Thirty-year-old Disha, an 8-month pregnant woman, was sitting in the gynaecology wing’s OPD at Sanjay Gandhi Hospital, waiting for the doctor to arrive. Anxiety and weakness are taking a toll on her as the staff had asked her to seek medical care elsewhere owing to the unavailability of doctors. A fatigued Disha along with Asha worker Sangeeta argued with the staff to let them meet the doctor as she was unable to cope with the weight of the baby. She failed to meet the doctor that day.
Reason: Doctors were occupied with operations.
Disha was found to be severely anaemic by the doctor at a mohalla clinic close to her house. The mohalla clinic doctor immediately referred her to the Sanjay Gandhi hospital for a thorough check-up.
After visiting the city hospitals for half of the day, Disha came to the same hospital and got her check-up done. However, this became possible only after several phone calls were made by the doctor at the mohalla clinic.
Lack of doctors is not strange with regard to Delhi’s hospitals.
Recently, the Delhi Commission of Women issued a notice to the state health authorities after it noted that a number rape survivors had to wait for almost 15 hours for medical examination to be conducted in Deen Dayal Upadhyay Hospital. Another victim reported that it took 12 hours in Lok Nayak Hospital and 8.5 hours in Safdarjang Hospital. The reason being, doctors were occupied with other duties and no other doctors were free.
Delhi hospitals are witnessing a shortage of doctors for the last six years and the Covid pandemic has made it worse. The lack of enough doctors led to fewer and shorter patient-doctor meetings. In some cases, hospitals have halted overall functioning owing to this shortfall.
As per the data shared by the Delhi government’s health wing last year in August, the capital had more doctors than prescribed by international standards for every 1,000 citizens. However, in reality, the sanctioned strength of doctors in hospitals is still not fully utilised due to which there remains a systemic crunch of medical staff.
Dr G S Greval, immediate past president of Delhi Medical Association, said that it’s a three-tier issue and that the manpower distribution is also very poor. “Distribution of postings in OPD and emergency wings is less as compared to those in academic departments. Senior residents take up emergency duties,” said Dr Greval, and asked, “Why can’t we deploy lecturers also in emergency and OPDs from time to time?”
According to Dr Jugal Kishore, head of the Community Medicine department at Safdarjung Hospital, there is severe crisis of specialist doctors in the city’s hospitals. Last year in August, the state health authorities revealed that there is a shortfall of doctors and medical staff at government hospitals. Around 19 per cent of the total posts of doctors, over 14 per cent posts of nursing staff and over 18 per cent posts of paramedical employees are lying vacant.
The highest percentage of vacant posts is of doctors, according to the health authorities. They stated that, of the 2,583 posts of doctors at government hospitals, 487 or almost 19 per cent are vacant; while 1,203 of the 8,407 sanctioned posts of nursing staff and 834 of the 4,578 posts of paramedical staff are also vacant. This comes despite the fact that the national capital has the best of hospitals, including AIIMS, Safdarjung Hospital and LNJP.
Why are positions lying vacant?
According to Dr Rohan Krishnan, founding member of the Federation of All India Medical Association, the main reason behind vacant positions in Delhi hospitals is the hiring exam which is conducted by the Union Public Service Commission (UPSC) and the Delhi State Commission. “While the UPSC has been hiring doctors by conducting Combined Medical Services Examination, Delhi government has not conducted the exam since ages,” he said.
However, even the recruitment done through UPSC has very few vacancies and is a pan-India exam. “The exam which was conducted on July 17 was for MBBS doctors not for doctors with MD or MS or senior resident doctors. This is one of the reasons why specialist doctors are in such less numbers in government hospitals,” he said.
Dr Krishnan said that numbers of senior residents is also dwindling because there have been no hirings for the position. Senior residents are mostly the ones responsible for emergency duties of the hospital.
Super speciality hospitals like Delhi State Cancer Institute too are struggling to stay afloat and has been working with two-third of the posts of doctors in the hospital lying vacant.
Delhi State Cancer Institute, a Delhi government-run hospital was established about 16 years back to treat poor cancer patients. Not just doctors, there are not enough nurses and paramedical staff here as well. When this newspaper contacted Delhi government’s officials to know why it has not conducted the exam to hire regular doctors, they told that all the hiring are done through UPSC and not through any state exam. “State government has no role to play in hiring of doctors,” said Shaleen Mitra, Officer on Special Duty (OSD) to the health minister.
Contractual nature of work
The doctors with Central and state government institutions have been hired on contract basis and not as regular employees. In Delhi, a majority of the senior resident doctors and junior residents are working on contract. The contractual nature of a job does not bring much to the table for a doctor when it comes to focussing on their careers.
Dr Ashwini Dalmiya, president elect of the Delhi Medical Association said that while there is no dearth of eligible doctors in the city, the human resource management has remained a failure. “They don’t want to give young doctors the money and respect they deserve and that is why they recruit them on contract and ad-hoc basis. The system is being run by bureaucrats who don’t know the nitty gritties of the medical profession,” Dr Dalmiya said.
“Why will a doctor come on a low salary as compared to regular employees where there is no job security, no perks and benefits, not even health insurance,” said a doctor working with a Delhi government hospital on contract basis, adding that even leaves are very less, hardly 10 days of leave was allowed to her in two years. Not only that. The doctors on an ad-hoc basis have to get their contract renewed from the HOD every 89 days. “The humiliation one has to go through to get the contract renewed every 89 days is sickening,” said the doctor. “I cannot even encash my earned leaves,” she said.
According to Dr Rohan Krishnan, his association also sent a letter to the Delhi government and health ministry regarding the extension of days to hire doctors on contract basis, there was no response.
Several doctors have also claimed that even to renew the contract, many government officials take bribes from doctors and for the post of a senior resident, Rs 5 lakh bribe is being charged by the officials. However, this claim has not been provided with any substantial proof.
Dr Alka Chaudhary, a senior doctor working at a mohalla clinic in Peeragarhi, asked why would young doctors come to far off locations where there are no equipment and facilities to treat patients, and for them to learn and grow in their profession.
Lack of equipment
While the Delhi government’s focus has been to promote Lok Nayak Hospital as a model hospital, the other state-owned hospitals have suffered and lacked even the most basic equipment. However, even Lok Nayak Hospital’s Burns and Plastics wing has been affected by a severe crunch of specialist doctors, official sources told this newspaper.
“The government has only focussed on a few including Lok Nayak Hospital and not on other super speciality hospitals built in far off locations. They still have a long way to go as they do not have the required equipment,” said Dr Alka Chaudhary, a doctor deployed under the National Health Mission.
Recently, the state government announced that it will be developing seven more hospitals in the city. However, even the newly built and operational super speciality hospitals do not have doctors or equipment.
On March 31, the Delhi High Court pulled up the government for its failure to make expeditious appointments at the Indira Gandhi Super Speciality Hospital in Dwarka. Here, even the supply of drinking water was deficient.
“Which young doctor would like to work at such a hospital where there are no basic amenities or the equipment? Young doctors want to get trained in order to get better at their job and thus choose private hospitals where the pay is good and where there is scope for learning with the support of good equipment,” said Dr Rohan Krishnan.
Worst sufferers: MCD doctors
The worst affected in this battle are the doctors working with MCD hospitals who have not been paid for the last 8 months. According to Dr Atul Jain, a senior resident doctor at Swami Dayanand Hospital, the MCD has stopped the salaries of doctors. “In such a scenario, who would like to work here?” he questioned. He said that a number of vacancies of specialist doctors are lying vacant in various
MCD-run hospitals. But due to mismanagement and lack of funds, no appointment have been made
so far.
While Delhiites feel the absence of quality healthcare, the doctors themselves complain of working under stressful and long hours due to shortage of staff in government hospitals, finds Ankita Upadhyay
