At 10 a.m. on a Thursday, the 150-bed Government General Hospital in Telangana’s Nagarkurnool district is a beehive of activity. People, from mothers in their 20s to seniors in their 80s, form a queue of about 70 people, each of them clutching their outpatient slips. Outside the diagnostic labs, a slightly smaller queue extends far beyond where the corridor turns. In the duty doctor’s room, a 5x5-metrespace, there are two beds, a chair, and a washroom. It is here that medical professionals spend gruelling 24-hour shifts, their bags and tiffin boxes on the beds. The room is not designed for comfort, but for the hard work of healthcare in India.
Some of the doctors here serve as assistant professors at the Nagarkurnool Government Medical College, which is attached to the hospital. These assistant professors, with work experience of about a year of senior residency after three years of post graduation, were recruited in May this year and assigned to various medical colleges across the State, with a particular focus on the eight new ones inaugurated by Chief Minister K. Chandrasekhar Rao in 2022. This is part of the Telangana government’s ambitious Whitecoat Revolution — a plan to establish one medical college in each of the 33 districts.
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This plan is nearly complete, with 26 government medical colleges already operational in the State and eight more set to be inaugurated in the upcoming academic year. While the government appears committed to developing the infrastructure, there is growing concern about the availability of manpower. In many of the new medical colleges, there is a faculty shortage, putting a burden on existing doctors.
The establishment of 17 government medical colleges in the past two years has positioned Telangana as the State with the most MBBS seats in the country, offering 22 seats per 1 lakh population, according to data provided in Lok Sabha. On July 28, 2023, in response to a question asked in Lok Sabha, Minister of State in the Ministry of Health and Family Welfare Bharati Pravin Pawar shared that Telangana has a total of 8,540 MBBS seats. Considering the population of Telangana which is approximately 4 crore, the number comes down to 22 seats per 1 lakh population.
The National Medical Commission (NMC), the regulatory authority responsible for overseeing medical education and professionals in India, stipulates that the medical colleges shall follow the ratio of 100 MBBS seats for 10 lakh population in that State and Union Territory. According to the data available, Telangana has more than double the number of seats as recommended by the NMC. While this increase in seats is a significant achievement, it also entails the responsibility of recruiting adequate staff to ensure that these medical colleges produce well-trained doctors.
Of the 1,442 assistant professor posts sanctioned by the government, the final selection list released on May 8 this year revealed that only 1,061 applicants had been selected, leaving 381 posts empty. The recruitment was conducted for 34 departments under the Directorate of Medical Education.
At the Nagarkurnool medical college, which was opened last year and currently has two cohorts of MBBS students enrolled, doctors report a staff shortage across a majority of the 19 departments. Classrooms bear the creative touch of students, featuring handmade charts on human anatomy. Of the nine sanctioned assistant professor posts, only four have been filled.
“We do not expect an immediate transformation into the famed Gandhi Medical College or Osmania Medical College, both of which are in Hyderabad, but we do require essential services to the best possible extent,” says an assistant professor from the college.
Infra growth but vacancies galore
Prior to the formation of Telangana in 2014, there were only five medical colleges for the area that currently forms the State. The Telangana Rashtra Samithi (now Bharat Rashtra Samithi) government established two new medical colleges in 2016-17 in Mahabubnagar and Siddipet districts, and another two in Nalgonda and Suryapet districts in 2017-18.
After a hiatus of four years, in 2022-23, the government initiated the establishment of eight medical colleges in Mancherial, Ramagundam, Jagtial, Wanaparthy, Nagarkurnool, Mahabubabad, Bhadradri Kothagudem, and Sangareddy.
In September this year, the government inaugurated nine medical colleges in Kamareddy, Karimnagar, Khammam, Jayashankar Bhupalpally, Kumaram Bheem Asifabad, Nirmal, Rajanna Sircilla, Vikarabad, and Jangaon, taking the State’s total to 26.
The remaining districts of Jogulamba Gadwal, Narayanpet, Mulugu, Warangal, Narsampet, Medak, Yadadri Bhuvanagiri, Rangareddy, and Medchal Malkajgiri are expected to be covered in 2024-25, to realise the ultimate goal of one medical college in each district.
Of the recruitments announced in May this year for assistant professors across the State, the only two departments which saw 100% recruitment were Medical Oncology (one post) and Radio Oncology (five posts). The highest number of vacancies were in the Obstetrics and Gynaecology department where 116 applicants were selected against 187 sanctioned posts, followed by 155 against 177 posts in the Anaesthesia department, 131 against 149 posts in the General Surgery department, and 118 against 144 posts in the General Medicine department.
The other departments that also fell short of assistant professor posts include Paediatrics (85 applicants for 94 sanctioned posts), Orthopaedics (66 for 72 posts), Radio Diagnosis (41 for 56 posts), and Pathology (42 for 48 posts).
The highest number of vacancies were in the Forensic Medicine department (18), followed by Community Medicine (16), Hospital Administration (15), Cardiac Thoracic Surgery (14) and Physiology (13). The remaining departments have vacancies in single digits.
Stressful job, distant postings
Doctors who are currently posted at the medical colleges say that the number of assistant professors who joined duty is even less than the appointed 1,061. There are also some who left the job within a few months, as they were unable to bear the stress. Many assistant professors either did not join or left quickly because they were posted in places away from areas they were stationed.
A recently-married assistant professor from Jangaon was assigned to Mahabubnagar medical college. Her husband, hailing from Vikarabad, has been posted at Niloufer Hospital in Hyderabad. The couple struggled to balance their personal and professional lives. They were hoping for postings in the same district. “Can we not expect this level of consideration from the government,” asks the doctor, adding that the State administration, including the Health Minister and Director of Medical Education, do not accommodate such transfer requests. “The department is unapproachable when it comes to sharing our concerns.”
Regarding the challenges that doctors are facing with their postings, Health officials maintain that “the postings were allocated through a fair counselling process”. “If any doctors have concerns or issues with the allocation process, they are not obliged to continue their service,” a senior Health officer, unwilling to be named, told The Hindu.
A doctor from the Government Medical College in Jayashankar Bhupalpally district blames the faculty shortage on the proliferation of medical colleges: “Given the proximity to Warangal district [about 70 km away], it would have been prudent for the government to allocate the funds sanctioned for the new medical college towards enhancing the infrastructure in Warangal itself, rather than establishing another medical college so close to the district.”
The construction of the new college building in Bhupalpally remains pending, with only 70% of the structure completed, adds the doctor.
NMC specifications
The NMC has set specific requirements for medical colleges. According to the guidelines, a medical college with 50 seats should have 14 professors, 20 associate professors, and 25 assistant professors, totalling 59 faculty members.
For a college with 100 seats, there should be 17 professors, 27 associate professors, and 41 assistant professors, putting the total at 85. In the case of a 150-seat college, it should maintain 19 professors, 40 associate professors, and 55 assistant professors. A majority of the medical colleges in Telangana fall within the 100- and 150-seat categories.
The senior Health officer adds that there will be a gradual increase in faculty recruitment for each college over the years. “The Health department is aware of the existing vacancies. After the election process concludes, the department intends to release a recruitment notification to address these vacant positions,” he points out.
There have been numerous instances across the country where the NMC has revoked permission granted to certain medical colleges due to insufficient faculty strength. In Telangana, these colleges are at risk of facing similar repercussions.
A doctor from the Government Medical College in Suryapet district, who studied at the Government Medical College, Amritsar, Punjab, says the NMC had suspended admissions at the newly-established Chintpurni Medical College at Pathankot in that State due to the college’s inadequacy in terms of faculty and infrastructure. Whenever such a situation arises, it is the students who suffer the most, having placed their trust in a government institution for their education, he adds.
“The Telangana government should consider this as a cautionary example and, in light of it, either refrain from establishing additional medical colleges or ensure that the new colleges do not find themselves in a precarious position where, in a few years, the NMC might withdraw permission for the majority of these institutions,” asserts the doctor.
President-elect of the Indian Medical Association, R.V. Asokan emphasises the need for a balanced approach by the government, blending populism with prudence. “If a large number of doctors are available, but are still not choosing to join government services, then the Health department must assess the situation. Rather than increasing the number of medical colleges, it would be more meaningful for the government to allocate greater attention to the public health sector,” he says.
Delay in salary disbursement
Beyond the challenges relating to faculty shortage, doctors say they also face salary issues. A doctor, who recently joined as assistant professor at the Government Medical College in Bhadradri Kothagudem district, reveals he has received only one month’s salary after commencing duty in May 2023.
Initially, the administration cited the necessity of obtaining a Permanent Retirement Account Number (PRAN), which was causing a delay. The doctors were informed that salaries could not be disbursed without PRAN, prompting them to wait for two to three months.
“Whenever we approach the administration to address this concern, we are told that if the Health department submits a four-month salary request to the government in a single go, it would be considered a supplementary bill, a process that the government is hesitant to approve,” a doctor shares, requesting anonymity.
Consequently, the administration processed the September salary as a regular bill and obtained clearance, resulting in the disbursement of only one month’s salary yet again. The outstanding dues for the three months in between remain pending.
Now, with the Model Code of Conduct in effect until the November 30 Telangana Assembly elections, the doctors anticipate further delays in the bill settlement. This implies a potential sacrifice of an additional two months’ salary (for October and November), as another doctor points out.
A similar situation has surfaced at the Government Medical College in Jayashankar Bhupalpally and the Kakatiya Medical College in Warangal, where doctors have also been waiting for their salary for four months since joining.
While the government’s primary objective is to achieve the goal of setting up one medical college in each district, doctors wish that it does not lose sight of the immediate requirements. “We want the government to prioritise the creation of a limited number of medical colleges and bolster the existing public healthcare infrastructure alongside medical education,” a doctor says.
