When training becomes service

The ongoing strike by MBBS and BDS interns across government medical colleges in Jammu & Kashmir has brought a long-simmering issue to a boil. At its core, the dispute touches on the purpose of medical internships, the historical evolution of stipends, the status of foreign medical graduates, and the question of what constitutes fair compensation. Advertisment The compulsory rotatory internship—instituted as a mandatory 12-month bridge between theoretical medical training and independent practice—was historically viewed purely as an educational extension. In the 1970s, receiving ₹200 per month was standard across many Indian state medical institutions. At that time, it was explicitly framed as a nominal 'pocket-money allowance' rather than remuneration for labour, as the state bore the brunt of medical education costs, and living expenses were low. Over the decades, however, two structural shifts transformed this equation: Government tertiary care facilities now handle immense patient volumes. Interns do not merely 'observe'; they shoulder frontline clinical duties—handling emergency triage, night shifts, ICU monitoring, and surgical assistance for 80–90 hours a week. A token sum from 1970 translates to a significant financial strain today. Protesting doctors in J&K note that their current stipend of ₹12,300 per month amounts to roughly ₹400 a day—less than the daily wage of unskilled labour in many sectors. The situation becomes even more complex when examining Foreign Medical Graduates (FMGs) returning from countries like Bangladesh, Iran, Russia, and former Soviet republics. After completing their degrees abroad, these students must pass the mandatory Foreign Medical Graduate Examination (FMGE) / Next-STEP exam conducted by the National Medical Commission (NMC). Even after passing this rigorous exam, they are mandated to undergo 1 to 2 years of internship in recognized Indian hospitals to adapt to local clinical protocols before acquiring full registration. Historically, many states denied FMGs any stipend whatsoever, forcing them to work intensive hours without pay. Recent NMC guidelines, however, stipulate that FMGs should be paid on par with Indian graduates, but implementation across states remains highly inconsistent. The willingness of FMGs to work even under uncompensated conditions reflects the high stakes of acquiring the license required to practice or sit for NEET-PG, rather than an agreement that zero stipend is fair practice. Advertisment Interns across GMC Srinagar, GMC Jammu, GMC Anantnag, and SKIMS launched an indefinite strike since 31st August this year, seeking a hike from ₹12,300 to ₹30,000 per month, citing that stipends in states like Assam, West Bengal, and Central Institutes range between ₹26,300 and ₹44,000. Health Minister Ms Sakina Itoo and the Health and Medical Education (HME) department have acknowledged the demand as 'genuine' and inflation-justified. A government committee in 2023 had already recommended a hike to ~₹25,000–₹26,300. Recent parleys between the Health Minister and intern delegations ended in a deadlock. The ministry requested a one-month window to clear the file through the Finance Department, asking interns to resume duty. However, interns have refused to call off the strike without a written government order, pointing out that similar verbal assurances and departmental proposals have bounced between the Health and Finance departments for years without implementation. From a legal, ethical, and operational perspective, several arguments define what a fair policy should look like: While internship is legally part of the degree requirement prior to full NMC registration and NEET-PG eligibility, it is also active service. Modern hospitals rely on interns as the primary workforce for routine clinical tasks and immediate triage. Compensating that labour at a baseline living standard is a matter of basic workplace fairness. Medical education and licensing standards are uniform across India under the NMC. Allowing extreme disparities—where an intern in one state earns ₹44,000 while another in a neighbouring Union Territory earns ₹12,300 for identical work—creates structural inequities. Young doctors at this stage have completed 4.5 years of rigorous, costly education. Expecting them to cover basic room, board, and exam prep costs on ₹400 a day in an inflationary environment is unsustainable. A balanced resolution requires moving away from viewing stipends as optional financial aid and recognizing them as a standardized, inflation-indexed compensation for essential frontline care during mandatory service. Prof Upendra Kaul , Medical Educationist anprof ud Founder Director of GKF