2019: Looking Back at the Year for Healthcare Professionals The stress levels under which they operate under is so alarming that over 60 per cent of them admitted that they find themselves unable to treat patients without the fear of violence.

Year 2019 was particularly tough on Indian doctors. A series of incidents of assaulting doctors once again highlighted the threat they face in their daily practice. The attacks sparked strong protests and strikes across the country as doctors demanded a safe and violence-free environment. In June, doctors from West Bengal went on a strike demanding justice for two junior doctors who had to endure violence at the hands of patients. In a matter of days, the protest gained nationwide support from doctors, threatening to derail medical services across the country.

Later in the year in Assam, tea estate workers brutally assaulted a 73-year-old medical officer leading to his death. This was one of the most brutal episodes of violence against doctors. In many parts of the country, doctors joined a strike against this incident, reigniting debate over safety laws and safe working environment for them. The nationwide strikes can only be termed as a fierce outcry against years of threats and abuses. According to a study conducted by the Indian medical Association, a staggering 75 per cent of doctors have been at the receiving end of mental or physical abuse at some point in their careers. The stress levels under which they operate under is so alarming that over 60 per cent of them admitted that they find themselves unable to treat patients without the fear of violence.

In response to the demand for stringent safety laws, the Union ministry of health prepared a draft legislation seeking up to 10 years of imprisonment and INR 2-10 lakh fine on those assaulting healthcare professionals. However, this legislation was reportedly stalled by the ministry of home affairs which insisted that no central legislation can be brought to protect practitioners of one specific profession and that current laws were sufficient to deal with the issue.

Addressing the Violence Issue

The incidents of violence this year also generated a very pertinent discussion on why it is futile and misdirected to blame doctors or the poor state of healthcare in India. When the encephalitis tragedy broke out in Muzaffarpur, a leading television anchor was criticized for heckling an on-duty doctor of a public hospital. Critics rightly pointed out that the anchor should have been demanding her answers from the government, not from a doctor who is himself a victim of the poor state of Indian healthcare.

To understand what is compounding the mistrust and hostility doctors face on a daily basis, we first need to understand the current state of healthcare in this country. According to a survey, more than 60 per cent of healthcare expenses are out of pocket and an estimated 25 per cent of Indians slide below the poverty line on account of their medical expenses alone. Hospitalized patients spend over half their annual expenses on healthcare and the poorest one-fifth of Indians have twice the malnutrition, mortality and fertility rates compared with the richest. Shortage of doctors in government hospitals is glaring. According to a survey done last year, India faces a shortage of 600,000 doctors and 2 million nurses. The public ire faced by doctors is often symptomatic of the public anger towards the state of healthcare. It is not just safety standards that need to be upgraded but we also need to address the gaps in infrastructure and shortage of medical personnel if we want to address the root cause of violence against doctors. Making healthcare more accessible is the answer.

The State of Medical Education

While the government is pulling out all stops to get more students to pursue medicine, the statistics seem to paint a more somber and concerning picture. Recently, the Union minister of state for health made a shocking announcement that 5,671 post-graduate medical seats, including 5,543 broad specialty courses and 128 super-specialty courses, were lying vacant for the current academic year. A hefty fees structure and the presumed difficulty of practicing certain specialties are the main reasons behind the vacancies. We hope that the government takes concrete measures to bring down the cost of post-graduate medical education so that students do not give up on their medical education midway or migrate abroad.

To that end, the central government announced its plans to roll out the NMC bill with the intent to replace the controversial Medical Council of India. While the bill proposes a lot of measures to ensure probity, increase the quality of medical education and bring down medical education costs, it carries its own set of problems. Among other measures, the government intends to introduce a six month bridge course that will enable community health workers to practice medicine. While the intention was to meet the chronic shortage of trained health workers in rural and remote areas, there is a very legitimate fear that it will promote quackery, worsening the quality of medical care and putting a dent in the already tenuous doctor patient relationship in this country.

Unsurprisingly, doctors and students from across the country took to the streets in protest, requesting the government to reconsider its move. While Union health minister Harsh Vardhan sought to assure medical bodies the primary aim of the step was to increase access to preventive care at the mid-level, questions remain regarding the implementation of this clause.

We Can Do Better

It is the duty of the government to ensure that doctors get all the infrastructure and legal support they need so they can do their jobs in peace. Public spending on health must go up and any violence against doctors must be met with strict retribution so patients stop lashing out on them for systemic faults. Ensuring safety is also important to keep attracting the brightest minds towards healthcare. Unless the work environment is made more conducive for doctors, we cannot expect to achieve universal health coverage in line with the United Nation's Sustainable Development Goals.