On Saturday, the strike by the Young Doctors Association (YDA) brought healthcare available in major public hospitals all over Punjab to a halt. Patients were severely inconvenienced and some patients even died due to non-availability of medical care. All this is very unfortunate and many in the media are blaming the doctors for these tragic deaths. Most recent reports suggest that the Punjab government has refused to accept the demands put forward by the YDA and is going to ‘terminate’ the services of the doctors on strike. The common refrain heard from supporters of the Punjab government in the media, the bureaucracy and among politicians is that the doctors are ‘messiahs’ and should put the welfare of the patients ahead of their own needs. What everybody seems to forget is that doctors are people too. They have to support their families, pay for food, rent, transportation and other requirements of daily life. Exactly how much a doctor, who, after finishing high school, goes through six years of extensive education and probably another couple of years of training, should make in terms of money is the question being put forward by the YDA. Is Rs 22,000 a month adequate compensation for such well educated and well trained people, especially when they are also providing life saving services, working under pathetic conditions and putting in long hours at work? Having worked in the public healthcare system in Punjab for more than six years, I can attest to the fact that our public hospitals – especially the big ones – are ‘orphans’ for the present government and its bureaucratic ‘enforcers’. Building better roads is clearly of greater importance than providing better healthcare to the poor and disadvantaged citizens of this province. And the welfare of physicians taking care of these patients is the least of their concerns. Over the last year that the YDA has been agitating for better remuneration and a proper service structure, the healthcare enforcer of the Punjab government has done his best to pacify these young doctors by making promises that he and his political masters had no intention of fulfilling. This disregard or perhaps outright disdain for the demands of these young doctors by the present government of Punjab eventually pushed them to the extreme position of going on what is now a month long strike. In a previous column in these pages, ‘Why are young doctors so upset?’ (Daily Times, March 7, 2011) I had highlighted some of the issues that are relevant to the present discussion. Instead of going over all of those, I would like to concentrate on one particular issue. The way the present political government in Punjab is treating doctors in the public service is not due to some wanton disregard for their welfare but is the result of an ideological preference of this government for private sector services and infrastructure development that benefits their middle class vote bank. The welfare of the very poor is for them not a major political priority and nor is support for the workers involved in providing such welfare services. ‘Conservative’ politicians, even in some developed countries in the West with established social welfare ‘safety nets’, are now shying away from providing free or subsidised services for the poor. We can see a similar ideological ethos at work in Punjab at this time. Frankly, over the last three years, no major effort has been made to improve the quality of healthcare available to the poor in major public hospitals or even in regional healthcare centres. This is a deliberate policy preference and not just due to inadequate funds as is evidenced by the massive simultaneous expenditure on building roads in Lahore that primarily benefits people who own cars. At the same time, I admit that the YDA’s demand of tripling the young doctors’ salaries in one go is excessive and perhaps unreasonable. However, I can suggest a more rational approach. First, an appropriate base salary that is commensurate with the educational status of these young physicians. Second, added rational bonuses for people who are married and have children. Third, appropriate house rent and transportation allowances and, finally, added allowances for certain types of work. Physicians working in intensive care units and emergency rooms should receive ‘combat’ allowances, physicians working in excess of the usual six hour day should receive overtime payment at one and a half times base salary for those hours and other such compensation where appropriate. Also, an added bonus should be built into base salaries for advanced medical qualifications. Besides these financial inducements, equally important are two other aspects. First, an appropriately equipped and staffed work environment and second, a distinct professional structure that leads to long term employment within the public medical system at an overall pay package competitive with the private sector and with chances of professional advancement based on qualifications and experience. At the same time, all ad hoc appointments that are almost always based upon nepotism and favouritism must be immediately terminated except for the individuals with unique qualifications and for positions where appropriately trained physicians are not available within the system. Unfortunately at the present time the ‘enforcement’ mentality prevails and the threat to fire all striking physicians is both unreasonable as well as counterproductive. The point person for the government of the Punjab in this matter is the present health secretary and he has, I must admit, lost all credibility as an honest interlocutor. Before serious negotiations can take place between the Punjab government and the YDA, the government must bring in somebody to represent it, someone who has both the complete confidence of the government as well as the trust of the striking physicians. Negotiations in good faith can definitely bring the situation under control and bring back healthcare facilities to normal working conditions. But once that is done, real changes must happen to move things forward in a positive direction. The writer has practised and taught medicine in the US. He can be reached at smhmbbs70@yahoo.com