MUMBAI: In a bid to bridge the doctor-patient gap in rural areas, the state government has proposed to reserve 10% of MBBS and 20% of medical post-graduation seats for in-service doctors who are willing to work in interior areas for five and seven years, respectively. The quota seats, though, come with a stringent condition: Those failing to work in state-run hospitals after completion of the course could face imprisonment of five years and even cancellation of their degrees.

The state cabinet approved the decision on Monday and will introduce a bill called Maharashtra Designation of Certain Seats in Government and Municipal Corporations Medical Colleges in the legislature to make it a law. The reserved seats will be available in state and civic-run medical colleges as well for aspirants who want to work for a long period in government centres. By preliminary estimates, 450-500 MBBS seats could be earmarked under this quota while the count of PG seats for in-service MBBS graduates could be around 300.

“The decision has been taken to ensure that we have enough doctors to man the primary health centres and other rural health facilities in rural, hilly or remote areas. Students getting a seat under the quota will have to sign a bond. Any breach would attract imprisonment of five years as well as cancellation of degrees. Only those with the state’s domicile certificate can opt for the quota,” said Dr T P Lahane, head of the Directorate of Medical Education and Research (DMER). A senior medical education department said a similar concept exists in the Armed Forces Medical Colleges, Pune.

According to the latest economic survey of Maharashtra 2018-19, the doctor population ratio in the state is 1:1,330 against the WHO recommended 1:1,000. In remote parts of the state such as Gadchiroli, though, the ratio continues to be abysmally low with one doctor for a population of 5,000 or more. Officially, the state has over 1.5 lakh allopathy doctors, of whom around 66,081 are PG degree holders.

The decision has evoked a mixed response from experts, mainly because of the state’s failure in implementing the existing bond services effectively. All MBBS and PG students studying in the public medical colleges are supposed to serve a mandatory one-year bond after the completion of each degree failing which MBBS students have to pay a penalty of Rs 10 lakh, PG doctors Rs 50 lakh and Rs 2 crore by super-speciality candidates. However, data has shown that less than 10% candidates proceed to finish the bond or even pay the penalty.

“It’s a unique approach no doubt, but one can’t help but wonder that the state could have got 5,000 doctors by implementing the bond concept right,” said Dr Abhay Shukla of Jan Arogya Abhayan. “We have already seen that penalty doesn’t work. Also, jailing a person seems to be too punitive a step to make doctors work, when vast countries like Canada and Australia manage to get doctors to work in rural areas by providing good facilities,” he added.

Echoing the same, former dean of KEM Hospital Dr Avinash Supe said the decision was a bold one but must be complemented by upgradating rural infrastructure. “There will be many takers. But the state has to ensure that the centres have updated facilities and infrastructure is well-maintained. We shouldn’t allow their skills to go waste. Else, they will not benefit the society after 5 years,” he added.

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