Rural committee discusions

Dr. P. SRINIVASAN

Asst. Professor Dept of Radiotherapy, MNJIO & RCC

BIPARTITE AGREEMENT

G.O.Rt. No. 906

First Meeting

• On 26/6/2012• Information about the meeting given through

phone at 4:00 PM • Except the copy of the G.O Rt. No. 906, no other

material evidences/ workouts were submitted to the committee members during the first meeting.

First Meeting• Requested for the MCI order / notification making it

mandatory for the students to do one year of Compulsory Rural Service after MBBS

• No evidence was submitted. I am only told that there is a MCI guideline and also the Andhra Pradesh State Government is keen on Rural Service for the students as the government is spending huge money towards their education

• The students are informed well in advance, the bond had been signed by the students and thus they have to do it.

First Meeting

• The Government’s version as mentioned in the committee meeting is,1) Doctors are not available in the Rural areas 2) Society responsibility for Doctors is as important

as Family responsibility and 3) Posting of the students is the only way the man

power deficiency can be curtailed.

First Meeting• There was no clarity about the selection process, counseling methodology,

areas of allotment of postings. It was mentioned that the University will issue the merit list. There was no clarity whether the APPG entrance rank would be considered or the marks obtained in the PG course.

• There was no clarity where the Diploma, Degree and Superspeciality

students were going to be posted in the concerned specialties only? • There was no clarity about the salary / consolidated pay to be made to

them.

• There was no clarity whether they would be working with / without additional qualification registration at AP medical Council.

First Meeting• There is no clarity about their accommodation, their security, their working

pattern or duties, under whom the students will be working, their eligibility for leaves, duty off, procedures for extension period etc.

• There was no clarity about the break in their career advancement.

• Whether the bond is applicable for the students who have joined under management quota in the Private medical colleges?

• Will the period worked be treated as in-service period to ascertain seniority in

case the student joins the Government system? Will they be absorbed into the Government Health department by giving any preference?

• Will there be any rule of reservation for the postings?

Second Meeting• Second scheduled meeting did not take place

on 29/6/2012.The second meeting was conducted at 4.00 PM on 24/7/2012.

• First representation from my side dated 10/7/2012 requesting exemption for the present batch of students whose results were announced on 11/6/2012.

Second Meeting

• Second meeting on 24/7/2012• Proposals worked out by the Government were

informed• I would like to put it on record that the minutes of the

First meeting were not circulated on 24/7/2012• Requested for the MCI order / notification making it

mandatory for the students to do one year of Compulsory Rural Service after MBBS. No evidence was submitted. I am only told that there is a MCI guideline for the same.

Second Meeting• University had issued the merit list and the marks

obtained in the PG subject was taken into consideration. The copies were circulated but no material was given

• same shall be placed in the website of the DME, AP. • Students will be posted in the concerned specialty

only. • No clarity about the salary / consolidated pay• It was mentioned that an Honorarium shall be paid. For

the Present batch it was discussed that the amount shall be more than the last pay received.

Second Meeting

• With regard to clarification whether they would be working with / without additional qualification registration at AP medical Council, it is mentioned that only a provisional certificate will be issued

• Registration shall be done only after completion of the one year bond period.

• There is no clarity about their accommodation, their security, their working pattern or duties, under whom the students will be working, their eligibility for leaves, duty off, procedures for extension period etc.

Second Meeting• Career advancement - There is no clarity about what they

will do in case they get PG seat or DNB seat. Students must be allowed to pursue their higher education

• Applicable to all students and that means the students who have joined under management quota in the Private medical colleges will also work for one year.

• It was informed that there will be not be any rule of reservation for the postings.

• The meeting specifically concentrated on the issue of Present batch of Diploma students.

• It was requested that the discussion about MD/MS students, DM/M.Ch students shall be discussed in the next meeting.

Second Meeting• There is no clarity whether the period worked

will be treated as in service period for ascertaining the seniority in case the student joins the Government system. Must be considered as period of service

• There is also no clarity whether they will be absorbed into the Government Health department by giving any preference for the compulsory rural service done in case the student wishes to join the system

Second Meeting• The Government appointed the committee very late• Even before there was some consensus within the

committee; the Notification Rc.no.33801/ Acad (A) 2012 dated was issued and placed in the website on 24/7/2012 at around 6.00PM.

• The committee had two Postgraduate students and Dr. P.Srinivasan as representatives from the Junior Doctors but they were kept out of the decision making process. They were just informed what has been done.

• Forcing a pre conceived thought on the students.

Second Meeting• The Notification Rc.no.33801/Acad(A)2012 dated 24-7-

2012 was issued and placed in the website on 24/7/2012 at around 6.00PM.The Subject of the notification reads “ DME(A) – Tribal Rural Rejuvenation Implementation Project ( TRRIP) – Posting of all non – service doctors after completion of Postgraduate courses – Regarding”.

• As per the GO Ms 40, 41 , 42 , 43 , it was mentioned that the candidate who have completed their PG Degree / Diploma would be posted in Community Health Centers , Area Hospitals , District Hospitals, Teaching Hospitals and Super Speciality Hospitals as Senior Residents.

Second Meeting• But according to the notification Rc.No.33801/Acad(A)2012

released on 24-7-2012 , there was mention of postings in the CHC’s, including the Tribal Areas.

• Even though it was mentioned in the committee meeting that all the areas are opened for counseling, the notifications does not reflect the same.

• It is brought to my notice that only selected places are shown, wherein there are vacancies.

• We also submit that if these doctors are not registered as Specialist with AP Medical Council, they have to work under some government appointed doctor, but cannot work independently in these vacancies. These technical issues need to be considered before we implement the scheme.

Second Meeting

• The names of certain candidates serving extension in their respective courses have been omitted. There are candidates who have excelled in their examinations but could not complete their course in time due to some unavoidable reasons. What is the fate of these candidates? How and when will they be recruited and on what basis?

• Kindly mention the methodology / criteria adopted in the ranking when two or more students have obtained same marks. What is rationale to keep the cut-off date as 15-7-2012?

Second Meeting• The Government had failed to give guidelines well in

advance even though it had more than 2 years for doing the same.

• The government had failed to discuss the issues with the Junior Doctors for two years. Even after the agitation and signing of bipartite agreement on 14/2/2012, the government failed to constitute the committee immediately.

• The government had constituted the committee only on 25/6/2012 and it is pertinent to note that this is after the results were declared. This alone is sufficient to point out that the Government is least bothered about the issues of junior doctors.

Third Meeting

• Third meeting took place on 26/7/2012• Still there was lack of clarity from the government

side. • No material evidence was placed to the

clarifications sought in the second meeting.• The minutes of the second meeting was not placed

before the committee. • The only statement - Government has decided

about the rural service, the policy decision cannot be questioned

Third Meeting

• Thus I earnestly request you to exempt the present batch of students to prevent further chaos and hope that the committee comes to an amicable solution so as to prevent any disharmony between the Government and the Junior Doctors. The implementation shall be done only when full report of the committee is submitted.(submission DATED 26.07.2012)

Third Meeting

• We as a committee have to put in the recommendations as per the terms of reference of the committee

1) To work out the modalities with regard to placing the junior doctor in the rural areas and respective departments after completion of MBBS/ PG Degree/Diploma Courses.

2) Rationalization of Stipends paid to interns and Postgraduates.

3) Implementation of MCI guidelines with regard to internees and postgraduates.

Third Meeting

• I have requested for the MCI order / notification making it mandatory for the students to do one year of Compulsory Rural Service after MBBS.

• No evidence is submitted till date. • This issue absolutely is well within the terms of

Reference of the committee. • The MCI regulations are the guidelines followed

for medical education in this country.

Third Meeting

• The merit list was placed on 26/7/2012 in the website of the DME, AP.

• The University had issued the merit list and the marks obtained in the PG subject was taken into consideration.

• The present batch of students were not informed about this methodology and were under the assumption that their PG ranks will be considered.

Third Meeting

• This incident has happened because the government failed to give the implementation guidelines well in advance.

• I would like to place it on record that this decision was not taken by the committee and it is unilateral decision of the University and the Government.

• How can the criteria for ranking be defined after the completion of an examination?

• The students are also worried about malpractice and increased corruption in the future exams for better marks.

Third Meeting

• No clarity regarding the selection policy adopted for ranking candidates who scored same marks in the P.G final examination.

• Why was the cut off point for candidates eligible for counseling kept as 15-6-2012 when the counseling date was fixed on 28-7-2012?

• The committee was informed they will include all the candidates who finish their study period till the date of counseling.

Third Meeting

• How to select the candidates who have taken the maternity leave and other leaves, will they be selected in the main stream along with other candidates or will there be a separate counseling done for them? There cannot be separate counseling or different merit criteria as the posting is compulsory

• we have suggested that these candidates should also be given posts along with the regular batch and He/She would join the service as soon as the extension period is completed. The members of the committee concurred.

Third Meeting• It was mentioned that an Honorarium shall be

paid. • For the Present batch it was discussed that the

amount shall be more than the last pay received.

• The committee also had discussed about risk allowance to be given to the candidates in case the consolidated pay structure is far below the pay scale for similar doctor at entry level in service for same qualification.

Third Meeting

• The amount of which is yet to be finalised.• Regarding the mode of payment, it was

discussed that the committee shall make the recommendation to the government that the candidates should receive the emoluments amount by 5th of every month.

• There is no clarity about the budgetary allocation towards the honorarium.

Third Meeting

• The designation, the posting order and the salary/honorarium are all linked to one another.

• As there is no clarity from the government’s side regarding the designation of these doctors, their duties and its relation to the signed bond, the final amount for honorarium cannot be finalised.

• The Junior Doctors have asked for an official order regarding the financial sanction for the above postings and would like to be paid regularly, failing which they should have the right to abstain from work.

Third Meeting• whether they would be working with / without additional

qualification registration at AP medical Council, it is mentioned that only a provisional certificate will be issued and the registration shall be done only after completion of the one year bond period.

• It is also brought to my notice that the APMC had registered the additional qualification of some students but retained the original copy of the registration and given the Xerox copy of the same.

• I personally feel that the government cannot stop the registration of doctor’s additional qualification as there is no provision for the same and it will be violation of guidelines of the MCI.

Third Meeting

• Only when their additional qualification is registered, the can be posted to any vacant post.

• But the government is not ready to register them and pay them their full salary.

• Under this circumstance and also as per their bond they cannot be posted in vacant areas, but posted under some senior doctor of same specialty

Third Meeting

• Regarding the matter of providing a residence, We were informed that they will provide one room in the CHC with a bathroom facility if available in the CHC

• It is the duty of the government to provide proper residence or give the appropriate HRA.

• Those posted will be entitled to have 30 casual leaves to be availed in a calendar year.

Third Meeting

• With regard to the issue about the hindrance to academic career, the committee came to a conclusion that mandatory service should not hinder anyone’s personal academic career

• It was agreed upon by the committee that a candidate will be allowed to pursue for higher education without any hindrance and that the candidate will be allowed to do one year compulsory service any time during his career without any obstruction to his higher studies (M.D/M.S/Diploma/DNB/DM/Mch).

• In this context the committee members opined that the total service must be of one year duration only.

Third Meeting• The committee also agreed that there was a delay in

allotting the posts this time so the undue delay period starting from one week after the announcement of results (i.e 18/06/2012) should be considered and the compulsory period must be finished by 17/6/2013.

• There is no clarity as to what amount shall be paid for the period without work as the government has forced this situation on the students.

• In a normal setting these students would have started their working career and earned around Rs 40,000/month

Notification released on 27-07-2012

• All of a sudden the counseling for rural service which was supposed to take place on 28-07-2012 was postponed and the reason was quoted as “due to unavoidable circumstances”

• This notification was kept only on the official website of the DME in the evening of 27th July2012

Writ Petition• This callous attitude of the Govt. has brought

the issue to the Hon’ble High Court of Andhra Pradesh through the Writ petition number: WP23147Y/2012/ WPMP29557/2012 dated 27-07-2012. The coercive attitude of the government is responsible for judicial intervention.

Notification released on 30-07-2012• It was surprising to notice that there was another

notification on the website of the DME stating that the counseling would be online.

• There is lot of discrepancy in showing the vacancy of seats and the students believe that lot of posts in many areas have not been disclosed and this has lead to lot of curiosity and utter confusion in the student community.

• If this is a senior resident program, show all the posts as these will be super-numery and in case these are for service in vacant positions, all the vacant positions must be disclosed.

Notification released on 30-07-2012• The notification released on 30-07-2012 still shows vacancies

in Community Health Centres in Tribal areas. The students feel betrayed by the Government.

• The G.O.MS 40,41,42,43 have not mentioned anything about TRRIP. Why is this term used again and again in the notifications?

• The details whether the CHC is in rural or tribal area has been deleted in the recent update purposefully to deceive us.

• For example the CHC’s in Seethampeta and Kothuru in Srikakulam district come under tribal area. This was mentioned clearly in the first notification but not in the recent notification.

PHC required 1955These statistics are from mohfw.nic.in, nrhm statistics updated till march 2011. Short fall is for the government to look into and create more PHC as required and upgrade some PHCS

PHC Sanctioned 1624

PHCShortfall 331CHC required 488 These statistics are from mohfw.nic.in, nrhm statistics

updated till march 2011. Short fall is for the government to look into and create more CHC as required.

CHC Sanctioned 281CHC shortfall 207

Statistics

PHC DOCTORS Required ( R ) 1624 There is vacancy of 76 out of 2424. As such there is no shortfall.

Where is the problem? How can the government say that the doctors are not available in the rural areas?

Sanctioned ( S ) 2424In position ( P ) 2348Vacancy (S-P) 76Shortfall ( R- P) *4 + Doctors 03 doctors 1052 Doctors 6561 Doctors 863Nil Doctors 0 There is no PHC without a doctor as per this statistics.

CHC - OBG Required ( R ) 281 These statistics are from mohfw.nic.in, nrhm statistics updated till

march 2011. Short fall is for the government to look into and sanction more specialists Gynecologist at CHC’s.

Sanctioned ( S ) 122In position ( P ) 156Vacancy (S-P) *Shortfall ( R- P) 125CHC - PEDIATRICS These statistics are from mohfw.nic.in, nrhm statistics updated till

march 2011. Short fall is for the government to look into and sanction more specialists’ pediatricians at CHC’s.

Required ( R ) 281Sanctioned ( S ) 122In position ( P ) 118Vacancy (S-P) 4Shortfall ( R- P) 163

mohfw.nic.in, nrhm statistics updated till march 2011.

Office order Rc. No. 33868/ACAD(A)/2012 dated 09/08/2012

• The office order Rc. No. 33868/ACAD(A)/2012 dated 09/08/2012, from the office of the Director of Medical Education, AP, Hyderabad was issued through the DME website on 11/08/2012.

• The Subject matter of this order is the Posting orders for the Compulsory rural/ Govt. service postings for the Post Graduate Diploma/Degree candidates for the academic year 2012 -2013.

• The reason for pre dating the order is unknown.

Order Rc. No. 33868/ACAD(A)/2012 dated 09/08/2012

• The order Rc. No. 33868/ACAD(A)/2012 dated 09/08/2012 is significant in relation to the G.O.Rt.No. 906, HM & FW, E1, Dept, dated 25.06.2012 and nullifies the importance of the committee. I raise a strong objection to the office order as the committee report has not been finalized.

• “ During the compulsory rural / Govt. Service, the Doctors are instructed to maintain a log book for the entire period. They are encouraged to do project works in relation to the local, rural and tribal health problems and bring out solution which should be replicable, at the end of the posting. The doctors are supposed to submit the log books and project reports duly signed by the local Chief Medical Officer, DM & HOs, Dist. Coordinators, Deans/ Principals/ Director of Teaching Institutions along with the attendance certificate. The final attendance certificate will be issued by the Director of Medical education (Academic) to be submitted to the Registrar, Dr.NTR UHS for getting the Original Diploma/ Degree Certificates”.

• How can the DME ask the students them to maintain log book after completion of their prescribed course?

• How can the DME as the students to do projects in rural, tribal areas and bring out suitable solution which should be replicable? The DME has gone absolutely out of mind. Is it the duty of the student to bring in suitable solution? Replicability? Is this possible with the students? What are the other doctors in the service of the government doing? What are their duties and responsibilities? MCI nowhere puts all these conditions for Diploma or Degree. DME cannot dictate these terms on his own in the name of doing good to the society.

• The submission of the log book cannot be made a precondition for getting the original Degree / Diploma certificates as this nowhere written in the MCI PG guidelines.

• So, I conclude that there is no MCI order/ guidelines for the Compulsory rural service / Govt Service/ or any other methods of bonded service.

• I express my serious objections to the compulsory service which is not within the framework of Medical Council of India’s PG guidelines 2000 with all its amendments till date. If however any guidelines from the MCI are available with the DME or the Government, Please furnish me the same.

• The office order Rc. No. 33801/ACAD (A)/2012 dated 09/08/2012, from the office of the Director of Medical Education, AP, Hyderabad was issued through the DME website on 14/08/2012. The Subject matter of this order is “DME(A) – Tribal Rural Rejuvenation Implementation Project (TRRIP) – Postings of all non –service doctors after completion of Post graduation Courses”. The reason for pre dating the order is unknown. It is also pertinent to note that this order bearing the Rc.No. 33801 was prepared ahead of Rc. No.33868 but released later for the best manipulative reasons known only to the government

Tribal Rural Rejuvenation Implementation Project (TRRIP)

• I would like to mention very clearly that this

Project has nothing to do with the bond signed by the Student at the time of joining the course. These students cannot be posted under this project and hence the action of the DME and the Government is unconstitutional, arbitrary and irrational. As a member of the committee, I strongly oppose these manipulations.

Issue of Emoluments

• The office order Rc. No. 33868/ACAD(A)/2012 dated 09/08/2012 reads, “The candidates are entitled for the consolidated monthly honorarium payment during the period of compulsory rural / Govt service for the Period of one year as per existing norms”. There are no existing norms and this is a blatant lie from the DME and the Government.

Issue of Emoluments

• No clarification was given and it is shameful, that even at the time of issuing the posting order there is no clarity for the DME or the Government.

• We have to question ourselves whether it is correct to force the students in the name of policy decisions of the government.

• I simply put it as forced atrocity of a senior towards a junior.• All of them are Doctors with post graduate qualification and I

am sorry to say that I cannot be a part of Doctors’ team which is insulting its own profession.

• We need to maintain some ethics and cannot pass on some irrational orders just because we happen to be seniors.

• The committee also agreed that there was a delay in allotting the posts this time so the undue delay period starting from one week after the announcement of results (i.e 18/06/2012) should be considered and the compulsory period must be finished by 17/6/2013.

• There is no clarity as to what amount shall be paid for the period without work as the government has forced this situation on the students

• In a normal setting these students would have started their working career and earned around Rs 40,000/month.

• It is informed to me that the DME had made a press statement that the delay period will be considered but still there is no clarity.

Rank Reg No. Name College Marks

30 1065408 SRIPURNA P MIMS, NELLIM 293

31 1053410 RAJANI P SVS MEDICAL COLLEGE, MAHABUBNAGAR 293

32 1063414 V NAVYA SESHU Dr. PSIMS, GANNAVARAM 293

33 1003419 M JAYALAXMI AMC, VISAKHAPATNAM 293

There is no clarity regarding the selection policy adopted for ranking candidates who scored same marks in the P.G final examination. The DME has to make it open, what criterion was used in this situation mentioned below.

• There is no consensus on how to select the candidates who have taken the maternity leave and other leaves, will they be selected in the main stream along with other candidates or will there be a separate counseling done for them? The cut off dates for the selection process are not defined. What if they take a maternity leave now during the compulsory period? DME needs to issue the clarification immediately.

•

• I personally feel that the government cannot stop the registration of doctor’s additional qualification as there is no provision for the same and it will be treated as violation of guidelines of the MCI. DME needs to clarify on this issue.

• What are the guidelines for those who obtain their diploma/ degree from outside Andhra Pradesh? Will their degree be registered at AP Medical Council?

Educational career advancement

• It is pertinent to note that some students who had got selected for the DNB course, where forced to go the Hon’ble High court and it is mentioned that they were given No Objection Certificate from the Government in the last minute.

• These students were unnecessarily made to spend money for their court cases, flight charges to Delhi to submit the NOC’s to the DNB board.

• The DME must owe the responsibility for this incident and must understand that they are in responsible position and must be under impression that the responsibility bestowed on them as power and act in dictatorial manner.

?GOVERNMENT DRAFT? COMMITTEE REPORT

DME DRAFT REPORT APJUDA STANCEThe Committee members accepted for the Rural / Compulsory Government service after completion of MBBS/P.G.Diploma / P.G.Degree / Super Speciality for one year after each study

The representatives of Junior Doctors Association did not accept this proposal. This proposal is taken from G.O.Ms 40 HM & FW (E2) Dept. dated 10-02-2010 Rule 3(a).

Dr.N.T.R.University of Health Sciences will provide the pass list with a marks merit lists to the Director of Medical Education at their earliest after declaration of the results by the University.

This proposal is taken from G.O.Ms 40 HM & FW (E2) Dept. dated 10-02-2010 order 3(b).

A Committee constituted by Director of Public Health and Family Welfare / Commissioner of A.P.V.V.P / Director of Medical Education( Acad) / Director of Medical Education will bring out the various placements for the candidates at the Primary,Secondary and Tertiary Health Care services basing on the policy of filling up of the demand and supply gap.

The representatives of Junior Doctors Association did not accept this proposal. This proposal is taken from G.O.Ms 40 HM & FW ( E2)Dept. dated 10-02-2010 order 3(a).

The marks merit lists and the place of postings required will be displayed in the website.

Accepted

The candidates are requested to download the proforma with list of required positions and fill it up the maximum number of options depending on their merit rank and send it online to the e mail of the DME within a stipulated period of One week.

The representatives of Junior Doctors Association did not accept this proposal. Students have sent protest letter along with the application form.

The Committee will also again sit down and place the postings of the candidates as per their merit order and the posting orders will be displayed in the website.

The candidates are instructed to download the orders and join in their respective place of posting through the Principals of their concerned Medical Colleges and report to the In charge Medical Officer / D.M.& H.O./ District coordinator / Principal / Dean / Director.

The representatives of Junior Doctors Association did not accept this proposal.

The candidates are given a task of developing the work culture as a basic foundation of their professional career*.

The representatives of Junior Doctors Association did not accept this proposal. Please furnish the MCI guidelines

The candidates are entitled for 30 days casual leave stretched over a period of 12 months without exceeding 9 days at any time.

Discussed

The In Charge Medical Officers concerned are instructed to send a non – joining report within 15 days of issuing the orders for those candidates who have not joined after receiving the orders.

Not discussed

A log book also will be submitted by the candidates at the end of their training.

The representatives of Junior Doctors Association did not accept this proposal. Please furnish MCI guidelines

The candidates are encouraged to submit their project reports after completion of 12 months period. ( Model Project Report Annexure )


Special incentives and risk allowance will be provided to the candidates depending on their performance

Risk allowance discussed but no conclusion drawn.

At the end of one year after completion of the posting attendance certificate will be issued by DME. Marking a copy to Registrar , Dr. N.T.R.U.H.S and the University which in turn* will award the original degree certificate


Tribal Rural Rejuvenation Implementation Programme ( TRRIP)

The representatives of Junior Doctors Association did not accept this proposal. Even thought the DME claims that TRRIP is no more a compulsory service it is nothing but a compulsory bonded service.

TRRIP - The programme is purely based on filling up of the demand and supply gap of manpower in all the levels of health care delivery system in Andhra Pradesh State Authority for the specialist and basic services in the medical field.

Medical Students cannot fill up the demand of manpower in all the levels of Health care. The government is requested to recruit doctors through regular permanent recruitments.

The present special postings in the rural areas for MBBS doctors, Secondary level hospitals for Diploma candidates and remote peripheral teaching hospitals for the specialists and super specialists will give them rare and unique opportunity to personally feel and appreciate the social, economical, hygienic and the sanitation issues.

The speciality doctors have to serve only in their area of specialization. Even at Osmania General Hospital we feel a neurosurgeon personally feels for the patient , appreciates their socio economic conditions , understands the psychology of the rural patients and does the requisite specialized medical / surgical treatment

Objectives of the programme –

To face and taste the differences , troubles and bad circumstances in most backward area in the rural AP state.

Experience the way of life in the rural AP state.• They doctors make a patient a team member the treating teams.

• The doctors do not require the burning stove rule to be applied on them at any point of their professional career.

• The young doctors are enjoying the lifts and comforts which our elders are not having but prepare for attending any difficult situation through this training.

• The energies of the young doctors will be diverted towards the positive and constructive side of* their professional career.

• They get an opportunity to learn to compensate towards man , machinery , material , and money in their working conditions.

• They also put efforts to bring the cutting edge technologies poor of the poorest at the most remote areas of the state and try to set standards in the medical treatment protocols.

• They have an opportunity to build up a very strong foundation for their PTR ( Past Track Record) .

• After the training they will be most fitting in the era of the medical services turning into health care industry.

• The trip training certainly gives confidence and courage to the medical graduates to stand both in rural and urban setting of their medical practice.

The DME has completely deviated from the G.O.RT No.906 HM & FW ( E1) Dept. through which the present committee was constituted to study the implementation of rural service. The terms of reference of the committee where ,1) To work out the modalities with regard to placing the junior doctors in rural areas and respective departments after completion of MBBS / PG Degree/Diploma courses.

2) Rationalization of stipends to interns and postgraduates3) Implementation of MCI guidelines with regard to internees and Postgraduates.It is unfortunate that the DME has totally lost on the above terms of reference and has set himself separate objectives about TRRIP. We the representatives of APJUDA strongly feel that this forced execution of compulsory service under NRHM is not valid as per MCI guidelines and hence unacceptable.

They have an opportunity to build up a very strong foundation for their PTR ( Past Track Record) .

• After the training they will be most fitting in the era of the medical services turning into health care industry.

• The trip training certainly gives confidence and courage to the medical graduates to stand both in rural and urban setting of their medical practice.

It was decided by the Government of Andhra Pradesh that the MBBS doctors after completion of their one year internship have to do compulsory rural government service in Secondary health care for the period of one year. The Super Specialists will have to do a compulsory Government service for a period of 12 months in a referral medical college . RIMS medical colleges and also in the teaching institutions where there is need for specialists.

This policy decision is being questioned . There are no MCI guidelines for the same. Similar G.O.Ms No. 202 , 203 , 204 were cancelled in the year 2002. Similar G.O.Ms No. 284 dated 18-07-2001 was also cancelled.

The government should strictly follow the MCI rules and regulations.

During the compulsory Govt. service the doctors are instructed to maintain a log book for the entire period


They are encouraged to do project work in relation to deficiencies , difficulties , hurdles in the local tribal and rural areas where they will be working and bring out suitable solutions which should be replicable


At the end of posting the doctors are supposed to submit the log books and project report duly signed by the local chief medical officer , DM. & HO s and district coordinators , Deans and Principals and Directors of the teaching institutions with an attendance certificate.


The final attendance certificate will be issued by the Directorate* of Medical Education / DME ( Acad ) and submitted to the registrar , Dr.N.T.R.U.H.S. for getting the original degree certificates.


Leave particulars : The doctors are entitled for the casual leave for the period of 30 days during the postings . The leave will be spreading for a period of 12 months but not at a time. Leave will not be granted for more than 9 days for any given point of time and for any extension leave , it will be treated as absence and the candidate will have to do extension for the required period for the number of absent days for obtaining the final attendance certificate.

Discussed in the committee

The specialist doctors will be posted in the speciality departments only and at any cost no mismatch is allowed. The superspecialists are also posted in their respective specialities only.

Discussed in the committee

Rationalization of the stipends paid to interns and post graduates.

The Committee examined different modalities and it was understood that the 1st year PG will be getting Rs 20,700/- , second year PG getting Rs 21,850/- , Third year PG getting Rs 23,000/- , 1st year superspecialist will be getting Rs 23,000/- , 2nd year superspecialists getting Rs 24,150/- , 3rd year superspecialists will be getting Rs 25,300/- and house surgeons are awarded a stipend of an amount Rs 9,180/-

These amounts are the present stipends after the 15% hike since January 2012. However the proposal of hike in stipend which was to be discussed in April 2012 as part of the bipartite agreement and which was referred to the present committee was not discussed. As the issue of Diploma students became the focal issue and the inordinate delay pertaining to this issue forced the APJUDA representatives to concentrate only on this issue . It was agreed upon to discuss the other issues later but the DME preferred to finalize the committee report without any hike.

Decision of the committee : Regarding honorariumsIt is decided by the committee that the honorariums to be fixed is to be higher than the last month stipend of the post graduates study and lower than a fresh newly joined first month salary of Civil Assistant Surgeon for all the categories . Presently the internees are getting Rs 9,180/- and a freshly joined Civil Assistant Surgeon working in a tribal area is getting a consolidated salary of Rs 30,000/- . Hence for a MBBS graduate a figure of amount may be fixed between the two. However the Junior Doctor representatives are demanding the risk allowances for the doctors working in remote tribal and rural areas. The matter was discussed with the Commissioner of Family Welfare for the grant of incentive in the form of Peace rate for those doctors who are able to do extra number of cases ( surgeries , deliveries, procedures and anesthesia etc) for that month as calculated and recommended by the individual key performance indicator duly approved by the DM & HO s , district coordinators , Principals , Deans and ect. Above the hours* turnover of work as decided by the local chief of the unit.

The proposals for the release of budget towards the payments of the honorarium sent to the Government periodically and the amount will be deposited the PD account of DME and monthly honorarium paid online to the accounts of these doctors working under the scheme before 5th to 7th of every month or may be sent to the account of the doctor. The doctors are requested to to provide the account number of their bank account for facilitating the deposits of the honorariums.

As per the G.O.Ms 165 HM & FW ( E 1 ) Dept. dated 20-07-2010 Rule 4( iv) , a consolidated remuneration @ 150% of stipend payable to house surgeons in 2015 for junior residents rendering compulsory rural medical / dental service in the rural areas and 175% of the stipend payable to the house surgeons in 2015 for Junior residents rendering compulsory rural medical / dental service in the tribal areas shall be paid.

The committee has not fixed any amount for the present batch of Diploma candidates. The finalization of the emoluments could not be achieved due to lack of clarity of the candidates from the Government’s side.Similarly the emoluments for the post MD/MS doctors and superspeciality doctors were not discussed. We don’t understand what “Peace rate” is?

The honorarium must be paid regularly .

The MCI made it mandatory that Junior residents( MBBS ) and the Senior residents ( Diploma ) with one year experience in the same speciality or PG degree candidates or Super specialists must do one year compulsory rural service for better understanding of the TT protocols.

The statement is false . We do not agree to it. Please provide the evidence. The representatives of Junior Doctors Association did not accept this proposal. Please furnish MCI guidelines

The doctors will be appointed in public health institutions under medical education service / Health services. Doctors should normally complete compulsory government service posting within a period of 12 months itself from the date fixed in the posting orders. They will be eligible for weekly off , duty and 30 days casual leave. They will not be eligible for any other leave. That is , the doctor should complete 345 days of duty including weekly off/ duty off. Extension or long leave exceeding 20 days casual leave will be given only on pregnancy/maternity related ground.

The doctor should complete 335 days of duties including weekly offs and duty offs and they shall have 30 days of casual leave.

Candidate failing to fulfil the govt. service within the stipulated time or extended time will be permitted to undergo further studies in any Govt. institutions or enroll in the Govt. jobs in the state. The details of such candidates will be reported to the Medical Council of India for appropriate action. In addition to this , compensation and other expenses met through the public money for their studies shall be levied through revenue recovery procedures from defaulters / surities as fixed by the Government

When the compulsory Govt. service after Diploma / Degree is not recommended by the MCI what appropriate action can be taken by the MCI ? The representatives of Junior Doctors Association did not accept this proposal.

Work culture : get the data* of clinical services work in the speciality for the last 3 years.Analyze the data.Identify the deficiencies.Indent the government for requirements.Attend the meeting through video conferences.Work towards the betterment of the patient services.Improve the quality/Quality forWork in teams and achieve* the targets.Targets 12th five year plans state wise: targets of 2017 IMR =18,MMR = 57, TFR=1.8,2011 statistics show these MMR has decreased to 134/1,00,000 live births ,IMR was decreased of 49 to 46/10,000 live births.Develop an effective referral system or record mention ed for the hospital. The backup facility and support would be provided by the NRHM.

Absolutely unrelated. Irrelevant matter for the compulsory doctor service.

15) INCENTIVE BASED OPPORTUNITY :

The in-charge medical officer will an average of the work turnover on if teams does more then the average they will be paid incentives basing on their reference.

Unable to understand the irrelevant statements.

Focus on training and development ,organizational development,career development.


The doctors are advised to do a primary projects on possibilities ABSENTEEISM INVOLVEMENT in union activities/groups referral system


• I have submitted three letters prior to this and it is unfortunate that our view points though not accepted, they are not even considered for record purpose. The DME must incorporate the difference of opinion raised in the Final report.

• We submit that it is the failure of Government that has led the issue to this juncture. The health care deterioration has nothing to do with students posting and it is for the government and its officials of Health department to do the introspection. I once again kindly request you to exempt this batch as of now because there is no clarity at present and it needs lot of proper understanding of many issues before it is implemented. Why should the student wait endlessly due to inefficiency of the government?

• It is here by requested that the government should come out with reasonable answers for all the above questions, opt for a long term plan to solve this problem, formulate a plan after looking into every minute details and after a thorough understanding of the issue taking into consideration the views of students as voiced by their representatives.

• Thus I earnestly request you to exempt the present batch of students to prevent further chaos and hope that the committee comes to an amicable solution so as to prevent any disharmony between the Government and the Junior Doctors. The implementation shall be done only when full report of the committee is submitted.

THANK YOU

Rural committee discusions

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Transcript of Rural committee discusions