West Bengal finds itself on the horns of a dilemma with the health department being asked to reflect on the query posed by Justice Debasish Kargupta of Calcutta High Court ~ “How does Bengal expect to produce doctors for its 42 super speciality hospitals if it does not encourage post-graduate education?” This is a critical question for any Government and there is no easy answer.

Should the state attempt to expand its medical outreach and ensure qualified medical presence in as many places as possible?

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Or should it lay focus on post-graduate medical studies to increase the pool of specialists, who largely are available in the state’s more prominent hospitals when they do not seek greener pastures elsewhere in the country or abroad?

While the elitist position would be that West Bengal should strive to reclaim its position of eminence in specialist medical care that existed before Independence, an egalitarian approach would write a different prescription – one that ensures the presence of doctors, even if they are armed only with a MBBS degree, in as many of its remote areas as possible.

State medical education is hugely subsidised, and a necessary pre-condition of this subsidy is a spell in rural areas for fresh medical graduates.

It is the reluctance of many to fulfil this part of the bargain that has led the state to a position where its resources are stretched to breaking point and it is less than enthusiastic about post-graduate pursuits, which are sometimes an alibi for avoiding rural duty.

The fact though is that young doctors, not just now but over generations, have found ingenious methods to escape the drudgery ~ and discomfort ~ of rural service.

Public health professionals on the other hand point out that interventions at the first stage are the most effective, in other words the presence of doctors in as wide a swathe of the state as possible serves the greatest good.

The state was forced to submit in court that Bengal’s healthcare system runs the risk of collapsing if it abides by the norms and allows 10 per cent of the 6,600 MBBS doctors on its rolls “to go on leave for post-graduate studies”.

This submission suggests that West Bengal needs more doctors than it does specialists. It would also suggest that the state must lay focus on adding more medical colleges in the long term.

In the short term, it should bring in specialists from elsewhere to fill gaps in state-run hospitals. In any event, those who can afford it rush to Chennai and Bengaluru, rather than trust their lives to state-run hospitals.

Until the basics are in place, it may be difficult to dream of the glory days of yore. Decades of neglect of the healthcare system have brought West Bengal to this difficult point where it must choose between basic needs and aspirations of its bright, young doctors. There are no easy answers as we said at the outset. A sagacious approach is needed.