India's medical education system is facing a silent crisis, one that has devastating consequences for its postgraduate medical students. These young doctors, who should be learning and growing in their fields, are instead being crushed under the weight of an understaffed healthcare system and an environment fraught with emotional and physical exhaustion.
A Tragic Reminder
In 2023, the tragic suicide of 27-year-old Sugirtha Selvakumar, an anaesthesia postgraduate student, brought to light the intense pressures faced by medical residents. Working nearly 20 hours a day under relentless psychological stress, Sugirtha's final act was a heartbreaking testament to the severe toll this system takes on young doctors. Despite the outrage her death sparked, little has changed since then.
A recent Right to Information request revealed that 58 postgraduate medical students have died by suicide in the past five years. An online survey by the National Medical Council uncovered that nearly 37,000 medical students have self-reported mental health issues, including suicidal thoughts. However, the actual number is likely much higher, as many students suffer in silence.
A High-Stakes Trap
Gaining a postgraduate seat in a medical college in India is like entering a high-stakes trap. The gruelling three-hour entrance exam is just the beginning. The societal pressure to succeed in postgraduate medical education is immense, making it nearly impossible for students to quit, even when they face unbearable conditions. Adding to the burden, students who wish to leave their seats are often hit with exorbitant fines, ranging from Rs 5 lakh to Rs 40 lakh, a financial burden most cannot afford.
Filling the Gaps
Postgraduate residents are not just students; they are the backbone of an overburdened healthcare system. These young doctors are expected to juggle their studies with patient care and a myriad of other responsibilities, from carrying samples to the lab to covering for their seniors. Despite their critical role, they often receive little support and are left to pick up the slack when other staff members fail to do their jobs.
The pervasive attitude that "leave is not a right" only exacerbates the problem. Resident doctors are made to feel guilty for taking even a single day off, as their absence would increase the workload for their already overburdened colleagues. The question then arises: why aren't more doctors being hired to alleviate the pressure? There are countless post-MBBS doctors in need of employment, yet the system continues to rely on postgraduate students to fill the gaps.
The Myth of Toughness
The toxic culture within medical education perpetuates the myth that toughness equates to competence. Residents are often shamed for attending to basic human needs like sleep, food, and self-care. This culture can be traced back to the origins of the residency system, introduced by Dr. William Stewart Halsted, who was infamously able to work without sleep or food due to his cocaine addiction. However, continuing this outdated and harmful system only serves to endanger both doctors and patients.
Research shows that overworking doctors does not improve their skills or patient outcomes. A study published in the BMJ found that doctors trained for fewer hours performed just as well in their first year of unsupervised practice as those who worked longer hours. Yet, medical residents in India continue to be overworked and under-supported, leaving them exhausted and unable to learn effectively.
Students or Staff?
Postgraduate medical students exist in a grey area between students and staff. They are expected to take on the responsibilities of a full-time job without the benefits of formal employment, such as paid leave, provident funds, or bonuses. Many are even denied free healthcare by their colleges and are forced to pay out of pocket for their medical expenses.
This exploitation is compounded by the emotional abuse that permeates medical departments. Senior doctors often engage in unprofessional behavior, insulting and bullying residents in the name of "teaching." This toxic environment leaves many young doctors feeling isolated, demoralized, and afraid to speak out.
Why Not Complain?
Given the dire situation, one might wonder why resident doctors don't simply file complaints. The reality is that fear keeps them silent. Many worry that their heads of department or thesis guides will retaliate by failing them, forcing them to remain in an environment they already find unbearable. Others fear that complaining will only lead to intensified bullying, with little chance of any real change.
The glorification of struggle within the medical community only adds to this fear. Raising concerns or admitting difficulty is often seen as a sign of weakness, leading residents to suffer in silence rather than risk being perceived as unfit for their roles.
The Path Forward
Addressing this crisis requires immediate and tangible action. First and foremost, the practice of imposing exorbitant seat-leaving fees must be abolished, allowing students to exit programs without financial ruin. Additionally, colleges must hire non-postgraduate and senior residents to fill the gaps in manpower, ensuring that patient care does not fall solely on the shoulders of postgraduate students.
Investing in better infrastructure is essential to prevent the exploitation of resident doctors. Medical colleges must fulfill their responsibility to provide structured education in a professional environment, without overburdening students. Disciplinary bodies should be established at the college, state, and national levels to allow students to raise concerns without fear of retaliation.
Only by addressing these issues can we hope to create a medical education system that not only produces competent doctors but also fosters their well-being. If the healthcare system continues to ignore the cries of its future caregivers, the consequences will be dire for both doctors and patients alike.
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