Staff shortage leaves Tamil Nadu’s obstetricians and gynaecologists overworked

Tamil Nadu is facing a shortage of obstetricians and gynaecologists (OB-GYNs) in many of its Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres. Some of the centres are functioning with skeleton staff, forcing doctors to take turns doing frequent 24-hour shifts — in some cases two to three 24-hour shifts a week.

Inquiries with government OB-GYNs across the State revealed that several health facilities had been short-staffed for a number of years, and vacant posts remained unfilled. The situation was being managed by skeleton staff, or by diverting doctors, or by engaging Non-Service Post Graduates (NSPGs) during their bond period. In such a situation, the State’s government’s ambitious plan to reduce Maternal Mortality Ratio (MMR) from 45.5 per one lakh live births to below 10 in two years by constituting a task force is far from the ground reality, they say.

“The number of OB-GYNs in CEmONC centres is inadequate. This is a field where one-to-one monitoring and quick decision-making is required, but we are unable to do so as we have at least four other patients waiting. This is not only a problem of doctors being overworked but also a question of patient safety. Rules mandate a maximum of 48 hours of work per week. But many of us work for almost double the mandated hours. In the last 10 years, I have seen a number of OB-GYNs abandon service due to increasing workload and pressure,” an OB-GYN said, on the condition of anonymity.

Some doctors were experiencing burnout, she said, adding: “Voluntary retirement is not permitted. If a doctor goes on maternity leave, there is no one to work in her place till she returns.”

Another OB-GYN said that the heavy workload ends up affecting their decision-making ability by the end of the week. Currently, two doctors were managing the centre. “As a result of this, we do 24-hour duty two to three times a week. We need at least four to five OB-GYNs here. In a ward of 40 to 50 patients, we have one staff nurse and one OB-GYN on duty. All routine work, including new patients, deliveries including 10 to 15 LSCS (Lower segment caesarean segment) a day, emergency cases, and those with medical complications such as hypertension need to be managed,” she said.

The government was pushing all deliveries to government hospitals, but the manpower, sanctioned 10 to 15 years ago, remained unchanged, another doctor said. She and her colleagues do 24-hour duty once every four days. “We need at least six to seven OB-GYNs. There is a need for more anaesthetists and paediatricians, too,” she said.

At another centre, OB-GYNs take turns to do 24-hour duty every third day. “NSPGs who are willing to continue in service are not being absorbed by conducting Special Qualifying Examination. There are CEmONC centres running with a single doctor,” a doctor said.

P. Saminathan, president, Service Doctors and Post Graduates Association, said, “When CEmONCs were established in 2005, no exclusive posts were created, but existing posts of doctors in GHs were redesignated. Each CEmONC needs at least four OB-GYNs, an equal number of paediatricians, and two anaesthetists on call. In 2017, we made a representation to the government to have a minimum of seven OB-GYNs in CEmONC centres, and to create exclusive posts, but nothing has happened so far. The number of deliveries in the government sector has increased tremendously, but the number of sanctioned posts has not increased comparatively,” he said.

If the government wants to reduce MMR, care should penetrate to the ground level. Steps should be taken to post an OB-GYN in every block in the State, an official source said.

Acknowledging that there was a shortage of OB-GYNs in the Directorates of Medical Education and Medical and Rural Health Services, Health Minister Ma. Subramanian told The Hindu that he had issued instructions last month to hold walk-in interviews for OB-GYNs. “We want to first address the issue of vacancies in OB-GYN, and then look at other specialities. A file has been sent to the Finance Department for approval,” he said.