chahoud B, Schunemann HJ. Graduates of Lebanese
medical schools in the United States: an observational study of international migration
of physicians. BMC Health Serv Res 2007;7:49.
Page 10 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Table 1. Demographic, award and emigration information on AIIMS graduates, 1989–2000
Characteristic Category Total Emigrated
% (n)
P-valuea
(2-sided)
Gender Men 350 54.9 (192) 0.436
Women 78 50.0 (39) –
Region 1b 101 61.4 (62) 0.090
2c 30 63.3 (19) –
3d 132 46.2 (61) –
4e 165 53.9 (89) –
Affirmative action 87 28.7 (25) < 0.0001
No awards 375 53.6 (201) 0.096
One award 28 42.9 (12) –
Two or more awards 25 76.5 (18) –
a P-values based on χ2 test and assess whether the proportion of students migrating differs across groups.
b Region 1: Punjab, Haryana, Himachal Pradesh, Chandigarh.
c Region 2: Maharashtra, Andhra Pradesh.
d Region 3: Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan.
e Region 4: Karnataka, Tamil Nadu, Kerala, North Eastern States, Jammu & Kashmir, West Bengal, Delhi.
Table 2. Quality and emigration among AIIMS graduates 1989–2000: logistic regression
results
Dependent variable: indicator of emigration
(standard error of the logistic regression estimates)
Explanatory variable
model 1 model 2 model 3 model 4
N 428 113 428 428
Constant 0.06
(0.35)
−30.80a
(10.81)
−0.37
(0.34)
−0.40
(0.35)
Sex
(male = 1, 0 otherwise)
0.08
(0.27)
−0.71
(0.53)
0.15
(0.26)
0.16
(0.26)
Time (since graduation) 0.24a
(0.11)
−1.91b
(1.02)
0.25a
(0.11)
0.25a
(0.11)
Time squared −0.02a
(0.01)
0.87b
(0.48)
−0.02a
(0.01)
−0.02a
(0.01)
Affirmative action
(yes = 1, 0 otherwise)
−1.42a
(0.28)
– – –
Log (entrance marks) – 7.47a
(2.58)
– –
Indicator variable
(one or more awards)
– – 0.25
(0.30)
Indicator variable 1
(one award)
– – – −0.36
(0.41)
Page 11 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Indicator variable 2
(two awards or more)
– – – 0.99a
(0.47)
Dummy for region 1c 0.20
(0.27)
0.43
(0.54)
0.35
(0.26)
0.38
(0.26)
Dummy for region 2d 0.76b
(0.45)
0.02
(1.58)
0.35
(0.42)
0.43
(0.42)
Dummy for region 3e −0.25
(0.25)
−0.28
(0.53)
−0.26
(0.24)
−0.24
(0.24)
χ2 43.21 15.41 14.68 20.03
AIIMS, All India Institute of Medical Sciences.
a P < 0.05; P-values based on logistic regression (Wald test).
b P < 0.10; P-values based on logistic regression (Wald test).
c Region 1: Punjab, Haryana, Himachal Pradesh, Chandigarh.
d Region 2: Maharashtra, Andhra Pradesh.
e Region 3: Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan.
Page 12 of 12

by

Dr. Umesh Kapil, Professor, AIIMS

7. Diphtheria, measles on a killing spree. The Times of India, New Delhi, 2004; pp 12.

Source: The Hindu http://www.hinduonnet.com/2007/08/09/stories/2007080950660100.htm

Thiruvananthapuram: The Government has decided to impose one-year Compulsory Rural Service (CRS) on students passing the MBBS/ Medical PG degree/DNB or Diploma from Government-run Medical Colleges.
It will be mandatory for those students also who secure admission for medical PG/DNB or Diploma courses under Government quota in self-financing and cooperative medical colleges.
The doctors will be given a monthly pay of Rs.15,000 with an additional Rs.5,000 for those serving in difficult rural areas. The decision was taken at a high-level meeting convened by Health Secretary Vishwas Mehta here on Tuesday.
The Government has also decided that it will send advisory to the State Public Service Commission to debar candidates who have not fulfilled the CRS obligation, from seeking employment in either State or Central Government service. Doctors will not be considered eligible to appear for any higher examination unless they have completed one-year CRS.
The diploma students, however, need do rural service of only six months this year. From next year onwards, this will be for a year.

The Government has also made it clear that it may enforce the regulation of the Medical Council of India, which says that action be taken against a physician posted in a rural area, if he is found to be absent on more than two occasions during inspection by Health Department authorities.
Legal action and cancellation of registration will also be considered against those doctors who fail to fulfil the bonded obligation to serve in rural areas, the Government has warned.
The decision to cut short the CRS for medical PG students from two years to one year has been welcomed by the Junior Doctors’ Forum, which had been actively campaigning for this.
The bonded obligation on PG doctors to work for two years for the Government on a monthly pay of Rs.15,000 had met with stiff resistance.

From http://in.news.yahoo.com/071101/211/6mpo4.html

Six-year-old Prakash’s parents came to Mumbai all the way from Rewa in Madhya Pradesh to get him treated for an acute heart problem. But, inspite of taking an appointment for Thursday, they were asked to come back later as resident doctors across Maharashtra's medical colleges were on a strike.

“We have been asked to come later, now we don't have money for all this,” Prakash's mother, Seema Manglani said.

Mumbai witnessed many banner-wielding agitators on Thursday but they certainly did not conform to the image of compassionate doctors. The agitating doctors were protesting against the government's decision to impose compulsory rural internships for every course after MBBS.

According to the new course guidelines, three years of internship is required after post graduation and five years internship after super specialisation, increasing the total education time to 22 years.

However, doctors say rural hospitals are not equipped enough to afford them satisfactory practice.

"If government doesn’t have infrastructure at municipal and basic levels how is it telling that infrastructure is waiting for us there,” member of the Maharashtra Association of Resident Doctors, Dr. Vasant said.

Like every other citizen the doctor also has the right to follow a profession of his choice the way he wants to, but the corollary is – what about the patients' right to a normal and healthy life?

(With inputs from Aruna Ramesh)

From http://www.hinduonnet.com/2007/09/13/stories/2007091354441003.htm

On rural service









The decision of the Union Health Ministry to introduce compulsory rural service for medical students needs to be coupled with legislation which ensures basic facilities for doctors who are posted in the villages. Most of the government health facilities are in a sorry state. They are left to fend for themselves when it comes to infrastructure and support staff. Most of the quarters available for the medical staff are in a dilapidated state. If the work atmosphere is good, there are excellent avenues for professional growth and research, and there is transparency in recruitment and transfers, many of our doctors will remain in government hospitals, rural or urban.

Jeevan Kuruvilla,

Vellore

* * *

The concept of compulsory rural service is no doubt noble. But the plight of doctors posted in villages is miserable. There is virtually no infrastructure and there is acute shortage of medicines, communication facilities, and ambulance services. Doctors can hardly discharge their duties. Students will simply while away their time to fulfil the mandatory requirement. It will turn out to be a national waste.

K.R.P. Gupta,

New York

* * *

If students are forced to serve in the rural areas, villagers will become guinea pigs. Doctors with some years of practice should be asked to serve in the villages. Their licences should be renewed only if they do so.

C.G. Senthilkumar,

Washington

* * *

A fresh graduate is himself a learner. Agreed, there is a dire need for doctors in villages but not inexperienced ones. Why should young doctors be made scapegoats to camouflage the government’s failure to upgrade the infrastructure in the PHCs? The cause would be better served if adequate diagnostic facilities, beds and paramedical staff are provided in village medical centres.

Shivam Sharma,

Aligarh

* * *

What will happen if defence personnel refuse postings in the border areas or hostile terrains citing various reasons? The students of medicine should look at the one-year rural posting as an opportunity to serve the poor who are desperately in need of good doctors. One year will pass, but the commitment to serve the poor will be strengthened.

V. Balachander,

Thanjavur

* * *

The medicos should understand that the opportunity to serve the rural people is a godsend to them. Earning the respect and love of poor villagers is more valuable than money.

G.N. Devaraj,

Bhavanisagar

* * *

I am of the view that compulsory rural service should be extended to all professionals. Engineers should be sent to villages to sort out water supply and sanitation issues and assist in the construction of roads and bridges. Veterinary surgeons can improve the condition and yield of livestock. Students of law can ensure that legal disputes are nipped in the bud. Teachers should be compulsorily attached to rural schools.
And all people’s representatives should be forced to spend at least one week every month in villages and obtain a certificate from the panchayat. These steps will ensure the overall improvement of rural areas and reduce the movement of villagers to cities.

Vinod Garg,

Hyderabad

Copyright: 1995 - 2006 The Hindu

From http://www.indiaenews.com/health/20071025/77129.htm

The tenure of short service commission (SSC) doctors in the Armed Forces Medical Service (AFMS) has been extended from 10 to 14 years, with the cabinet Thursday approving the move.

'With the extended tenure, SSC doctors will also be eligible for time-scale promotions as applicable to permanent commission doctors,' Information and Broadcasting Minister Priya Ranjan Dasmunsi told reporters here after a cabinet meeting presided over by Prime Minister Manmohan Singh.

'This decision will help mitigate the shortage of officers in the AFMS. It will bring about parity with the existing time scale promotions available to the permanent commissioned officers and meet the career aspirations of SSC officers in the AFMS,' Dasmunsi added.

The existing 10-year tenure of SSC officers in the AFMS was based on the tenure earlier prevalent in the three services, a defence ministry background note said.

'However, the total tenure of SSC officers in the three services has already been increased from 10 to 14 years. Therefore, there was a need for revision of tenure of SSC officers of the AFMS on a similar pattern,' the note stated.

'The AFMS cadre is also experiencing a shortage of doctors due to a high rate of attrition. This (extended tenure) will reduce the deficiency and the experience of (SSC) officers can also be utilised for a longer tenure,' the note added.

From http://www.indiaenews.com/politics/20070907/69196.htm

From correspondents in Tamil Nadu, India, 10:30 PM IST

Union Health Minister Anbumani Ramadoss may have good intentions but even in his home state Tamil Nadu, his allies the DMK and the Left parties are opposed to his suggestion that medical college students be given their degrees only when they complete a year's service in rural areas.

Ramadoss' proposal was criticised Friday by Tamil Nadu Chief Minister M. Karunanidhi even as the minister announced the country's first 200-acre medical park, to be set up in Chengalpet, outside Chennai, as a major manufacturing centre for high-end medical hardware.

He said that most medical students came from rural areas and that, 'there could not be two opinions that medical students should have concern for the rural people'.

However, the extension of the medical programme (for the MBBS degree) by one year for rural service 'is not acceptable', Karunanidhi said.

Ramadoss had drawn criticism Wednesday from the Left parties that supported a black badge demo by medical students across the state.

Communist Party of India state secretary D. Pandian said that a majority of the students were from rural areas, 'but the government should not increase the duration of the MBBS course, as it would affect the students, particularly the girls'.

Speaking in Tindivanam on Monday, the health minister had told the media that his ministry was mulling a proposal to award the degree from next year 'only to those who complete rural postings'.

He said, 30,000 medical graduates across the country will have to work for four months each in the district headquarter hospitals, taluka hospitals and primary health centres under the supervision of the district medical officer.

Following this, on Wednesday, medical students across Tamil Nadu went on a flash strike. Nearly 1,300 students and house surgeons, including 500 girls staged a black-badge demonstration.

திருச்சியில் மருத்துவக் கல்லூரி மாணவர்கள் ஆர்ப்பாட்டம்
திருச்சி, அக். 23: மருத்துவக் கல்லூரி மாணவர்களிடம் அளித்த உறுதிமொழியை மத்திய அமைச்சர் மீறுவதாகக் கூறி, அவரைக் கண்டித்து திருச்சி கி.ஆ.பெ.விசுவநாதம் மருத்துவக் கல்லூரி மாணவர்கள் செவ்வாய்க்கிழமை ஆர்ப்பாட்டம் நடத்தினர்.
"எம்பிபிஎஸ் படிப்புக் காலத்தை ஐந்தரை ஆண்டுகளிலிருந்து ஆறரை ஆண்டுகளாக உயர்த்துவது தொடர்பான பிரச்னையைத் தொடர்ந்து, மாணவர்களுடன் பேச்சுவார்த்தை நடத்திய மத்திய சுகாதாரத் துறை அமைச்சர், கோரிக்கைகளை உயர்நிலைக் குழு அமைத்து பரிசீலிப்பதாக உறுதி அளித்தார்.
ஆனால், தற்போது அவர் உறுதிமொழியை மீறி செயல்பட்டு வருகிறார். மேலும், தமிழக மருத்துவ மாணவர்களை வட மாநிலங்களில் கட்டாயமாகப் பணி அமர்த்தவும் முயற்சி செய்து வருகிறார்.
மத்திய அமைச்சரின் இந்த நடவடிக்கையைக் கண்டித்து, திருச்சி மருத்துவக் கல்லூரி மாணவர்கள் மற்றும் பயிற்சி மருத்துவர்கள் கருப்புப் பட்டை அணிந்து வகுப்புக்குச் சென்றனர்.
இதைத் தொடர்ந்து, தமிழ்நாடு மருத்துவ மாணவர்கள் கூட்டமைப்பு சார்பில் கல்லூரி வாயிலில் மாலை ஆர்ப்பாட்டம் நடைபெற்றது.
கூட்டமைப்பின் மாநில அமைப்பாளர் எஸ். வரபிரசாத் ஆர்ப்பாட்டத்துக்குத் தலைமை வகித்து, கோரிக்கைகளை விளக்கிப் பேசினார். கொட்டும் மழையில் நடைபெற்ற ஆர்ப்பாட்டத்தில் நூற்றுக்கும் மேற்பட்ட மருத்துவக் கல்லூரி மாணவ, மாணவிகள் பங்கேற்றனர்.

From http://www.hinduonnet.com/2007/10/24/stories/2007102457690300.htm

TIRUCHI: The announcement of Union Minister Anbumani Ramadoss on Friday that the proposal on one-year compulsory rural medical stint for the students would be drafted by December triggered vociferous protests from the student fraternity in the city.

About 120 house surgeons and 450 undergraduates and postgraduates took to roads after college hours on Tuesday, bracing heavy downpour. They raised slogans demanding the withdrawal of the directive.

Earlier, the students attended classes wearing black badges as a mark of protest.

Two representatives from 13 medical colleges in Tamil Nadu would meet shortly and discuss further course of action. The Tamil Nadu Medical Students’ Association (TNMSA) has contacted the medical student’s association of AIIMS, JIPMER, and medical colleges in Orissa and Maharastra in a bid to organise a nation-wide protest.

To
The News Editor,


Dear Sir,

On behalf of our organization a Press Meet will be held. Kindly send your reporter and publish our news.

Date : 23/10/2007 – Tuesday
Time : 12.00 Noon
Venue : Chennai Press Club
S – 5, Government Estate, Anna Salai, Chennai – 2.

Subject : Compulsory Rural Service. Next course of Action.