How to mitigate Toxic Conditions for Medicos and Resident Doctors in India

Resident Doctors' Struggles and Mistrust.

• The phrase "Eight hours labor, eight hours recreation, eight hours rest" was coined by Robert Owen in 1817.But  Resident doctors face prolonged shifts exceeding 36 hours, leading to mental harassment and verbal abuse. 

• PG doctors work 80 to 100 hours a week without holidays, affecting their physical and mental health.
• Overwork can lead to dissatisfaction with patient care and lack of time for learning and patient care.

• PG resident doctors face academic pressure, financial constraints, and mental health issues which remain unaddressed. Several students struggle due to unsupportive learning environments,  which compels them to pick alternative careers. Additionally, difficulties in meeting academic requirements or disciplinary issues also contribute to students leaving midway,”
• A recent online survey done by NMC reveals that almost 37,000 medical students have self-reported mental ailments with suicidal risk.
• An RTI filed in 2024 revealed that in the past 5 years, almost 58 postgraduate medical students have ended their lives. These staggering numbers are just the tip of the iceberg. 
• As many as 153 MBBS and 1,117 in postgraduate medical courses have dropped out of medical colleges in the last five years, according to the National Medical Commission (NMC) data. Over 1,200 medical students dropped out in last 5 years raising concern over mental health. 
• Apart from the dropouts, at least 122 medical students, 64 in MBBS and 58 in post-graduate courses died by suicide between 2018 - 2023.
• The mental health issue is further exacerbated by the harsh realities of bond service, which places an undue financial and mental burden on medical students in MBBS, PG or in the Super Specialty wing. Serving bond obligations adds significant pressure on residents, detracting from their ability to focus on their studies and patient care.
• “The language barrier  also pose an additional challenge, especially for students from diverse linguistic backgrounds, exacerbating their difficulties. This situation often leads to depression and a higher rate of suicides among young doctors.
•  Often students opt for medicine due to parental pressure and family prestige. Later, they struggle with the academic grind, many of them repeat the coursework or exams, and eventually drop out of their course. 
• Lowering eligibility for NEET has allowed undeserving candidates to study medicine, who do not necessarily have an aptitude to cope with the vast syllabus.”
• • Multiple tasks during shifts can lead to errors in patient management.

• Mistrust towards doctors in the public domain and a lack of empathy towards them are common.
• There is an increasing trend of medico-legal cases filed against doctors, leading to defensive medicine.
• Despite not being responsible for hospital facilities, patients express frustration at doctors.
• Few hospitals and medical colleges have Public Relations Officers (PROs) to address patient issues, leading to suboptimal patient care.

The new PG medical education guidelines released in 2023 have not addressed any issues regarding mental health problems and burnout among PG residents. 

 Toxicity of Departments

• Despite continuous duties and personal sacrifices, doctors are often criticized for lack of resources, failed government policies, and political melodramas.
• Faculty members of government medical colleges often maintain the same work environment as residents, with residents working 7 days a week.
• Some faculty members deny residents leave, claiming they worked harder during their residency.
• Faculty members often ask favors from residents, such as helping them prepare presentations and write-ups.

Many postgraduate students are not even awarded free healthcare by their colleges and might have to pay out of their pockets to avail of the same. 

"Greedy Doctors" Propaganda
• The narrative that doctors care only about money is distorted, with an average salary of 65,000 for a resident doctor and over 80 hours of working hours per week.
• The work environment is unhealthy, with long hours of continuous duty, lack of personal care, and disregard for mental health affecting medical care standards.

Absence of a Proper Referral System
• Despite a good network of primary health centers, people still seek care at tertiary care centers like medical colleges, even for trivial illnesses.
• Many medical colleges provide outpatient consultations to only referral cases, adding to the burden of an emergency department.

 What can we do to solve this problem?

1.     Strict compliance to work hour restrictions for residency. Government should implement the Central Residency Scheme, which was formulated following a Supreme Court order in 1992, which guarantees a weekly off on rotation basis and work hour restriction of 12 hours a day.

2.     A  large-scale study done in the US reveals that once physician work hours were restricted, patient adverse outcomes and human errors fell by a third. Reducing workload can enhance academic activities, improve duty hour compliance, and improve patient safety.

3.      Manpower up-gradation across all government hospitals so that the ideal doctor: patient ratio can be achieved.

4.      A large-scale study in BMJ analysing almost 4,85,000 patient records reveals that internal medicine doctors trained for fewer hours treated patients just as well in their first year of unsupervised practice as doctors trained for more hours.  

5.       Capping of admissions per day depending upon the number of doctors available for duty. This can be done only if the peripheral hospitals are strengthened with manpower and infrastructure.

6.       Educating the public about the purpose of each level of health care so that trivial diseases like common cold and pharyngitis won’t seek treatment at tertiary centers.

7.     Introducing some labor protection and making PG stipends uniform and adequate across states .

8.     Students who wish to discontinue their education should not be penalized financially or mentally.

9.     Hiring non-PG residents, senior residents, etc. so that there is no lack of manpower, and ensuring that employed staff performs their duties adequately.

10.  Having disciplinary bodies at the level of the colleges, states and the center is also necessary to ensure that students can safely raise their concerns without fear of persecution.

11. periodic comprehensive health check-ups and free treatment to the family of resident doctors.

If Government, NMC  and health departments fail to implement these critical changes in the residency program, doctors will continue to face the heat of patients’ frustration. As doctors are also humans, they will retaliate after a breaking point.

IMA JDN DOING ENORMOUS WORK  towards mitigating the prevailing toxic environment in medical colleges by organizing series of work-shops to provide psychological support and strengthening the learning modules and providing the needy help in thesis making and research.

Its an open appeal to all principals of 700 medical colleges to consult the nearest local IMA branch to take the help of senior leaders of IMA in providing hand holding support to their resident doctors &interns.

  In the face of alarmingly high levels of stress, burnout, and psychological distress among India's medical workforce, urgent action is required to mitigate the toxic conditions threatening their well-being and the quality of patient care.