Dr. Aviral Mathur, Senior Resident, Lok Nayak Hospital, Maulana Azad Medical College (MAMC), who was recently appointed as the new President of the Federation of Medical Resident Associations (FORDA), shares his perspective on recent issues related to medical domain.

Studying medicine in India has become increasingly difficult due to regular fee increases in private colleges, fierce competition, violence that the medical community sometimes experiences, and lack of timely stipend payments. On these questions, we sought the advice of Dr. Mathur, who seemed to have everything right. He also stresses how very important a work-life balance for doctors is and, referring to the delay in paying allowances for doctors, insists that they assert their rights by following “no pay, no work”.

NEET is a very competitive exam, what do you say to those who don’t pass? What other options can they choose?
NEET UG is witnessing more than 10 lakh candidates and although the seats have increased, the number of candidates has also increased.

However, students have other options like Allied Medical Specialty courses, BDS, and other general courses. Students can also choose AYUSH courses. I see so many people exploring Ayurveda and homeopathy as an option. I am amazed at the number of students who join these courses. Additionally, bachelor’s and master’s degree courses in related fields such as microbiology, pharmacy, and physiology courses are also an option.

There are basically three types of students: the serious type; the sincere kind who doesn’t know how desperately he wants it and lastly, the one who just sits around for fun and isn’t interested in what he is studying, the first type will stop at nothing less than MBBS, the latter will qualify as NEET but will have to settle for private colleges where fees are exorbitant. Students who somehow manage to find resources move there, so this is another option for students who cannot make it to government medical schools. The third type opts for shorter courses where they can get to market early. If they pursued mathematics in high school, it opens up more fields for them.

Few students also opt for countries like Sweden, China, and Ukraine to pursue their MBBS. And for this they began to come under fire, for example, the ordeal of students returning from war-torn Ukraine. What do you have to say about that?
As I said, there are the first diehards who will settle for nothing less and they will crack. The second group, which is not able to devote as much, lands in Sweden, Norway, Ukraine, China and Russia. This is mainly due to the high tuition fees for medical courses at private colleges here. In Russia, a student can complete their entire course for Rs 10 or 20 lakh, as opposed to Rs 80 lakh or more that it would take in India.

These students can complete their education there and upon their return, they only have to pass one exam called the Overseas Medical Graduate Examination (FMGE) to become eligible to practice medicine here. Moreover, the private colleges in India are in remote places, somewhere on the outskirts, so for a new school that grew up in a metropolis, it becomes too difficult to adapt. There, they prefer to get out of the whirlwind of excessive spending and favor foreign diplomas. The mindset in India is that going to study abroad makes someone an exceptional student, but that’s not always the truth. This student who goes to Sweden or Ukraine could very easily have done his studies here but unfortunately, it would cost him a fortune.

What about the quality of education? Which is better – Private Indian Colleges or Foreign Colleges?
It varies from college to college. There are many private colleges in India like Kasturba Medical College, Manipal, then Jolly Grant Medical College, Dehradun – these are very good private colleges for MBBS. The education system is good and they teach holistically with very good patient attendance. So, while there are private colleges that are proven, there are others that are not even comparable to medical standards.

As for foreign medical degrees, I know quite a few students who came back with a degree from abroad and joined a government college for their PG course. So their upbringing must have been really good. However, I noticed that these students are theoretically stronger and Indian students are practically stronger.

What do you have to say about the Indian medical students from Ukraine who were initially promised help but are still stuck here? Do you think they can be integrated with government colleges?
Integrating them into the Indian education system may not be possible. Educational systems are structurally very different depending on the location. ENT (ear, nose and throat) is a subject that Indian students study from their third year, while in Europe they do it before the third year, but again in Russia it will not be taught before their fifth year. It is therefore a political decision.

We trust the National Medical Commission to make a logical decision and they must have deliberated before making their decision.

Young doctors and others have faced a lot of violence and harassment over the years. We have also seen cases in the recent past. What measures have been taken by the government to ensure their safety?
It is fundamental to demand security in case you feel threatened. Such professional hostility is not conducive to positive change and if you feel threatened while on duty, you demand protection. All branches of any profession that deal with the public are witnesses to this situation. Therefore, we cannot demand a special law just for us doctors and instead we now demand government awareness programs and campaigns that can educate and sensitize people. So far we have done this at the institutional level and are in talks with the government.

What about the Supreme Court case, in which pleas were filed challenging the NMC circular on government college fees for 50% seats in private medical schools? Is it really possible, what the NMC proposes?
It should be possible, rather, it should be made possible. Pursuing medical studies in India has become a deterrent for Indian students due to high tuition fees. This should be changed and we welcome this change. Personally, I think this should be applied and implemented all over India instead of just certain parts.

Recently, we have witnessed protests at Osmania Medical College in Hyderabad, Telangana over unpaid stipend for more than seven months and similar situations have also been seen in other medical colleges across the country over the years. What do you think is the root cause and what do you think can make the government a little more proactive?
Yes, I just had a conversation with someone about how doctors in a college in Haryana get their stipends at a three month interval. There is no difference between government or private colleges, both do this to their doctors and it is really unfortunate. I feel bad as a resident doctor myself when I hear or witness these incidents. A resident doctor is already 25 years old and some of them are often older. At this age, working so much with every 24 or 48 hour shift with paperwork!

The basic needs they look forward to are their daily durability and a good night’s sleep. This problem prevents students from working hard because they are unable to reward themselves. Work must be balanced with reward and this is fundamental for every human being. Not receiving their salary while working so hard can make the person mentally and financially ill. On public holidays, they cannot afford to go out. Few physicians have home responsibilities or student loans to pay off, so this problem is extremely serious.

When such incidents occur, we write letters to institute officials to raise the issue with higher authorities, however, if the official does not respond, we write directly to higher authorities such as ministries. When the high authorities are also not worried, we have no other choice but to stop the work. In the NEET PG consultation last year, when doctors halted work and went on strike, the Supreme Court ruled saying, ‘No work, no pay’ and doctors’ salaries were deducted for striking for their basic rights. So, there should also be a decision that would say “No pay, no job”. That’s what we stand for.

As you said, the job of a doctor is very stressful with shifts of 24 to 48 hours. How can young doctors cope with the stress of the profession? Do you have a message for them?
It is important for doctors to find a balance between their social and professional life. I have never advocated that physicians take a continuous 24 or 48 hour shift. I would advise them to always make time, maybe go see a movie, spend time with family, and learn to disconnect. It is very important to disconnect and recharge. I also recommend mindfulness, meditation, eight to ten hours of sleep, and hanging out with friends.

A doctor who takes some time off for himself will not affect the general health of a country. In fact, it is the government that should improve the infrastructure to integrate more doctors. The issues you raised today are all linked, a doctor is stressed and overwhelmed because there are not enough young doctors, there are no young doctors because they went to study at abroad, they went abroad because fees are high and doctors here tend to face violence; and this overworked doctor, in reality, was the one who belongs to the first category of students who obtained the best grades and worked the hardest to arrive at this place.

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