An SMS that did the rounds among medical students when the proposal to extend the MBBS course, to include a year of rural posting, appeared imminent, went like this: “Govt. of India announces special packages for aspiring doctors. Become a ‘super-specialist’ in just sixteen and a half years!! Do MBBS for 5.5 years and get one year ‘compulsory’ rural posting. In case you get a PG seat, study 3 yrs and get an assured ‘compulsory’ rural posting for two years. In the rare event of your managing to get a seat for DM or MCH, study for 2 yrs and be rewarded with a guaranteed ‘compulsory’ 3 year rural posting... Yet 2 b announced special packages: Married block in boys and girls hostels, Kindergartens in PG hostels... and who knows maybe a cremation ground too...”

The SMS may appear facetious but it eloquently expressed the fears in the minds of medical students throughout the country. Already under the stress of coping with a five-and-a-half-year course, the thought of sitting in villages and providing treatment without nurses, basic amenities or even medicines, is a frightening prospect. Many aspects in the world of medicine do not come with a guarantee. An emergency procedure given with the intention of saving the patient’s life could have the contrary effect. And then you can imagine the ire of the local community? Then what about women medical students? Will they not be vulnerable in an isolated rural setting?

Is there a solutions to the problem? A policy targeting graduated doctors sounds more interesting. Why make it a part of the MBBS course? Why shouldn’t we, instead, encourage fresh medical graduates to join the rural service under the NRHM by paying them what they deserve and giving them incentives like grace marks in PG entrance tests?

I recently had the fortunate opportunity to meet former president Dr A.P.J. Abdul Kalam. I asked him if he had a solution to the problem. Amused by the question, he replied, “Should I give you a beautiful answer, a difficult answer or a suitable answer?” When I told him to choose the answer that would best suit the country, he said, “In India, we have 700 million people living in six lakh villages — and our primary health centres are not properly manned. I have therefore suggested to the government that it includes PURA, or Providing Urban Amenities to Rural Areas, in its 11th Five Year Plan. “Once the connectivity and the involvement of various sectors in rural areas are achieved, doctors won’t have a problem serving in these areas.” The former president went on to ask why there were no compulsory rural postings for students graduating from IITs and IIMs.

Dr Kalam really touched upon the nub of the problem: the major social change taking place among graduating professionals. There is, today, a clear disparity between medical graduates and management/engineering graduates. Fresh graduates from engineering streams get placements and handsome pay packages almost immediately after passing out. Medical graduates, in contrast, have to work towards acquiring a specialisation and then a super-speciality, before they can even contemplate a handsome remuneration. Considering the high expenses in acquiring a medical education today, this is a source of great frustration.

There are many who wonder why medical students are so opposed to “serving the people” in rural India. They need to look at the big picture.

The writer is in his final year of MBBS