Supreme Court Seeks National Policy from Centre on Mandatory Rural Service for Doctors

The Supreme Court has sought clarification from the Central Government regarding its stance on preparing a national framework for mandatory rural service for doctors. This matter arose during the hearing of a case challenging the mandatory service rules of the Karnataka government. According to a Hindustan Times report, the Supreme Court on Tuesday expressed regret over the 'policy deficit' in establishing a national consensus regarding mandatory rural service for medical students.

A bench of Justice PS Narasimha and Justice Alok Aradhe suggested during the hearing that the court could lay down constitutional principles to guide states in framing rules. The objective is to ensure that doctors can serve the country's underserved rural population. The court has asked the Central Government whether it intends to formulate a national policy and, if it decides to do so, with whom it plans to consult.

This case challenges a notification issued by the Karnataka government in 2023. Under this notification, a rule was imposed requiring students studying on private seats in private and deemed universities to also perform one year of mandatory service. The bench emphasized that this issue is not limited to the validity of Karnataka's notification alone, but that this policy will have a major impact on the future of India's healthcare delivery system.

The bench observed, "What is being suggested is not a mandate. As a principle, are the policy makers and constitutional requirements consistent with the principle of whether rural service for doctors in India is a necessary step for the improvement of our health and national health? This is the core issue." The court further stated that the government needs to consider this subject at the policy-making level. Constitutional interpretation of the right to health as a fundamental right and the state's obligations towards it could form the basis for examining the need for mandatory rural service.

Expressing concern over the future situation, the court said that in the coming times, where access to hospitals will practically mean access to hospitals run by private entities, moving away from the needs of rural areas is a matter worth examining as a constitutional principle. The increasing contribution of private entities in healthcare delivery makes this matter serious.

According to the Hindustan Times report, these observations came at a stage when Additional Solicitor General Aishwarya Bhati told the bench that postgraduate medical students are eligible for mandatory service on a rotational basis, but there is no such national requirement at the undergraduate level. She further stated that health is a state subject and many states have introduced bond provisions for doctors to serve after completing medical education. Bhati also mentioned that a committee has recommended uniform acceptance of such bonds by states. However, the Central Government has indicated that it may undertake a consultative process rather than having the court pass an order that could affect medical institutions across the country.

Senior Advocate Raju Ramachandran, assisting the court as amicus curiae, suggested that the court should set appropriate guidelines by utilizing Article 21 of the Constitution, which guarantees the right to life, and the Directive Principles of State Policy to address legislative gaps. In response, the bench clarified that the court is examining the underlying constitutional principles rather than determining a uniform method for the implementation of mandatory rural service. Methods such as whether to enforce this requirement through bonds or rules can be determined separately.

The bench said, "We will frame it as a guiding principle in the form of its constitutional requirement. Its structures will be made by the states in consultation with the National Medical Commission." The court has posted the matter for hearing next week and asked the Centre to clarify whether it proposes to formulate a policy and which stakeholders it intends to consult.

This case arose from the challenge to the 'Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012' and the rules framed under it in 2015. According to this law, MBBS graduates, post-graduate diploma and degree holders, and super-specialty candidates who have studied in government institutions or obtained government seats in private or deemed universities are required to perform one year of mandatory public rural service. Completing this service is mandatory for obtaining a No-Objection Certificate (NOC), which helps candidates obtain permanent registration with the Karnataka Medical Council.

Through a notification issued on 28 July, 2023, this requirement was extended to students enrolled on private seats in private and deemed universities as well. The petitioners have challenged this extension. They argue that students who pay significantly higher fees for private seats form a separate class under Article 14 of the Constitution and should not be subjected to the same mandatory service conditions. They have sought directions to the Karnataka health authorities to issue the necessary NOC without demanding a guarantee for mandatory rural service and to the state medical council to grant them permanent registration.

This dispute is also linked to the Supreme Court's 2019 judgment in 'Association of Medical Super Speciality Aspirants and Residents versus Union of India'. In that case, the court upheld the mandatory bond imposed on candidates seeking admission to post-graduate and super-specialty medical courses. While acknowledging the validity of these requirements, the court emphasized the need to address the stringent and varying conditions imposed by states and suggested that the Central Government and the Medical Council of India should consider a uniform policy for mandatory service for doctors trained in government institutions.