Recently, the Ministry of Health (MoH) announced 40 slots for Medical Degree (MD) programs, with 24 slots available at Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) and 16 slots in ex-country institutes but only 6 doctors applied for it. 4 doctors are civil servants and 2 doctors are from Royal Bhutan Army. 2 more doctors who were selected for MD programs in the ex-country category dropped the program.
A senior doctor from Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) shared that for MBBS doctors, the course itself spans around 5 to 6 years, followed by a mandatory service bond of 10 to 12 years. If they choose to pursue a master’s degree, an additional 12 to 15 years of service bondage is required. The collective bondage period of approximately 29 to 30 years can be quite challenging and demotivating for doctors.
On the other hand, doctors with qualifications other than MBBS are required to serve a relatively shorter bondage period of 6 to 8 years. As a result, these doctors often opt to pursue master’s degrees abroad, where they have more flexibility in their career paths.
The doctor shared that with the decent pay and health staff being overworked due to the current shortage, doctors are expected to provide significant commitment and services.
The doctor also mentioned that scholarships for further studies are typically offered to MBBS doctors in countries such as Bhutan, India, Bangladesh, Sri Lanka, Thailand, and Malaysia. This opportunity allows them to enhance their skills and contribute to the healthcare sector in Bhutan. However, the lengthy bondage period associated with the scholarships raises concerns among aspiring doctors.
Another senior doctor at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) has shared his views on the challenges faced by medical professionals in Bhutan, particularly regarding the prolonged bondage requirements. According to the doctor, the lengthy commitment to service as a prerequisite for higher education is discouraging doctors from pursuing further studies.
Similarly, a third doctor shared that even though he spent eight years in medical school he is still considered an undergraduate while his friends from the same batch got into civil service and were also promoted to higher positions.
He shared that when doctors go for long-term training in an ex-country, they don’t get promotions but rather they become juniors to their colleagues and indirectly it is a punishment. The responsibilities increase and so does the stress level and, in the end, there is no appreciation for the hard work and years of dedication. There are no benefits to opting for MD programs.
Also, the bondage period gets doubled and there is no logic to do that.
For instance, after five years in the medical field and when a doctor goes for an MD program for two years, they have to serve around 12 years under service and if the same doctor wishes to pursue long-term training or fellowship programs, the bondage period will be 3 times the approved duration of the course. Also, doctors are not eligible for EoL. With this bondage, doctors are trapped.
If doctors do not go for further studies, they are free from service obligations and it is assumed that this is the reason for many doctors not applying for the MD programs, said the doctor.
Many fresh doctors are not opting for MD programs as rather they would wait for three years to avail EoL which is for two years. In those two years, they will work abroad and pay off their financial obligation. Many doctors are preparing for Australia Medical Council Examination, if they can do well, the doctors can work there and earn 8,000 AUD per month. Similarly, there is the United States Medical License Examination and Membership of Royal College of Physicians, which doctors are applying for it.
He said the obligation of bond comes right after the scholarship is offered by the government. “Either we need to pay double the amount of the course, including the air ticket, and one is free of bondage. They have been designed in such a way that one cannot pay back the amount as the medical fees are heavily expensive,” said a doctor.
The system is not attractive at all and there are no private hospitals and no room for professional development. “My friends have reached a research level and they are supported by their country and helped in professional development whereas, in the country, doctors are just normal civil servants”.
It is a grave situation, as of the 40 slots, only four from the Ministry of Health and 2 from RBA applied for it for different reasons. In the next 5 to 10 years, there will hardly any experienced doctors in Bhutan and those who are staying back are due to the bond obligations.
One of the doctors who chose not to apply for the MD scholarship program has raised serious concerns, calling it a scheme of trap. Despite dedicating 6 to 7 years to their service, the doctor said that transfers are rarely approved due to nepotism. Many doctors want relocation to be closer to their families, only to be denied transfers even after years of dedicated work.
The doctor said there is a service bond of almost 12 years following the completion of their MBBS degree. Pursuing further specialization through a Master’s program would triple this bondage, with the excessive repayment amount of more crores, making it nearly impossible to pay back the amount.
This has led to growing concerns that the system is designed to keep the doctors in a lifetime bond of service. Moreover, the doctor shared about the decent pay scale, noting that Bhutanese doing interns in India earn twice as much as a doctor’s salary in Bhutan.
Meanwhile, the Health Minister, Dasho Dechen Wangmo, expressed her concern over the limited number of MBBS doctors applying for the Master’s Degree scholarship, which had 40 available slots. Surprisingly, only six applicants came forward to apply for the scholarship.
The health minister attributed this low turnout might be due to the immense pressure faced by healthcare professionals, which leaves them with limited time to prepare and apply for further studies.
It is the biggest concern and even a single health staff is leaving is worrisome. The health minister said it is very unusual this year.
The health minister further shared, the government is looking at if the bond is causing attritions and is doing the assessment.