‘Bonded Labour’: Karnataka’s private medical college students in a fix over mandatory rural service

NEW DELHI: Karnataka’s effort to make rural service mandatory for all medical students, including those in private colleges, has always found its way to the courts with medical students seeing it as a “lost year” and private students questioning its legality.

In January 2024, the Karnataka government amended the compulsory rural service Act to partially relax it. With the new amendment certain meritorious students are given an exception from rural service with the government citing lack of posts to accommodate all students graduating in a year.

While the latest amendment gives leeway to at least some students from taking up the mandatory rural service, private medical students have again approached the court arguing that their seats are not subsidised and hence they should not be forced to take up “bonded labour”.

Meanwhile, authorities are denying students permanent registration with the state medical council and students are blaming the authorities for not communicating the rules in advance.

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MBBS Rural Service Bond: Few vacancies

As per the Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012, “every candidate after successful completion of MBBS degree” has to practise medicine in rural Karnataka for one year.

The reasoning behind the mandatory rural service is to fix the doctor-to-patient ratio in the region. The doctor-to-patient ratio in India is 1:834, that is one doctor per 834 patients, according to the National Medical Commission. However, this figure hides the lopsided distribution of doctors and their shortage in rural areas as most prefer working in the cities. Karnataka is not the only state to do this. States such as Kerala have also applied this rule to both government and private colleges.

However, the government has now amended the Act to say that mandatory rural service need only be done “in
the existing vacancies as specified by the state government”. This was done to ensure that the state only takes in the required number of doctors and is not forced to create new posts when there is none.

“The problem started because there were no vacancies in government setup either in medical colleges or in rural areas. In a year, on an average, there are around 1,000 to 2,000 vacancies in MBBS and there are 1,000 to 1,200 posts for postgraduates. But around 9,000 MBBS students and 4,500 postgraduate students graduate every year. So, there is a discrepancy between the number of students and the vacancies for rural posting,” said Pavankumar N Patil, member of Karnataka Medical Council (KMC).

Students who do not complete the mandatory rural service are fined up to Rs 15 lakh.

RGUHS and state-wide merit list

Now, the government has introduced a new counselling system which creates a state-wise merit list of students to allocate posts. Also, students who are the top performers in the state-wise merit list will get an option to not do rural service.

Rajiv Gandhi University of Health Sciences (RGUHS), the nodal university for all medical colleges in Karnataka, is tasked with drawing up this merit list. Experts said that the decision ensures that there are enough doctors in the rural areas while a “significant number of students are also getting exemptions” with the amendment.

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“As a whole, it is a good decision. By this government posts are filled on a rotational basis. The only confusion that the council will face is that the system now is that they have to wait for the results. Deemed universities have different exams, RGUHS has different exams. RGUHS cannot prepare a merit list without getting the lists from all colleges. And this might take three to four months,” said Patil.

“So, if any students want to get registered in the counselling cell, they have now made a provision that students
can pursue other courses and can complete the rural posting afterwards. If students sign this bond then the cell will issue an NOC (no-objection certificate) and with this NOC they can be registered under the Karnataka Medical Council,” said Patil.

Resistance from medical students

However, the Act has been facing stiff resistance from medical students. The Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012 came into effect in July, 2015 amid protests.

Several medical students even approached the High Court of Karnataka which initially stayed the law in 2015 but upheld it as “constitutionally legal” in 2019, stating that state has the mandate to impose compulsory service for “public purposes”, that is “wide enough to include not only military or police service but also other social services like the medical services”.

The judgement also noted that the mandatory service was for a short period of one year and that they were given remuneration. The law was to be in effect from July 2017.

The court cases did not stop at that. Several postgraduate students from government medical colleges who took admission in 2017-18 then approached the High Court of Karnataka arguing that they were not made aware of the implementation of the Act and that they should not be forced to follow it.

In April 2021, the court ruled in favour of the students and said that students of 2017-18 batch and prior be exempt from the rural service as students from outside the state might not be aware of the Act. The court also noted that the Act is binding for students from the 2018-19 batch onwards.

Karnataka Private Medical Colleges: No bonds signed

However, private medical college students of the 2018-19 batch, who finished their internship this year, say they were never informed about the policy. They are being denied permanent registration with the Karnataka Medical Council without an NOC from the Bond Enforcement Cell which is in charge of signing bonds for the one-year rural service.

Students argue that they had not signed any bonds at the time of admission that would require them to complete the mandatory rural service.

“When we tried to get our permanent registration from the KMC we were redirected to the Bond Enforcement Cell. Traditionally we haven’t had the requirement to get an NOC from the Bond Enforcement Cell but it was introduced this time. They said they cannot issue an NOC unless a person is signing a bond. We had not filed any affidavit for any kind of bond at the time of admission. Now we are being forced to do one-year rural service… The government has not paid any money for our degree. It’s our parents’ money and that too a huge sum. Parents and students are being exploited both by the private institutions and by the government,” said a student from a private medical college in Karnataka who did not wish to be named.

Students also argue that there is no current notification which mandates private students to do compulsory
rural service. “They didn’t show us any notification but they showed an internal correspondence which said that students that refuse to sign the bond will be denied registration,” said the student.

In April 2024, students of Kasturba Medical College, Manipal Academy of Higher Education, a private deemed-to-be university, filed a writ petition in the High Court of Karnataka seeking relief from mandatory rural service. They argue that the Karnataka Medical Council has “unduly denied the issuance of the NOC” for the students who have refused to sign the bond. Students also argued that the notification released in July 2023 specifies rural service is only mandatory for students “under a government college or government seat in private college”.

Much of the confusion stems from the mass of litigation the policy has generated over the years. The most recent judgement regarding the issue came in 2021, four years after the Act was restored. Moreover, the Karnataka HC’s 2021 judgement had noted that students from the 2018-19 batch, who are now applying for registration in 2024, will be eligible for mandatory rural service.

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‘Forced’ rural service

“Every time a new Act comes in place there is always a lot of confusion. There also seems to be some loopholes in the Act as well, because so many people have challenged it in the courts. But the rural service is mandatory for all from the date that the Act becomes effective,” said Patil. That is, July, 2017.

Before the 2023 amendment partially relaxing rural service for meritorious students, there were rumours that private students would be exempt as their seats are not subsidised. But this did not come to be.

“The government, except for giving the land and the provision for allowing students to study in Karnataka, has not given any exemption to these colleges. Either in the fees or anything else. Now, suddenly asking them to do it is not right. This has been argued in high court as well. Students are paying full fees in private colleges and suddenly this rule came in. It becomes like bonded labour. But unless there is an amendment to the Act, nothing can be done,” said Patil.

As the court cases continue, some experts argued that the Act was introduced to address the doctor-to-patient ratio in rural areas and that private medical students should treat it as a one-year service.

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“All private and government students are supposed to complete the rural service. If students don’t want to do it, that indicates they are not keen on serving people,” said Madhushankar L, secretary, Indian Medical Association (IMA), Bengaluru chapter.

“If they want to become doctors, what is there in spending one year in rural service? It is a good move by the government. Everyone should spend some parts of their lives for rural people. At least if these students give their one year in rural areas, the gap will be filled.”