Medical associations seek scrapping of bond policies for doctors

 Medical associations seek scrapping of bond policies for doctors

After suggesting that state governments should abolish seat-leaving bonds, the central government is mulling over the cancellation of service bonds

Shuddhanta Patra | Posted February 27, 2024 09:13 AM

To enable doctors to serve their home states, boost productivity, reduce stress and enhance mental well-being, the medical associations including IMA, FAIMA, and FORDA are demanding that all bonds concerning doctors including service bonds be cancelled by the state governments. The Health Ministry and NMC have started discussions on quashing service bonds with the stakeholders across the country. 

The healthcare system in India faces several challenges in providing equitable and quality health services to its population. Consequently, several state governments have implemented regulations seeking medical graduates, postgraduates and super-specialists to work in public and private medical colleges and hospitals for a duration of one to three years.  After requesting states to do away with the 'seat-leaving bond' policy in medical colleges, the government is reportedly mulling over abolishing service bonds for doctors. A service bond is a legal agreement between a medical student and a government agency or medical institution. It requires medical graduates to work in a specific area or healthcare facility for a specified period after completing their MBBS degree. The condition of the bond is imposed by the state to increase access to improved healthcare services, especially in rural areas. If the student decides to discontinue the course midway or does not wish to serve the stipulated duration, he/she will have to pay a hefty monetary penalty to the state government to leave the course.

According to an official working with the Health Ministry, service bonds for doctors are harming the productivity and mental health of doctors. “The doctors’ associations and NMC have suggested the government do away with the service bonds. In states such as Delhi, there is no service bond policy, but it is difficult to do away with it in states such as Chhattisgarh, Bihar, Jharkhand, and Odisha as there are very few doctors who cater to the rural population in these states. Abolishing service bonds is likely to impact medical services, but technically there should not be any bonds for medical students. The government is also against bond policy and it is discussing with other stakeholders if it can be quashed while maintaining the standard of medical care across the country."

The PG doctors who are studying in different states are frustrated and want to return to their home state, but cannot do so as they are under obligation of the bond policy. “IMA is against any kind of bond system for doctors and has asked the NMC and the Health Ministry to abolish it. Restricting the doctors to a bond system is not required as there are enough medical practitioners across the country. Hence, Tamil Nadu has recently done away with all bond policies for doctors," says K M Abul Hasan, president, Indian Medical Association (IMA), Tamil Nadu. 

Dr Aviral Mathur, Federation of Resident Doctors Association (FORDA) says that all bonds should be completely abolished. FORDA has spoken to the Health Ministry about the issue. “Union Health Minister Mansukh Mandaviya said that the government is contemplating the bond issues concerning doctors and it will come up with a solution soon. The human rights organisations are also against it and have reached out to FORDA on quashing them,” he says.

According to Mathur, with the introduction of the District Residency Programme (DRP) in 2023, which mandates postgraduate medical students pursuing MD/MS to do an internship for three months, there is no need for the bond policy for doctors as enough doctors will be available to serve in rural areas.  FORDA says that the government must reduce heavy monetary penalties for doctors and also bring uniform regulation across the country. 

The National Medical Commission (NMC) is of the view that medical students should not be burdened with any bond conditions as doing so is contrary to the principles of natural justice. An NMC official says that the Commission deliberated on bond issues concerning doctors during a meeting in January 2024 and is of the view that the states must reconsider its implementation as it affects the mental health of doctors and their higher education. Since then, the apex medical body has held several meetings with various stakeholders on the matter. "The bond policy is a hindrance for medical students opting for colleges in states other than their home state. It must not be implemented for hassle-free student mobility in higher education,” adds the NMC official.  

Madhya Pradesh Director of Medical Education (DME) Arun Srivastava in a telephonic conversation with Education Times says, “A meeting with NMC was held this week on quashing the rural service bond for medical students. We are waiting for the Commission’s direction on it.” Madhya Pradesh government has fixed a bond amount of Rs 30 lakh for students who wish to leave their course midway. This policy is prevalent in both government-run and private medical colleges in MP.

Chhattisgarh's medical bond system requires doctors to serve for two years after completing their PG medical courses. Also, students seeking MBBS admission must deposit Rs 25 lakhs as a mortgage or cash. Mortgaged property remains with the government until the bond is fulfilled, adding to the harassment of medical students.

Dr Rohan Krishnan, national chairman, FAIMA, says, “In a meeting with over 50 members of Parliament on February 7, the doctors raised the issues related to the bond policy. It should be practical, not exorbitant and free of obligation. Our organisation is completely against any kind of bond policy. We have observed mental harassment among doctors due to severe work pressure and when the doctors want to get rid of it, they cannot because of the penalty."

In Maharashtra, a doctor needs to pay Rs 50 lakhs to the government if he refuses to serve the state, says Dr Abhijit Rajesh Helge, Maharashtra Association of Resident Doctors (MARD), adding that the bond obligations are a reason behind increasing suicide rates among medical students. In Assam, state-sponsored MBBS doctors will have to pay Rs 30 lakh and the specialist doctors will be liable to pay Rs 1 crore as a penalty if they fail to serve in the state after completing their course.

Dr Partha Pratim Mondol, Anaesthesia Department, Calcutta Medical College, says, “Doctors feel like bonded labourers under the bond policy. To relieve the doctors of the pressure, the government can reduce the bond duration to just one year to ensure that medical service is intact.” West Bengal government has notified that the doctors will work for the state mandatorily for three years after completion of their Postdoctoral/MD/MS courses.