15-hour shifts, no sleep or water: India’s resident doctors cry ‘I Am Overworked’

The doctors, from medical college hospitals, insist they won't launch a strike but want SC order on reduced working hours and weekly offs implemented.

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New Delhi: 15-hour shifts, no break rooms, no sleep, food or water — tired of such working conditions, resident doctors with coveted degrees from some of the top medical colleges in India are coming together to tell the central government that they are being “overworked”.

The resident doctors have launched an ‘I Am Overworked’ campaign and have been mobilising graduate and postgraduate students in government medical college hospitals “across states like Delhi, Madhya Pradesh, Andhra Pradesh, Kerala”.

Dr Harjit Singh Bhatti, former president of the resident doctors’ association, All India Institute of Medical Sciences (AIIMS), told the ThePrint that the doctors will use the campaign to send recently appointed Union Health Minister Dr Harsh Vardhan a letter with their complaints.

The doctors also plan to send letters to deans of all medical colleges in India, use social media campaigns to boost visibility and increase pressure, and wear an ‘I Am Overworked’ badge on their scrubs on a chosen day of this summer.

There will be no strike or protest, the doctors say, but add that a “message needed to be sent”.

“The health minister’s job isn’t’ merely to privatise the healthcare industry — if it was, then anyone could do the job,” Bhatti said. “We’re hoping the health minister, who is also a doctor, will better understand our pain because he’s been through it himself.”

According to Bhatti, even the suicide of Maharashtra doctor Payal Tadvi was a consequence of more than just caste discrimination. “Resident doctors said that an unmanageable workload was also a major consideration in her death,” he said. “When junior doctors commit suicide, we must also factor in that they are being made to work over 15 hours a day with no rest, often without easy access to food, water and break-rooms.”

All in a day’s work

Bhatti said that he has seen his fellow residents break down, cry and scream during their shift, adding that some of his friends can’t even sleep for the four hours they get at night “because we dream about patients and paperwork”.

Alok Kumar, the head of the Indian Medical Association’s resident student wing in Delhi, said that “one of our biggest demands is the proper implementation of the Central Residency Scheme, which so far has been flouted across hospitals”.

The scheme, created following a Supreme Court order in 1992, limits the working hours for junior residents to 12 hours a day and grants a weekly off-day on a rotation basis.

“But there are days when we work between 8 am and 4 am the next day,” resident doctor Abdullah at the Jawaharlal Nehru Medical College, Aligarh, told ThePrint. “If we have a double duty that week, then barring a cumulative 7-8 hour break, we end up working for 56 hours,” Abdullah added, explaining that the primary problem is that “the number of residents hasn’t changed in the past 10-15 years”.

“But the stream of patients has increased manifold,” he said.

The numbers bear him out. According to data released by the health ministry in June last year, there is only one government allopathic doctor per 11,082 population, one government hospital bed per 1,844 population and one state-run hospital for every 55,591 population.

The situation is so dire in the country that a 2017 study in the medical journal BMJ Open pegged the average time that primary care physicians spend with patients in India at an abysmal 2 minutes.

“It is concerning that a large proportion of the global population has only a few minutes with their primary care physicians,” the report concluded. “Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.”

Unrealistic expectations?

Not everyone, however, is siding with the resident doctors.

Dr Anoop Mishra, who has been a personal physician to two former prime ministers and is currently serving as the chairman of the Fortis Centre for Diabetes, Obesity and Cholesterol (C-DOC), admits that residents, both senior and junior, are largely not in control of their time, but says that those of his generation “were more overworked 25 to 30 years ago, when there was nothing, no scheduling at all”.

“Residents could work three days continuously without respite,” he said.

The veteran doctor remembers his time as a resident in AIIMS, saying that it was only in the 90s that he and his colleagues started getting a day off. “They are overworked, no doubt about it but this is how medicine works,” he said. “I won’t say it’s totally irrational or something that is cruel, because that is how we all learned — by doing more work than is usually expected of non-medical people.”

Dr Mishra, however, also clarified that the work culture depends significantly on the hospital in question. “In AIIIMs, you can’t admit more patients than there are beds, so the resident to patient ratio stays consistent,” he said. “But in Safdarjung Hospital, patients are lying on the floor, making which definitely makes residents overworked and compromises patient care.”

For Kumar, the normalisation of the ‘grind’ only adds to the problem.

“Look at it this way,” he said. “A resident’s age is usually 24-26. It is a time when someone is striving towards stability. You come with a dream that if you study and work hard, sacrifice everything, then you’ll become a doctor. But you feel like you have no worth here, that seniors are humiliating you, that you’re being discriminated against for your caste, and that no one cares if you die of fatigue, then it all adds up to depression, emotional disturbance and complete exhaustion,” he added.

“It’s affecting their performance. If you are seeing an average of several thousand patients every year, how are you expected to remain focused and mentally present?” Dr Bhatti asks.

• The copy has been updated with an additional quote from Dr Anoop Mishra.