New Delhi: Divesh Garg, a 26-year-old resident doctor at a private medical college in Dehradun, committed suicide last month. His parents, according to media reports, have blamed the poor working conditions and alleged harassment by his seniors.
Dr Arun Kumar, Secretary General, United Doctors Front Association (UDFA), a network of resident doctors, told ThePrint that though Garg was under tremendous pressure as a postgraduate student of paediatrics at his workplace, he could not quit because owing to his financial condition, it was not possible for him to pay the huge fine mandated by the seat-leaving bond policy.
“There are numerous instances like this when this dubious bond system has forced doctors or those studying medicine to take extreme steps when they cannot take the pressure and toxicity at work or studies, but see no escape due to the exorbitant penalty involved,” Kumar said.
The seat-leaving bond policy for medical students is a legal contract between them and their medical institution that makes it compulsory for a student to pay a heavy fine if they leave their course midway. In other words, medical students are penalised if they quit their course before completing it.
Following the death of the Dehradun resident doctor, Madhya Pradesh last week scrapped the seat-leaving bond policy, becoming the first Indian state to take this step. The policy mandated MBBS students in the state to pay a fine of Rs 30 lakh to the institute they were studying in if they left their course midway. Also, if a student wished to move to a different institute after the second round of counselling, they had to pay Rs 30 lakh to the state.
Medical institutes in most states, except those in Delhi and central government colleges, impose such bond conditions on medical students at all levels, undergraduate, post-graduate and super-speciality.
The seat-living bond policy in Uttarakhand mandates postgraduate medical students to pay a fee of Rs 1 crore to their institute in case they leave their course midway.
The decision to scrap the policy in Madhya Pradesh comes months after the National Medical Commission (NMC), the regulator for medical education and doctors, wrote to states to “review” the relevance of the policy. The state’s decision is set to be implemented from the upcoming academic session.
The move has been widely praised by doctors and medical students, who view it as the first sign of success of their long-time demand.
Speaking to ThePrint, Dr R.V. Asokan, President, Indian Medical Association (IMA), the largest network of medical professionals in the country, called the seat-living bond policy a form of “slavery”.
Dr Divyabhushan Varshney, a resident doctor at the All India Institute of Medical Sciences (AIIMS) in Bhopal, told ThePrint that the decision to scrap the policy means that students who want to get enrolled in medicine but do not want to pursue it can now quit midway without worrying about the huge financial implications.
“Many times, young students qualify for medicine but realise the amount of pressure only after they start studying. So far, they were forced to continue due to monetary reasons. It is therefore a much-needed relief for MBBS students. We want a replication of this decision also for PG and superspeciality students,” he said.
Dr Yogendra Malik, NMC spokesperson and a member of its Ethics and Medical Rating Board, told ThePrint that he wanted other states to scrap their seat-leaving bond policies too.
“We understand that the mental well-being of the medical students at all levels is of paramount importance and, therefore, state governments should abolish the bond system. Any decision in this regard, however, can be taken only by states keeping in mind the state of their healthcare delivery system,” he said.
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Mixed opinions on seat-leaving bond policy
At present, a majority of Indian states not only have a seat-leaving bond policy which can range from Rs 10 lakh to 1 crore, but also a service bond policy.
A service bond is a legal agreement between a medical student and a government medical institution which requires them to work in a specific area, say, a rural region, or a healthcare facility for a certain period of time, which can range from one year to three years, after they have completed their MBBS, PG or superspeciality degrees.
Students who do not wish to fulfil the agreement are required to pay the institute they were studying in or the state in which it is located a penalty that can range from Rs 10 lakh to Rs 1 crore.
Lawmakers who favour these policies argue that these are aimed at preventing “wastage” of seats in medicine, and also to ensure that doctors serve in rural areas mandatorily, given the acute shortage of doctors in such regions in a number of states.
“These conditions were adopted by state governments after 1992, when the Medical Council of India (the predecessor of the NMC) implemented the residency scheme for medical students,” an NMC official told ThePrint.
Some medical education experts still support the policy.
“Bond policy is okay when education is subsidised like in government colleges,” Dr Thomas Chacko, a medical education expert from Kerala, told ThePrint.
However, Dr Aviral Mathur, President, Federation of Resident Doctors Association (FORDA) told ThePrint that now that the NMC has implemented the District Residency Programme (DRP) for doctors in all medical colleges, the bond system has no reason to stay.
The DRP is applicable for students who have been enrolled in medical colleges since 2021.
“This has ensured that there is no shortage of broad specialty PG doctors in smaller towns to serve rural patients,” Dr Mathur said, adding that now there is no dearth of MBBS seats in the country either.
According to data shared by the Union health ministry in response to a question in the Lok Sabha in August 2022, there were 1,07,950 MBBS seats in 706 medical colleges in the country during the 2023-24 academic session. Also, there are now over 50,000 PG or equivalent seats in India.
FORDA, in several representations to the NMC, has been demanding an abolition of the seat-leaving bond policy or at least a uniform bond-policy across states.
Dr Lakhsya Mittal, President, UDFA, told ThePrint that an abolition of bond policy could lead to greater flexibility for doctors, and encourage more students to pursue medical education without the fear of financial penalties if they decide to change their career path or the need to relocate for personal reasons.
“Without the bond system, doctors will have greater flexibility to pursue further studies, specialisations, or job opportunities without being tied down by compulsory service requirements or hefty penalties,” he said.
He added that while bonds are intended to ensure doctors serve in rural or underserved areas, the actual implementation often leads to dissatisfaction and resistance. “In fact, alternative incentives and support for rural postings might be more effective in the long term.”
Asokan said that the current system causes medical students, unlike those in other professional courses, to remain “slaves in an incompetent system”.
“Why should doctors be forced to work in a state for a specified number of years when the states cannot even guarantee their absorption after serving those years? They should be allowed to make decisions keeping in mind their well-being, convenience and career paths they want to choose for themselves,” he said.
(Edited by Radifah Kabir)
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