All PG medical students to work as full-time resident doctors for reasonable working hours: NMC PGMER 2023
New Delhi: The newly notified Post-Graduate Medical Education Regulations (PGMER) 2023 have specified that all post-graduate students will work "reasonable working hours" and they will also get "reasonable time for rest in a day".
Apart from this, there is also a provision for 20 days of paid casual leave, and five days of academic leave per year. Further, subject to the exigencies of work, post-graduate students will be allowed one weekly holiday, as specified in the new regulations.
Referring to the new regulations, the president of the Post-Graduate Medical Education Board of NMC Dr. Viay Oza explained to PTI, "All these will reduce stress on students. Earlier there was no written provision of leaves."
However, several doctors have expressed their disappointment with the fact that the new regulations did not specify the weekly working hours for the resident doctors.
Working Hours for Resident Doctors:
The Medical Profession is one of the harshest professions when it comes to the time and effort involved. The period of residency requires the full-time presence of the doctors in the hospital, day-in, day-out toppled with various night duties coming in rotation.
Moreover, despite efforts made by the government, the issue of mental health of medical students has remained unaddressed over the years. Doctors undergoing Junior Residency During the period of Postgraduate medical education complain of long work hours, low pay, almost inhuman working conditions, lack of basic necessities, and even lack of a clear structure of what is expected.
Even though there have been efforts in the past to address the long working hours, doctors complain that policy has remained limited to the paper only. The Supreme Court in 1990s had directed the Central Government to form a Uniform Central Residency Scheme defining base for all functioning of resident doctors.
Consequently, the Central Residency Scheme was introduced in 1992 and it addressed several issues including the number of duty hours done by a resident doctor, the issue of weekly off, accommodation of residents, leave travel concessions, etc.
Under this scheme, it was mentioned that the duty hours for the resident doctors would not exceed 12 hours at a time. It had also offered them with one weekly holiday by rotation.
However, these resident-friendly rules remained only on paper, and resident doctors are still found doing at least 70-80 hours of duty a week. In case of a high workload, the duty hours can further be extended. The situation is worse for clinical branches, where certain weeks the work hours can even reach 100 hours.
Previously, NMC had taken cognisance of the issue of mental health of PG medical students. In this regard, earlier, the medical colleges had been directed by the Commission to ensure adequate rest, weekly off, counselling for those who are under stress, arranging Yoga sessions on a regular basis, sanctioning leave when required, and respecting their dignity by providing a positive conducting working environment.
Medical Dialogues had earlier reported that last year there were reports that NMC was planning to introduce new rules to ensure that PG medical students do not have to work more than 48 hours a week and are given weekly off and proper time to rest.
PGMER 2023:
Finally, the PGMER 2023 was notified in the official Gazette on 29.12.2023, and addressing the issue of resident doctors it mentioned, "All post-graduate students will work as full-time resident doctors. They will work for reasonable working hours and will be provided reasonable time for rest in a day."
Several doctors have expressed their disappointment over the fact that the working hours for the PG doctors have not been defined by NMC. Commenting on the matter, the president of the Federation of Resident Doctors Association (FORDA) Dr. Aviral Mathur told Medical Dialogues, "We recently met the Honourable Health Minister and explained to him the issue. We said that there should be a bracket."
He opined that the working hours for the residents should not exceed 72 hours per week adding that it means that the residents will have to work around 12 hours per day.
Referring to the new regulations prescribing "reasonable working hours", Dr. Mathur added, "What is "reasonable" is a very subjective thing. What is reasonable for you might not be reasonable for me."
He expressed that there should have been a quantum defined under the regulations clarifying the bare minimum number of working hours for the residents to complete their course. FORDA has been raising the issue for a long time, he mentioned adding that if this issue gets resolved, the cases of mental illness, and suicides might also decrease.
Recently FORDA met the Union Health Minister Mansukh Mandaviya. Addressing the issue of working hours, the association mentioned in a Release, "We advocated for the implementation of a stringent advisory on working duty hours, emphasizing the necessity to cap the maximum number of hours, and we appreciate the Minister's commitment to ensuring the well-being of medical professionals."
Leaves for PG Residents:
The new regulations have also specified that post-graduate medical students will get a minimum of 20 days of paid leave (casual leave) per year. Apart from this, under these new regulations, doctors will also be allowed weekly holidays.
"Subject to exigencies of work, post-graduate students will be allowed one weekly holiday," mentioned the regulations. Further, the resident doctors will be given maternity leave and paternity leave as per Government rules and regulations.
There are also provisions for paid leaves for the PG medicos. However, the National Medical Commission (NMC) has clearly specified in the new PGMER 2023 that if a candidate avails leaves more than the permitted number of days, his/her term shall be extended by the same number of days to complete the training period.
Concerning the eligibility to appear in the examination, the regulations mentioned that the candidates can appear in the examination with 80% attendance.
Pointing out that earlier there was no written provision for leaves, NMC PG Board's president Dr. Vijay Oza explained to PTI that all these will reduce stress on students.
Referring to the issue, Dr. Mathur, the President of FORDA told Medical Dialogues, "We have mixed opinion. We welcome the move. At least they have defined the number of leaves. Previously individual institutions used to specify the number of leaves in their curriculums."
"20 leaves coupled with 5 academic leaves makes it around 2 leaves per month," he explained, adding that the association is planning to write communications to the authorities raising the issue of working hours, maternity leave, and other important issues.
Other Aspects of PGMER 2023:
The regulations also stipulate that it will be mandatory for the college to provide appropriate residential accommodation to post-graduate students. However, it will not be mandatory for the post-graduate students to stay in the hostel.
According to the new regulations, once a medical college is granted permission to start PG courses or seats, the course will be treated as recognised for registration of qualification for students. This will solve many difficulties faced by students to register their degree after passing their postgraduate examinations, Oza said.
"The new regulations will also clear the uncertainty that the students faced on whether these courses will be recognised by the NMC or not," an official source said.
According to the new regulations, the existing NEET-PG examination will continue till the proposed National Exit Test (NExT) becomes operational for PG admission.
"The NMC after consideration the comments and suggestions of various stakeholders and detailed in-house discussion unveiled groundbreaking reforms in post-graduate medical education, aimed at fostering quality, ethical practice, and inclusivity within the medical fraternity," Dr. Oza informed PTI.
"These reforms encompass various critical aspects of post-graduate medical training and aim to enhance the standards of education and practice nationwide," he said.
Under the new regulations, the undergraduate medical college can start postgraduate courses in the third year now. Previously it was from the fourth year in clinical specialties, Dr. Oza said.
Existing or proposed non-teaching hospitals owned and managed by the government can start post-graduate courses without having an undergraduate college. This will facilitate governments to start postgraduate medical colleges in smaller government hospitals/district hospitals, he said. There will be a minimum standard requirement document that will prescribe requirements of infrastructure, faculty clinical material etc for postgraduate institutes.
"All students will have to undergo courses in research methodology, ethics and cardiac life support skills," Dr. Oza further mentioned.
"For better implementation of these regulations, there is provision of penalty clause which includes monetary penalty, reduction in number of seats( admission capacity) or complete stoppage of admissions," he stated.
The regulations continue to prohibit the migration of students from one medical institution to another. Additionally, seat reservations in medical colleges for various categories will align with the prevailing laws in states and Union territories.
Reservation of seats shall be as per applicable laws prevailing in states and Union territories. Five per cent reservations will be for candidates with benchmark disabilities.
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