Absenteeism crackdown sparks calls for systemic reforms in T.N. public health sector

At the centre of an ongoing debate on unauthorised absenteeism of 1,420 government doctors and calls for stringent action is the larger question of the State of Tamil Nadu’s public health workforce.

Last week, the Health Department said it had initiated disciplinary action against 1,420 government doctors (postgraduates) for unauthorised absenteeism and violation of service bond obligations. While this triggered a debate, the controversy also brought to the fore longstanding concerns raised by government doctors over pay disparities, manpower shortage, extended duty hours, and workplace safety.

Demands for strict action against postgraduate doctors who secured seats through the service quota and subsequently left has reignited a long-smouldering debate, a public health professional said. “The demand is legitimate. Public resources were invested in these doctors’ education, and accountability must follow. However, to pursue punitive action while leaving unaddressed systemic failures that pushed these doctors out would be an exercise in incomplete justice. Tamil Nadu’s government health service is held together by thousands of doctors who remain, not because the system rewards their dedication, but in spite of the fact that it does not. There are several grievances, which are long-standing and voiced repeatedly,” he said.

First is the pay anomaly. A government doctor in Tamil Nadu earns 30% to 50% less than a counterpart employed by the Central government or in neighbouring States, he said, adding: “This is not a minor discrepancy. It represents years of lost income after more than a decade spent in medical training, often with significant financial sacrifice.”

Staffing crisis and long working hours are key issues. An obstetrician-gynaecologist said: “Over the years, there has been a multifold increase in the number of women coming to government hospitals for childbirth. But is the manpower adequate in government hospitals? The answer is no. The sanctioned manpower remains largely unchanged for two decades,” she said.

“The airline industry has a regulation that a pilot can fly only for a stipulated number of hours during a single shift. In the U.K., a single shift for doctors cannot exceed 13 hours. In contrast, doctors in Tamil Nadu work 36-hour shifts because of staff shortage. Many of us are overworked and burnt out. There is no opportunity for professional growth,” she said.

Another doctor said the government made no credible commitment to filling vacancies at scale. A doctor said State governments had failed to increase the number of posts according to the rising caseload. “Health infrastructure has expanded but there has been no proportionate increase in manpower. Instead of increasing sanctioned posts to match the growing patient load, the sanctioned strength has been revised and reduced primarily to align with National Medical Commission norms,” he said.

Some felt government doctors became scapegoats for administrative failures. Successive governments have found it politically convenient to position doctors against the public, a health officer said. “Drug shortage, staff vacancies, inadequate infrastructure — failures rooted in procurement delays and budgetary neglect — are consistently attributed to the medical workforce on the ground. This erodes public trust in doctors, who are themselves victims of the same broken system, and it absolves administrators of accountability they rightly bear,” he added.