AMC appeals for modified honorary system of medical teachers

The honorary system is now on its last vestiges in the states like Maharashtra but there is an urgent need to revive it throughout India. The state governments must be given an option by the MCI to introduce the system if they desire so

The Association of Medical Consultants (AMC), Mumbai, has submitted a memorandum to the Union Health Ministry for introducing modified ‘Honorary System for Medical Teachers’ in medical colleges across India. In view of this, the Association had recently undertaken a comprehensive study on this subject.

According to AMC, the quality of medical teaching in the country is on the decline recent years. Apart from this, India cuts a sorry figure in medical research more so at the international level. Reasons attributed for the scenario include failure of MCI to evolve a suitable staffing structure in teaching hospitals taking into consideration the economic realities of India; rapid induction of technology in diagnostic and therapeutic medicine resulting in fragmentation of medical specialities and development of newer sub-specialities requiring a very large teaching faculty and financial constraints.

The memorandum details upon the prevailing employment pattern of medical teachers in the country viz. Scheme of full-time teachers, Scheme of controlled practice, Scheme of practising full-time teachers and Combination scheme of full-time teachers and honorary teachers.

The fourth category is where the AMC is demanding for modifications. The memorandum says In this scheme the teaching faculty is 50 per cent full-time and 50 per cent honorary. This scheme was evolved by the British considering the economic realities of India where majority of the patients are poor, are not covered by any insurance and depend on public hospitals for their medical care. After independence, the MCI failed to take advantage of this scheme by suitably modifying it from time to time incorporating the advances in the medical fields and the changing pattern of medical practice.

According to the memorandum, the advantages of the scheme include Financial: By employing 50 per cent honorary faculty, the government can effect substantial fund savings as such staff would otherwise be recruited as full time staff at higher rungs of pay scales.

Better faculty On account of modern developments, various medical specialities have fragmented resulting in sub-specialities. But being a poor country, its not possible for India to employ full-timers in all the sub-specialities. The MCI has miserably failed in its duties to look into this reality, saddling the country with large number of sub-standard medical colleges with inadequate teaching staff.

Better co-ordination between public and private hospitals: Most honorary teachers are also attached to large charitable and trust managed hospitals which are legally committed to provide a part of their services to needy patients but renege on their social commitments. Presence of honorary doctors on the faculty of both types of hospitals, would greatly help in better co-ordination and better services for the poor patients.

Better teaching and patient care: Rapid medical advances have resulted in the need for induction of hi-tech medical equipment at rapid intervals in the teaching hospitals and upgradation of the training and skills of medical teachers. Most states in India are not even having sufficient funds to buy essential drugs for the public hospitals, let alone buy such costly equipment. Induction of honorary teachers who are usually attached to large private hospitals where such equipment is available and who are able to self-finance their training can not only upgrade the quality of teaching but also the patient care in teaching hospitals.

Benefit to the honorary teachers: Despite receiving honourarium, the Indian doctors, by virtue of the long established tradition, still prefer to work in the teaching hospitals as it gives them greater work exposure and academic satisfaction besides giving them a clout in their profession. However, these benefits are now also being provided by the recently established big private hospitals and the culture of honorary teachers may disappear from the Indian scene.

The honorary system is now on its last vestiges in the states like Maharashtra but there is an urgent need to revive it throughout India. The various state governments must be given an option by the MCI to introduce the system if they desire so.

AMC feels that the following modifications should be made in this system so as to make it suitable to the emerging realities:

While the private hospitals provide flexible working hours for their honorary doctors, the working hours of honorary teachers in the public hospitals have remained inconvenient, rigid and stereotyped for all these years.

Modification required: The honorary teachers should be given the freedom to evolve their duty rosters by spreading their 20 hours per week of service attending the hospital for minimum of five days from Monday to Saturday during the normal working day.

There is usually an intense rivalry between full-time teachers and honorary teachers. The main reason being that the career profile and pathways of the two type of teachers have been made vastly divergent. Eventual frustration creeps in both in full time teachers because of poor pay, lack of adequate avenues for promotion and painfully slower upgradation of hospital facilities; and in honorary teachers because of the lack of sufficient co-operation from the full-time teachers who blame their presence as the reason for the government neglecting their service conditions.

Modification required: The full-time teachers should be given the option to switch over as honorary teachers any time after seven years of full time service as and when the vacancy arises. This will help in the development of composite teaching faculty in the medical colleges and eliminate the prime cause of rivalry between the two.

Need to develop sub-specialities within the department.

Modification required: Honorary teachers can help in the development of various sub-specialities in a cost-effective manner. A specialised backache clinic can be kept for the spine surgeon in the afternoon, in addition to a morning OPD.

With the progressive replacement of out-dated concept of Post-Graduate students by the ‘Residency in-service training’ following recommendation of Sankaran Committee in 1981 and granting of S17 and S18 pay Grades by the Fifth Pay Commission, the services of the resident doctors (also interns) must be utilised on the concept of the junior medical staff and the various units within the department restructured accordingly.

The recent homicidal charge on a doctor, wherein the accident victim decided not to get admitted in his hospital, under section 304 of IPC has shaken the medical community. IMA has taken upon the matter and made submissions to the union health minister and union law minister pressing for an administrative order absolving doctors of criminal liability. We invite opinions from our readers on this issue, especially in the wake of increasing number of medical negligence cases. (For a detailed report, readers may refer to Aug 16-31 issue of EHM at www.expresshealthcaremgmt.com). Opinions can be sent at ehm@rediffmail.com by Sept. 20, 2001.