Traditional medicos step in for MBBS doctors at hospitals

Even as Indian Medical Association (IMA) opposes the practice of allowing AYUSH doctors (Ayurveda, Yoga, Unani, Siddha and Homeopathy) to work in many private clinics and smaller nursing homes, AYUSH doctors continue to be employed. 

For several years, Dr Rahamatullah(name changed), an Unani medicine expert has served as an allopathic doctor before shifting to traditional medicine permanently.  “AYUSH doctors are very much a part of private clinics. Even allopathic doctors are trained by specialists like gynaecologists, for example. Similarly, the Unani or Ayurvedic and other traditional physicians work under the guidance of a senior doctor at these hospitals,” he says. 

Dr Rahamatullah opines that the basic salary of Rs 25,000 is a very big sum for  alternative medicine practitioners. “Even if they set- up their own clinics, they wouldn’t be able to make this much money,” he says. 

On the other hand, MBBS doctors who are finding it hard to get a well-paying job, claim that AYUSH medical practitioners are actually preferred by private clinics as they work for far less than a qualified allopathic degree holder. “In fact, when I was working as a junior doctor, I used to be relieved from duty by an AYUSH doctor. Both of us were paid the same amount,” says Dr. Prakash, an allopathic doctor who quit his job at a private hospital to pursue higher studies. 

The Tamil Nadu Council also calls it a dangerous example. Dr JA Jayalal, president-in-charge of the Council, says, “We are seeing a  new trend where the physician assistant course  is gaining in popularity among AYUSH doctors. They undergo the course and assume the role of a junior doctor in private hospitals. They are absorbed because they adapt to the system easily without asking questions.” 

Dr Amalorpavanathan Joseph, a vascular surgeon who retired from government service recently, says, “I have trained some AYUSH doctors in these private clinics, we can entrust them with basic duties and over years, they learn.” 

However, there are traditional medicine practitioners like Dr AU Ramakrishnan a homeopathy expert, who says it is inappropriate to mix different streams of medicine. “I do not approve of bringing together two different streams of medicine. It is hard to be fully equipped to deliver one school of medicine without any gaps and mixing another doesn’t do justice to either stream,” he says.

Till about four months ago, Dr Prakash (name changed), who completed his MBBS degree a year ago, spent as much as 12-14 hours a day at a private hospital in the city shutting between the in-patients, out-patients and emergency wards. The salary he drew for all his efforts was about Rs 20,000. 

Prakash recollects, “On an average, there would be as many as 60 in-patients a day and the duty hours would stretch if on any given day there were more in-patients. All I was paid was a paltry sum of Rs 20,000 after spending six years studying hard to earn the degree. Many in my batch underwent the same rigour for equal or lesser pay. After a few months, I took off to prepare for a Postgraduate (PG) course.” 

Dr G Ramesh, a practising anaesthetist in the city, says that he in fact, wanted to do his specialisation immediately to escape the rigours of poor pay and gruelling hours at work. He says, “Many of my colleagues who tried hard and couldn’t get a PG seat, prepared for the civil services examination and cracked it. That’s the sad story of those who pursue medicine and drift to other fields due to lack of avenues.” 

The lack of a decent pay hits the ones who pass out of private colleges the most, points out Dr GR Ravindranath, general secretary, Doctors’ Association for Social Equality (DASE). “There is a vast difference in the fees charged at government and private colleges, and in the latter, the fee can run into crores. In fact, the low pay is a problem across private colleges and hospitals. At the moment, since MBBS doctors do not spend too much time in practise soon after completion of course, they don’t protest. We want to take this up in a big way to bring about minimum wages for the doctors,” he says. 

Earlier, MBBS doctors could start their own clinics and hospital soon after the course, but today just the degree won’t suffice, says Dr Amalorpavanathan. “Their prospects are bleak and they become cheap fodder for nursing homes as duty doctors. They can neither climb up or go down; the dimensions of the profession have changed. By the time they complete the degree, they are 23-24 and their counterparts in other professions have already started earning a handsome sum. In order to increase their earnings, they work at two nursing homes. It is a long-drawn struggle, and it is uniform everywhere. A resident doctor abroad is also paid a pittance and the first 5-6 years even in PG is a struggle,” he adds. 

However, Dr Jayalal, says that 50 per cent of the MBBS doctors prefer to prepare for specialisation and do not want to be in service. “They spend a lot of time preparing for the exams and that’s the reason why we don’t have doctors to serve society, though we have trained so many.”

The Doctor Population Ratio as per WHO norms should be 1:1000. In India it is 1:1674. Thus, there is overall shortage of doctors in the country which is more pronounced in rural areas. According to a recent government report, the total number of doctors in the country is 938,861. There are 737,000 AYUSH practitioners in the country. While Tamil Nadu is one of the leading producers of doctors with 102,328 doctors in the state, there is still an acute shortage of MBBS doctors who are ready to serve society.