National Doctors’ Day | ‘Look past tributes to work conditions’: Dr Ravi Malik on burnout crisis in Indian hospitals

The national guidelines stipulate that doctors' working hours must be capped at 48 hours a week and that their shifts must not exceed 12 hours a day. But it is an open secret that doctors regularly work 70-100 hours a week and undertake shifts lasting up to 24-30 hours as hospitals remain persistently understaffed.

The problem is worse beyond tier-one cities as the doctor-patient ratio falls from 1:811 in urban areas to 1:11,000 in rural areas.

In an interview with Firstpost on National Doctors' Day, Dr Ravi Malik stressed that understaffed hospitals and working hours that exceed the recommended limits are not only detrimental to doctors' wellbeing but also pose a risk to patients.

More from Health

"What 80-plus hours of work a week does to clinical judgment is now well documented. A doctor reaching the end of a 24- to 36-hour shift is making decisions about surgery and emergency care while the brain is operating well below its capacity," said Malik, Founder and Medical Director of Malik Radix Healthcare, Delhi.

It is not as though the problem is unknown. Beyond the anecdotes that have made the burnout crisis among doctors the worst-kept secret in the healthcare sector, the situation has been flagged at the highest levels of government.

Earlier this year, the Parliamentary Standing Committee on Health and Family Welfare expressed concern over "excessive continuous duty hours" for junior and senior residents and warned that fatigue-driven errors and burnout could compromise patient care.

After receiving representations from doctors and hearing that shift ceilings exist only on paper, the MPs advised the government to introduce a Clinical Duty Hours Regulation policy and ensure that it includes enforceable and monitored standards rather than mere advisories. They drew a parallel with the aviation sector and said the healthcare sector should have similar standards to ensure doctors have safeguards against overwork comparable to those that pilots have.

'Go beyond tributes': Malik's call for action

As the well-documented nature of the problem, Malik said that administrators and policymakers need to go beyond tributes on National Doctors' Day.

"Honouring doctors must mean looking past the tributes to the conditions they work in. A doctor kept awake for a day and a half at a time, and asked to hold other people's lives steady while it happens, deserves more than gratitude once a year. The question the day poses this time has a practical answer. Repair the hours and the staffing first, clear the routine paperwork that never needed a doctor, and the care everyone else receives becomes safer," said Malik.

Referring to a study from Maharashtra that found that resident doctors in Mumbai's public hospitals worked an average of 88 hours a week and that more than half showed clear signs of burnout, Malik noted that emotional exhaustion and depression have become common among doctors.

The real irony, said Malik, is that these are people who entered medicine with conviction and are being worn down by the conditions of the job.