Doctors, Dearth and Delays: How the Delay in NEET PG Counselling Affects Us All

For over a month, doctors in various parts of India, especially Delhi, have been protesting to expedite NEET PG counselling.

What started as a withdrawal of OPD services on 27th November, has been escalated to withdrawal of all services by resident doctors.

Following a plea by the MoHFW, services were resumed on 9th December with the assurance that the counselling would be expedited.

The issue remained unresolved on 16th December, prompting resident doctors associations, led by FORDA (Federation of Resident Doctors’ Association) to resume their agitation.

Even as more and more doctors join the strike, here is a look into the cumulative scarcity and exhaustion that has led to this protest and how these delays affect everyone.

What the Delay in NEET PG Counselling Means for Us All

The National Eligibility cum Entrance Test for medical post graduates(NEET PG), held every year for MBBS doctors, not only enrols them into specialty training, it also recruits them into hospitals for nearly 3 years.

While the Indian healthcare setup grappled with a pandemic last March, a significant part of the potential frontline medical workforce awaited recruitment. This was in 2020.

Despite the exam being held in January, counselling and reporting kept getting pushed. First year post graduates (PGs) joined the workforce only in June and July. Still, the batch of 2020 got recruited in 2020.

The Residents Remain Understaffed

Classes were suspended for MBBS undergraduates for most of 2020. So, the final year students who were supposed to join the workforce from February (as in Karnataka) only joined work in April 2021.

These delays meant that the PG batches of 2018, 2019 had already worked twice with a dearth of doctors.

This meant longer shifts, fewer breaks and the increased vulnerability to COVID among other stresses of being a resident.

In 2021, the NEET PG Exam was scheduled on April 18. Barely a week before the exam, it was postponed until further notice.

The reason for this delay was the second wave of COVID, a disease that residents would have high exposure to if they qualified the said exam, a disease that the previous batches were fighting understaffed.

The NEET PG exam was finally conducted on September 11ththis year.

The results were declared by the end of September. The newly announced EWS quota and OBC reservation (for all-India seats) were to be implemented from this year.

The seat matrix for each college and specialty was released in October. The chaos was palpable- the 13 point reservation roster meant that there were no seats for some categories in top colleges.

There was talk of how the added reservation quotas were unfair and excessive. The income cutoff for EWS was deemed arbitrary. These pleas were taken to the Supreme Court.

Long story short, the case is still in court. The counselling remains postponed. The residents remain understaffed.

Doctors Say, “Tired of Complaining About Things…”

Resident doctors and house surgeons often work night shifts along with their day shifts. It is these “junior doctors'' that usually have the most interactions with patients and keep the hospitals running.

OPD and post OPD days often merge into a long 34-36 hour shift. There are no weekends. Often even when they do head home, they’re on call.

With COVID, these included many added ICU/HDU duties. Dr Anmol Dhawan, a resident in Maharashtra tweeted (about residents), “...they generally do not get to go home when the night shift is done.

So their duty days (which are very frequent) are like one and a half day of work. Tweeting this on a chai break as I struggle to stay up on the second of my two consecutive 34-hour shifts.”

“(We’re) Mentally exhausted really. Tired of complaining about things to authorities especially during COVID. Anxiety before shifts(sic). I might be accused of using the word very liberally but one gets depressed from looking at all the gasping patients, the deaths and the lack of apathy from authorities. You're asked about things you have no control over and blamed for administrative incompetence.”

Dr Amit Anand, a resident doctor in Bihar

He says the work hours have doubled since COVID struck. Residents wouldn’t get tested for COVID because the hospital had no residents to spare.

Even the logistics and administrative work would be dumped on the already overworked residents. Such is the conditioning of doctors to long work hours, that mid-conversation, Dr Anand observed- they don’t have it as bad as the other states.

At the same time, NEET PG aspirants and Non-Academic Junior residents have to deal with the pressure of exam preparation along with their piling financial responsibilities.

Dr Anubhav Katyal, a NEET PG aspirant from Delhi, says that this entire period took a toll on their mental and physical health. There was so much uncertainty with respect to NEET PG that it was difficult to retain employment and to study.

While he was fortunate to score well in the exam, his life remains in a limbo.

They had to deal with their own illnesses, the loss of a parent and the unending delays.

Ad-hoc employment opportunities, too, were difficult to find after a while since most institutions prefer longer commitment. The unpredictable NEET PG delays made it impossible to commit.

Dr Anubhav says many of their friends worked despite the exam and they were often overworked and exhausted trying to balance work and preparation.

This is worse for doctors who support their families financially. It often becomes an impossible choice to write a tough PG entrance while working long hours.

In Karnataka, the recently graduated MBBS batch was mandated to perform rural service. These non-PG Junior residents were not paid for months. Many have still not received their salary.

Posts were created without earmarking funds for the same leading to many doctors performing mandatory yet unpaid labour. Often, as residents struggle with the extra burden, interns, too, have to step up to the mantle.

Soumya, an intern in a government hospital in Karnataka noted, the overall work load remains the same, interns and the current second year PGs do the work that three batches were supposed to do.

“... we don't have enough people to take proper shifts on duty days.”

COVID allowance was promised to residents and interns during the second wave. To add insult to injury, not only did these remain unpaid, their regular stipends too were often delayed.

It is not surprising then that #ExpediteNEETPGCounselling2021 is trending or that resident doctors have been on strike in Delhi.

On 27th December, the 11th day of the protests, the doctors marched to the Supreme Court demanding the same.

An intern (on condition of anonymity) from a Delhi medical college recounts that the peaceful march was intercepted by the police and physical force was used.

Many female doctors were manhandled by male police personnel. Doctors were forcibly stuffed inside buses and detained.

The use of physical force against doctors prompted FORDA(Federation of Resident Doctors’ Association) to call for the withdrawal of even emergency services in Delhi.

FIRs have been filed against the protesting Resident Doctors. Support has been pouring in from Resident Doctor Associations all over the country. More residents from hospitals in and around Delhi have been joining the strike.

The core demands are to expedite NEET PG counselling, to tender an apology for the manhandling of doctors and to withdraw FIRs against the resident doctors.

Despite a meeting with the Hon. Union Health Minister, to date, a resolution doesn’t seem to be in sight.

Healthcare Is Everyone’s Problem

Doctors have often been vilified for protesting. They are after all essential workers. This is a pandemic.

It is a vicious cycle, often the doctors that end up staying at hospitals have to cover for the ones protesting and end up with even more workload. Hospital administrations pressurise other batches to work extra.

“We will be marked absent, and will have to eventually repeat those many number of days of the posting later, which will also have an impact on our internship completion date and eventually the PG entrance exam eligibility.”

An Intern in Delhi

Threats, exhaustion, legal troubles, work stress, grief and severely injured morale seem to be a curse these residents and interns are stuck with.

As is inevitable, the direct sufferers in this situation are patients. It is them getting overworked, sleep-deprived doctors and it is the patients that bear the brunt of HCW burnout.

It is they who will lose faith in doctors and it is they whose quality of care gets affected by the inhumane working conditions of doctors. When push comes to shove, it is the patient who can’t even access care during these protests.

The worse things get for healthcare workers, the more patients suffer. Patients and doctors end up getting pitted against each other when really, they are both getting the short end of the stick.

“Makeshift” seems to be the go-to mode when it comes to healthcare in this country. Despite elections coming up in many states, healthcare is barely even considered an issue worth lobbying for by most voters and politicians.

Healthcare is often perceived as a healthcare workers’(HCW) issue though HCWs are rarely included in decision making. This doublethink has only led to the maintenance of the status quo.

It seems like a no-brainer that non-academic junior residents can be employed at least on an ad-hoc basis. (On the premise that they would receive fair compensation, on time.)

Yet, residents across the country have been struggling to get this implemented much like their demand for faster counselling.

It is a lonely, often misconstrued fight that begins and ends in the echo chambers of medics.

All this, despite a pandemic. Healthcare is everyone’s problem. Being prepared for a pandemic is everyone’s problem.

Arbitrary and hasty decisions are implemented without consulting all stakeholders beforehand and conversations only happen when these unstable systems are absolutely crumbling.

The residents have filled in for several shortcomings in administration and logistics. They have borne the blame for things that were not their prerogative in the first place.

They have dealt with grief, fear and abuse even as the pandemic claimed lives. For two years, these front liners have pushed on. Despite how heroic this sounds, this is not sustainable.

The doctors are not okay. Healthcare is not okay. We need more doctors in hospitals, now- for the doctors and for the patients.

(Dr Shivangi Shankar is a modern medicine doctor who writes in English and Hindi. She uses her art as a medium for catharsis as well as for making health and care more accessible for all.)