Prof (Dr) Sanjay Kumar Bhasin
Although there are hardly any gaps in the observations and recommendations of the high-level committee for the overall improvement of the health care delivery system and medical education at JKUT, but considering the wide range suggestions, a priority must be decided to achieve the objectives which are to be set by the decision makers on the basis of these recommendations. My main points in this regard are:
Educational institutions and not treatment centres: the training of quality graduate (MBBS) and postgraduate (MD/MS and MCh/DM) doctors is the sole responsibility of medical institutions, in addition to research and care tertiary health. Unfortunately, these medical institutions have been relegated to centers of health care delivery rather than becoming institutions of excellence for medical education. The lack of proper infrastructure and equipment, the imposed burden of patient care due to unnecessary guidance from sub-district and district hospitals, have directly affected academic and research work. Overcrowding coupled with associated factors makes doctors handicapped to provide quality services to patients in sub-district and district hospitals, resulting in more and more referrals to medical colleges. The descent course of medical education not only at JKUT, but nationwide must be halted immediately to avoid the collapse of medical education. If we fail in this endeavor, not only medical education, but also overall patient care will suffer severely.
Shortage of qualified teachers against less emoluments: As of now, two old GMCs have less shortage of teachers compared to new GMCs who are struggling to obtain qualified and experienced manpower. This issue is to get the best faculty even for AIIMS/PGIMER has become a big challenge in the era of corporatization of healthcare sector in India. Less pay/benefits offered to medical/paramedical personnel also prevent medical personnel from joining the government sector. In contemporary positions/experiences/qualifications, there is a huge pay/benefit gap between corporate hospitals and public hospitals. Faculty serving in JKUT’s GMCs have to suffer not only in terms of financial disparities but also in terms of incentives and even obtaining government sponsorships to attend state/national conferences not to mention international conferences. Files continue to linger in the corridors of power and, in the majority of cases, either rejected or approvals arrive too late by the time the conference is over. This is a big stumbling block in developing skills and keeping pace with recent advances.
Medical Equipment and Other Goods: Purchasing new and good quality medical equipment to keep up with the growing trends in medical science has always remained a big problem in the already established GMCs. Even the repair of equipment requiring very small sums goes through tedious official processes, buying new equipment worth crores can become easy but repairing equipment worth crores of rupees requiring a few thousand rupees becomes so tedious that the service concerned sometimes gives up on the idea of getting it repaired. The concept of buying LI seriously compromises the quality of the product. The concept of LI should be abandoned in procurement for the medical service.
Suggestions: All committee recommendations should be implemented in a phased and time-bound manner, with the top priority being to monitor:
* Autonomy of medical institutions: for the proper functioning of medical institutions, they should be granted greater autonomy without too much political and bureaucratic interference and influence. Boards of high-level institutions should be established with medical persons of the highest integrity and quality as board members, including deans/directors of all medical institutions and all HODs. The annual budgets must be made available to the municipality with an overhaul of the accounts already submitted and to the planning department. The principal should be a clinician while; The Dean should be from the non-clinical department with seniority and suitability as selection criteria. They should be supported by qualified superintendents and an administrative officer who should be gradually replaced by expert healthcare administrators. The process of passing on administrative training to more experienced faculty members should be initiated so that in due course they assume the responsibilities of health care administrators. All department heads should be given financial authority in the form of a recurring advance so that they can meet the day-to-day needs of the department. From now on, every department head has to run behind PMC Office or MS Office employees to get paper rolls, labels, files and other small items. Adhoscism at all levels of the medical institution should be discouraged and all medical schools should be placed under the domain of a medical university. This should be the first priority area.
* Salary benefits and other incentives: Improving au par salary benefits with AIIMS/PGI/SKIMS should be the top priority of the government which will definitely encourage new entrants to the faculty over abolishing the position of lecturer . Professor, Associate Professor and Assistant Professor will be put in the grade salary of 10000, 8700 and 7600 respectively while creating at least 10 senior professor positions in the grade salary of 12000 which will be an added attraction. Approval for conference attendance rests with PMCs and incentives in the form of academic stipend and book stipend should be initiated immediately. In the event of saturation at a particular level due to the unavailability of higher positions, the benefit of the dynamic career progression program should be extended to the faculty concerned so that they do not feel financially and otherwise discouraged. Each faculty member should be equipped with a laptop computer and internet facility in order to audit the research they carry out.
* Upgrading old GMCs as PGIMERs and establishing a medical university: The then Chief Minister of Jammu and Kashmir announced the establishment of a medical university in the state on 18 December 2016; which should see the light of day. GMC Jammu & Srinagar will be designated as PGIMER with greater autonomy and every effort will be made to strengthen the specialty and sub-specialty departments with more qualified faculty, paramedics and equipment in these GMCs. An exercise to start up the remaining super-specialties and the emergency medicine service must be undertaken immediately.
* Prohibition of private practice of teaching faculty: The private practice of government physicians has always remained a subject of hot debate and controversy for a long time and now the committee has also recommended the prohibition of this and rightly so. In the broader interests of research, academics, and better patient care, PP should be banned immediately in the face of the significant increase in faculty salaries and benefits. An isolated ban can create a special situation for the government.
Conclusion: All the recommendations of the expert committee are in the broader interest of academic research, teaching and patient care which must be taken seriously and implemented in a progressive but time-limited way to prevent further deterioration of the JKUT health care delivery system.
(The author is Hony. Secretary, JK Chapter of Association of Surgeons of India Member Secretary, Institutional Ethics Committee, GMC Jammu)