Reservations are a stress factor

I read with interest the articles by George Thomas (1) and by Neha Madhiwalla and Nobhojit Roy (2). The authors suggest that factors like poor working conditions, communication failure and inadequate facilities are evidently responsible for the increased friction between patients and doctors. In addition, I believe the undercurrent of resentment about reservation of seats in medical colleges contributes to the stress and violence. The recent strikes are over but the issue is unlikely to die down because urban, middle-class India remains severely polarised about caste-based quotas.

Reservations were introduced in the Indian medical education system for the benefit of castes that had suffered injustice for generations and who are, as a consequence, at a severe disadvantage. However the main reason that reservations still exist in India after 60 years of independence is the “vote bank” that politicians are afraid to lose. The politicians who are advocating reservations are not concerned about the quality of the doctors that our country will produce and so we see extension after extension of the reservation period. India may not be the only country in the world with a quota system in medical education, but it is the only country with a caste-based quota system and such a high percentage of reservations. Reservations in medical education should be on the basis of economic criteria so that the really deserving poor students benefit.

A reservation system based on caste, repeated strikes and incidents of assaults on physicians act as “push” factors for Indian physicians to go abroad. This migration further compromises the poor physician-patient ratio in India. It was recently reported that one Indian doctor is available in the US for every 1325 Americans in contrast with one Indian doctor in India for more than 2400 Indians (3). The Indian government should come up with better solutions to provide better patient care and avoid this loss of medical personnel.