How to attract Healthcare Workers to Tier-II cities?
By Arunima Rajan
Why do healthcare professionals prefer cities, and what should hospitals do to attract and retain talented professionals in tier II and tier III cities?
The healthcare industry is one of the booming industries, both in terms of revenue and employment.
Getting the "right manpower" at the right time and place is essential for type II and type III cities. Besides their technical capabilities, several aspects need to be considered while hiring healthcare professionals in type II and type III cities, says Sunil Kanjarekar, Director, HR of Jaslok Hospital.
"1. Wide Experience- Candidate should have vast experience in handling situations with confidence.
2. Multitasker- Candidate should be in a position to handle multi-task if required
3. Effective Communication- This skill is required with patient/ patient party or handling any situation
4. Should be able to run the show even with "Infrastructural Crisis."
5. Tech-savvy- Candidates should have experience working on multiple platforms.
Last but not least, patience and good hearing skills will be an added advantage," says the Director, HR of Jaslok Hospital.
But what do healthcare workers want?
Dr. Naaz Ahmed shifted back to Patna after completing her medical education from Aligarh two years back, basically because her husband and family were there. "I got the opportunity to complete my senior residency from a prestigious institute there, AIIMS.
“After completing the remaining two years of my residency, I noticed a massive lack of opportunity in this city/state. There are very few medical colleges here, and their faculty vacancy is advertised once in 2-3 years. You are only left with starting your practice as top-notch private hospitals' branches are also few.
“A good idea would be to increase the number of government and private hospitals in the state and keep a strict watch over malpractice. Malpractice is quite rampant in the peripheries due to the poor literacy level of this state. Maximum people first and foremost approach quacks, and by the time they reach a proper healthcare facility, it's too late. Also, the lack of proper facilities like inadequate beds, drugs for emergency management, oxygen supply, and hygiene are all concerning," adds Ahmed.
Dr. S Vasudeva Murthy works as a Principal of Jayamukhi College of Pharmacy in Narsampet, Warangal Rural, Telangana. He points out that the learning goals of graduates of tier II cities are changing rapidly. At one point, getting a simple bachelor's degree was sufficient, but modern workplaces demand more skills from professionals. "Small towns have a low cost of living, fewer commuting hours to reach the workplace, access to clean air and competitive wage rates. There is also good healthcare infrastructure, road and rail connectivity with Tier I cities for business or to access better healthcare," he explains.
Upskilling
Murthy pulls no punches while laying into policymakers during the telephonic interview.
"Migration of talent is a major concern. But it's hard to find well-trained graduates for recruitment to provide technological or economic support to healthcare organisations in small towns. Warangal is not too far from Hyderabad, yet the government doesn't promote industries in smaller towns like Warangal. The politicians' disinterest in developing industrial hubs, food parks and attracting MNCs or promoting any healthcare startups is another challenge," he adds.
"Only five per cent of the students prefer to work in rural areas. Students believe that you learn a skill best when you practice it in the environment you plan to use it. Fresh Pharm D. graduates earn around 20-25 K in Warangal and around 30K in Hyderabad. Students prefer to pick up new skills, and they think it's better to work at a bigger hospital in a big city. Hospitals do hire our students. But many are worried about their career path. Students with entrepreneurial skills do set up their clinics by collaborating with doctors. They earn around 1.5-2 lakhs," he adds.
Dr .Faiz Abbas Abidi, who works in Lucknow, has a different view on this topic. "Lucknow is my hometown, so it's always my first preference to work over here, as I am with my family, which is my biggest asset. On the professional part, Lucknow itself has emerged as a medical hub for two decades, and now with more government and private medical institutions coming, it's a wannabe destination for all seeking quality healthcare," he adds.
Timely Recruitment is Key
Abidi points out that adequate, timely recruitment of the medical workforce for effective functioning of district hospitals and tertiary care super speciality hospitals is the need of the hour. "In most of the public sector medical colleges and hospitals, there's a crunch of both doctors as well as allied healthcare force which makes it difficult to carry out the routine daily OPDs and IPD work. The number of patients is huge compared to adequate staffing to provide care to them. Patients also witnessed the shortage during the COVID crisis. A mere increase of beds in any hospital won't suffice as we need working hands to effectively manage and run the wards, both general and HDU's, ICU's, NICU's etc. Moreover, joining should be regular instead of contractual posts, which has become a new normal. Regular appointments would give a sense of job security to all, and everyone will work with more dedication," he adds.
Challenges in Rural Areas
Dr Abhijit P Gadewari was born and brought up in a remote Adivasi area of the Gadchiroli district of Maharashtra. "The work of Dr Prakash Amte near my home place and the surrounding economic poverty of Maria Adivasis created a strong impression in my mind to work in rural areas. After completing MBBS from GMC Nagpur in 2011, I wanted to learn clinical skills and explore rural health. It isn't easy to achieve both in rural government hospitals, so I searched for some organisations working in rural health with good clinical exposure. Dr Ulhas Jajoo of MGIMS Sewagram guided me to work in Jan Swasthya Sahayog (JSS) in Chattisgarh. Working in JSS not only motivated me to work in rural areas but prepared and equipped me with skills to work as a rural physician," adds Gadewari.
Staying and working in rural areas is full of challenges on a day-to-day basis, according to Gadewari. Apart from MBBS in Nagpur, his complete education happened in rural areas. Staying in rural areas was not much difficult for him, or he could adapt to the situation.
"One of the main difficulties was poor connectivity which is the road, mobile and internet. While working with Swasthya Swaraj in Kalahandi, Odisha, we used to walk 8-10 Km to reach a mobile network point. Similar was when I worked in a remote government PHC in Gadchiroli, Maharashtra, from 2017–19. Additionally, there was the horrible condition of doctor's accommodation in the PHC. There was no water, no toilets in all PHC accommodations, as well as the PHC building. I had to fight for nearly a year to get water supply in the PHC, which was also unreliable," adds Gadewari.
Gadewari had to leave his job and stay in a town for better internet connectivity to prepare and apply for the masters in public health in the UK and keep its follow-up. "This wouldn't have been possible if I stayed back in the village where I was working. Internet connectivity is extremely crucial to develop personally and update oneself as a doctor. The sense of staying behind the world is powerful in rural areas if you cannot connect with peers and learn skills. Good quality of infrastructure in government PHC for accommodation, water and electricity supply and internet connectivity would have been more motivating to work better. I would have spent my two years in a much better way if I had not spent my energy fighting for these things," adds Gadewari.
Do challenges for doctors vary across states? "To some extent, they were common such as basic infrastructure in rural areas, mainly connectivity. The language was the main challenge but learning a working-level language is not that difficult. I learned Chhattisgarhi, Odia and Maria (an Adivasi language in Gadchiroli) to communicate with patients and relatives. I work with NGOs in Chhattisgarh and Odisha and with the government in Maharashtra. NGOs have different challenges, such as a little less but sustainable salary compared to the government but a good, motivating working environment," adds Gadewari.
The Way Forward
Fara Siddiqi, Group Chief Human Resource Officer, Aster DM Healthcare, admits that there there is a massive disparity in the distribution of healthcare professionals between urban and rural areas.
"While the reasons have been long debated, addressing shortages of talent will require multiple interventions both by the public health system and support from the private sector. I would consider a few steps that can help at the strategic level:
Adequate healthcare infrastructure in rural areas to be uniformly developed at least at the primary care level
A community healthcare education system in rural areas which could focus on both preventive and curative aspects
Rotational deployment of doctors and paramedical personnel for a specified tenure in rural districts
Incentivising service for healthcare professionals deployed in rural areas" adds Siddiqi.
Siddiqi also highlights an acute shortage of vocational courses, diploma /degree and finishing schools available in these regions. Further, clinical skills are learnt best through guided practices in clinical environments. Aster has also tied up with institutes providing vocational courses, and with Diploma /Degree colleges in the regions we are present. "Along with this, we also offer internships to students. We have robust management trainee programs across Aster DM Healthcare to bring in new skills and talent to diversify the teams," she adds.
Siddiqi also suggests that in the short term, healthcare providers should partner with schools and colleges in rural areas to develop relevant courses, seminars and knowledge sharing sessions that will help build a talent pool. "At Aster DM Healthcare, we have partnerships with schools and colleges to bring young talent on board. We have developed a curriculum which works in the line of finishing schools to teach future-ready skills in the younger generation to help them adapt and onboard," she concludes.