Survey Finds Medical Colleges And Institutions Violating SC Directives

By Gautam Debroy

New Delhi: A survey conducted by the United Doctors Front (UDF) has accused the medical institutions of violating the Supreme Court directives of implementing the Central Residency Scheme, specifying fixed duty hours of resident doctors in medical colleges and institutions under the National Medical Commission (NMC).

"We strongly urge the government to implement the Central Residency Scheme 1992 without delay. It is imperative to standardise duty hours, ensure adequate rest, and establish grievance redressal mechanisms across all medical institutions. Without these changes, we risk continued exploitation of young doctors and irreversible damage to the healthcare ecosystem," Dr Lakshya Mittal, National President UDF told ETV Bharat on Tuesday.

Central Residency Scheme

Following a directive of the Supreme Court, the Union Health Ministry in 1992 asked all States and Union Territories to implement a "Uniform Central Residency Scheme" in all medical colleges and institutions. One of the features of the Uniform Central Residency Scheme states that junior doctors should work 48-hours a week and not more than 12 hours at a stretch.

States not following Centre's directives

According to the doctor’s association, despite clear directives from the Health Ministry, many colleges and institutions keep forcing resident doctors to work beyond human limits, leading to severe physical and mental concerns.

"These guidelines are totally ignored, putting the doctors and patients at risk," the UDF stated.

Task force on Mental Health and Well-being of Medical Students

Depression, suicides, seat leaving and serious mental health issues due to sleep deprivation and excessive workload has become a major challenge in the medical education sector in India. The NMC constituted a "National Task Force on Mental Health and Well-being of Medical Students".

The NTF was assigned to study on mental health & suicide of medical students, analyse factors contributing to these challenges, and propose evidence-based strategies for improving mental health & prevention of suicides. The NTF submitted its report in June 2024, which is very alarming.

"According to the NTF report, over 15 per cent of PG medical students are suffering from various mental health issues. The report has scary data of death by suicides, suicidal thoughts and attempted suicides. A big number of students assessed the future risk of suicidal behaviour," said Dr Mittal.

Structural nature of the issue

Doctors are breaking under the pressure of endless shifts, toxic work culture, and penalties up to Rs 50 lakh for leaving courses. This survey reflects voices from the ground — and those voices are demanding immediate reforms from the NMC and health institutions, said Dr Mittal.

"We are heading toward a silent epidemic of burnout and mental breakdowns among doctors in training. These findings are not just statistics—they are a wake-up call. If we don't act now to reduce duty hours and support mental health, the system risks losing its best minds to despair," said Dr Prem Aggarwal, senior cardiologist and Chairman, Medical Dialogues. The Medical Dialogues is also a partner in the survey.

The survey

The online survey was conducted via Google Forms and remained open from March 12 to 24, 2025, with participation from MBBS interns and PG medical students across all Indian states and union territories.

The primary aim of the study was to assess the mental health status, stress levels, and suicide risk among Indian medical interns and PG students. It also aimed to identify key contributing factors such as duty hours, leave policies, and institutional support systems and generate data to inform and advocate for regulatory reforms in medical education and hospital duty structures. The survey found 1,031 valid responses during the period.

Findings of the survey

Workload and Duty Hours: 62.17 per cent of respondents reported working more than 72 hours per week. Only 18.91 per cent confirmed receiving a regular weekly off, while 52.26 per cent reported receiving no weekly off at all. More than 58 per cent of participants were denied the 20 paid casual leaves and 5 academic leaves annually.

Mental Health Impact: 81.09 per cent of respondents felt overburdened due to duty hours. 84.77 per cent reported experiencing mental health issues, including anxiety and depression. A staggering 86.52 per cent felt that excessive hours compromised their efficiency and posed a risk to patient care.

Seat-Leaving Penalties: 44.91 per cent faced seat-leaving penalties up to Rs 25 lakh, while 13.09 per cent faced penalties above Rs 50 lakh. Such financial penalties add severe psychological pressure, especially in cases where students are already struggling with burnout or mental health crises.

According to the findings of the survey, super-specialty (SS) and PG students worked the longest hours (76.74 per cent works above 72 hrs/week), with SS respondents also reporting the highest mental health impact (88.37 per cent).

According to the findings, males were more likely to report more than 72 hrs/week (64.96 per cent) and face more than Rs 50 lakh penalties (14.4 per cent). Females, while reporting slightly fewer hours, still suffered high rates of burnout and penalty exposure.

Interestingly, the South Zone emerged as the most overburdened (72.36 per cent work more than 72 hrs/week), with 90.57 per cent reporting mental health impact, the highest among all zones.

"Both government (61.82 per cent) and private (63.27 per cent) institutions reported long hours, though seat-leaving penalties above Rs 50 lakh were more common in private institutes (26.87 per cent)," the findings revealed.

Recommendations

While compiling the survey, the United Doctors Front also gave several recommendations, including a 48-hour workweek cap, mandatory weekly offs and post-night duty recovery time, uniform stipend structure across institutions, counselling services and grievance redressal mechanisms and stricter NMC inspections and enforcement of humane working conditions.

Management’s opinion

When contacted, the health ministry denied giving any response to the issue. However, an official told ETV Bharat that the health ministry as well as the director general of health services (DGHS) has called for a meeting with the representatives of the United Doctors Front and other stakeholders on Tuesday.

"After 33 years, a big step forward. We were invited for a meeting on the residence scheme of 1992," said UDF president Dr Mittal.

Dr Ajay Shukla, medical superintendent of Dr Ram Manohar Lohia Hospital in New Delhi, said that the matter is under discussion. “We are discussing the issue raised by the doctors front,” Dr Shukla told ETV Bharat.

Dr Suneela Garg, renowned health expert and Prof of Excellence, Chair Programme Advisory Committee, National Institute of Health and Family Welfare (NIHFW) termed the findings as very important.

"The government must be looking into the issues. In fact, on earlier occasions also several surveys highlighted similar findings," said Dr Garg.