The National Medical Commission (NMC) Act, 2019 got the President of India’s assent last year.

TN always had 50% quota in PG courses for in-service doctors

The in-service doctors scored a major victory in Supreme Court on Monday (August 31) when the judges upheld states’ right to provide 50 per cent internal reservation for government doctors who want to apply for PG course seats.

The TN quota pattern

Tamil Nadu, however, was following the in-service quota for 28 years (till 2017) when the NEET (National Eligibility cum Entrance Test) was introduced. Accordingly, the reservation was cancelled by Medical Council (MCI) of India. Instead, the MCI started giving incentive marks.

Tamil Nadu has been surrendering 50 per cent of PG medical seats to the Centre for the past many decades while the remaining 50 per cent is filled by the state. Till 2017, half of all available seats were reserved for in-service doctors. While the quota system is still followed in medical diploma courses, government doctors seeking admissions to PG degree courses were deprived of the benefit.

In-service quota used to be provided in several states before, but in different proportions. In Tamil Nadu, besides 50 per cent in-service quota, doctors from rural and tribal areas were given 90 + 10 marks. They were required to write the exams for 90 marks and 10 marks were given based on their service and PG attempts. For example, 1 mark was provided for every year attempt, 2 marks were given per year of service if a doctor worked in rural area and 3 marks were given if the candidate worked in hilly or remote area.

The minimum service requirement to avail of the reservation was two years. Maximum marks offered were 10 and the upper service limit to get the benefit was 10 years. Based on these marks, the ranking was prepared and students were admitted. “As a result, a good number of MBBS graduates showed interest in working in rural and tribal areas. So we had a sufficient number of doctors in government hospitals across the state,” said J Kathirvel, secretary, Tamil Nadu Medical Officers Association (TNMOA).

Impact of cancellation of sub-quota

After the introduction of NEET in 2017, reservation for in-service doctors was cancelled by the MCI. Instead the MCI offered incentive marks up to 30 per cent. That is, a doctor practising in hilly area would get 10 per cent marks for every year of service, 9 per cent for working in difficult areas in plains, 8 per cent for remote areas and 5 per cent if they had worked in rural primary health centres.

The in-service doctors got a feeling that working in government hospitals was a disadvantage since they had to compete with non-service or private doctors in the open category.

“The service doctors get very less time to prepare for PG given the amount of workload. Because of this, the non-service doctors got an edge. In 2018, TNMOA filed a case against the MCI and medical counselling got delayed. Because of that, the Centre has returned a considerable number of seats to us. So in that year, 54 per cent of seats went to in-service candidates and 46 per cent to non-service candidates,” said Kathirvel.

But in 2019, the proportion was turned upside down. Only 43 per cent of seats were given to service doctors and the rest to non-service doctors. Even in the 43 per cent quota of seats, most in-service doctors would get only non-clinical seats like microbiology, pathology etc. Hot and most sought after seats like paediatrics, anaesthesia went to non-service doctors. This year only 38 per cent of seats went to in-service doctors. “If the trend had continued, then some years down the line, the government hospitals in the state could have faced shortage of doctors in speciality departments,” said Kathirvel.

How MCI rule affected TN’s health infrastructure?

The cancellation of in-service quota had a direct impact on the state’s health infrastructure.

Rajesh, a doctor practising in Thoothukkudi, said, “In the last three years, several doctors failed to get incentive marks because the area they worked in was not considered rural or remote.” Generally, when the government called for applications for 1,000 vacancies, it would receive at least 10,000 applications.

“But now most of the MBBS graduates who are selected for the job give priority to continuing higher studies than to join the service. Since there is no in-service quota, they lacked interest to practice in rural or remote areas.” The fact is that they do not want to “waste” two years of their career and again compete for the PG entrance like any other candidate. So they thought of joining the service after completing their PG. “If the trend continues, rural hospitals will not be left with MBBS doctors,” said Rajesh, who is one among many who benefitted from the quota system in 2014.

Interestingly, when the in-service quota was in effect in Tamil Nadu, the government used to expect service doctors to work in government hospitals till retirement (age of 58). “This was done to ensure there will be no shortage of doctors. But if there is no quota, after PG, the doctors will move to the private sector,” said Kathirvel.

What’s next?

In 2018, Tamil Nadu Medical Officers Association (TNMOA) had filed a case in Supreme Court seeking an interim relief against MCI’s powers in this matter, but to no avail. The MCI then argued that such reservations are against their rules and would bring down the standard of medical education and doctors.

Dr Gnanapragasam, state president, TNMOA, said, “Let the MCI conduct NEET and prepare ranking list. We asked the court to grant rights to the state to fill up the seats. For long, there was no problem in filling the seats because it was under the state’s purview. All these years, no law has been enacted to protect that reservation. During this present regime in Centre, all the powers are given to MCI and hence the commotion. Now that the SC has ruled in our favour, we demand the state to enact a law on providing in-service reservation at the earliest.”

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