[ Dr Komling Perme ]
The medical profession is often seen as highly respected and well-compensated, but the reality is not as ideal as it may seem. When a patient is not improving, the treating doctor experiences the same mental trauma. When on emergency duty, a doctor is often restless, and when attending a postmortem or medico-legal case, they may have to wait indefinitely for a court summons. On VVIP duty, it can feel like fasting. A medical graduate typically enters service at the age of 26, a specialist at 28, and a super-specialist at 31. As a result, the overall service life of a doctor is short. Throughout their career, doctors typically receive only three promotions, whereas in All India Services (AIS) or the defence service, there is greater scope for advancement if one excels. This discrepancy is merely hypothetical; every profession has its own set of challenges.
To improve the career prospects of government employees, the central and state governments have introduced provisions such as the MACP (Modified Assured Career Progression) and DACP (Dynamic Assured Career Progression) schemes. These schemes offer financial upgradation to officials after completing a requisite service period. One such scheme, the DACP, is implemented in central universities, the Railways, the armed forces, autonomous universities, and in more than 18 states in India, including Bihar, Odisha, Jharkhand, Madhya Pradesh, Goa, Haryana, Delhi, and Rajasthan, among others. In Arunachal Pradesh, the veterinary and animal husbandry department has been implementing the DACP scheme since June 2023, up to Level 14.
On 21 and 22 February, 2025, the Arunachal Pradesh Doctors Association (APDA) called for en masse casual leave in protest against the deprivation of the DACP scheme up to Level 14, despite financial approval from the finance department in June 2024. Other issues include amendments to the APHS (Arunachal Pradesh Health Services) Rules of 2000, delays in conducting DPC (departmental promotion committee) meetings (which result in senior doctors retiring without receiving their service benefits), and the rationalisation of postings to improve health facilities.
Since the NEFA (North East Frontier Agency) days, the state was initially run by Central Health Service (CHS) doctors until the late 1990s. Over time, the number of locally qualified doctors grew, and they gradually replaced the CHS doctors. Since the state does not have its own pay commission, doctors follow the central pay pattern. However, from past experiences, when 109 specialist posts were advertised, only nine joined, leaving 103 specialist posts vacant. These vacancies are critical because hospitals in areas like Aalo, Ziro, Bomdila, Tezu, and Khonsa are unable to offer quality healthcare services. As a result, patients from remote areas must travel to neighbouring states such as Assam or to the nearest tertiary hospitals in Naharlagun (TRIHMS) or Pasighat (BPGH) for treatment. This is a significant challenge for both the government and the stakeholders.
To attract qualified doctors, policymakers need to implement innovative measures, such as salary enhancements, attractive perks like a 13th-month salary for doctors serving in rural areas (as practiced in West Bengal), and transport allowances. Some states in India increase doctors’ salaries to prevent them from leaving for foreign countries. A study on public health policy, published by the Public Health Foundation of India on 12 January, 2012, emphasises that a bold decision on human resource policy is urgently needed.
When the APHS Rules, 2000 were established, there were only 485 doctors. Today, that number has increased to 1,140. Over the years, new posts such as the director of medical education, director of family welfare, zonal general hospitals, and district hospitals have been created and notified. However, key elements like manpower projection, recruitment rules, and training need to be incorporated into the APHS Rules, 2000. This would help realign the cadre to meet the evolving needs of the medical field. Unfortunately, these issues have not received attention in the last 24 years, leading to distortions in the cadre. It is the responsibility of the Cadre Controlling Authority (CCA) to review these rules every five years, as mandated by the Cadre Amendment Rule. In line with this, the personnel, public and pensions ministry’s personnel & training department has issued a memorandum to all ministries to improve planning.
It is clear from the relevant authorities that there is a lack of interest, delayed action, and inadequate attention given to these important issues, thus hindering the work of decision-making bodies. The en masse casual leave taken by APDA members is a reflection of the frustration felt by doctors. Just as parents investigate whether a baby’s cries are due to hunger, emotional distress, or pain, it is the responsibility of the authorities to identify and address the root causes of these issues. Unfortunately, no visible progress has been made to address the doctors’ grievances. (The contributor is President, Arunachal Pradesh Doctors Association.)