According to the commission, 61 doctors have benefitted since the reform was initiated

In a move to make up for the seniority lost, to attract, retain and motivate doctors who are in critical shortage in the civil service, the Royal Civil Service Commission (RCSC) has reformed their career path with four special provisions.

The provisions, which were approved for doctors by the commission and introduced in 2015, are now incorporated in the revised Bhutan Civil Service Rules (BCSR) 2018.

The four provisions are meritorious promotion for senior doctors, entry level at P3 for doctors with masters, more than two years study to be considered active service for promotion of doctors, and first promotion after three years plus one year of probation.

With the amendment, the BCSR 2018 states that according to section civil servants irrespective of the entry position level shall be eligible for their first promotion after serving five years, including probation period while for a civil servant in Schedule 13/A, four years including probation period shall apply.

Section 13.6.12 for civil servants in schedule 13/A[1], states that the entire duration of the course shall be considered as active for promotion provided the course duration is more than two years and fulfills the conditions as specified in the schedule.

Section 7.12.15 states that medical doctors with Post Graduate Specialisation shall be appointed in Position Level P3 provided they meet all the criteria as specified in Schedule 13/A.

RCSC Director, Tashi Pem, in an email interview said that in order to encourage more doctors to undergo specialisation at the Khesar Gyalpo University of Medical Sciences of Bhutan, the promotion would be granted during the training period as an exception to the promotion rules.

However, doctors can avail the above provisions if only they meet the criteria, which are specified in Schedule 13/A of BCSR 2018.

Tashi Pem said the commission and the health ministry have identified critical areas of specialisation for doctors to pursue.

“This means they can specialise without the need to complete their minimum years of service that is required under the training rule,” she said. “In a normal case, a civil servant cannot undergo long-term training before completing three years of service or during the probation period.”

A total of 61 doctors have benefitted since the reform was initiated, according to the commission’s report.

Tashi Pem said that as per the study carried out on doctor career path reform in January 2015, there were a total of 251 regular doctors including 32 specialists in the position of Executive Specialist (ES) and 38 expatriate doctors on contract to meet critical shortages in specialised services.

This is why she said that the career path was reformed and implemented in order to address the doctor requirement across the country and to offer specialised care.

The reform considered the loss of seniority due to long duration of MBBS & BDS studies, which takes about five and half years to a maximum of nine years to undergo such study programmes.

“This long study duration courses have made doctors comparatively junior to their peers, as they join service late,” Tashi Pem said. “Then subsequent promotions got delayed, as the same rule was applied irrespective of the course duration and the necessity of those specialised qualifications.”

Records with the commission show that a total of 149 doctors lost seniority ranging from one to 10 years with MBBS/BDS and specialisation. Ten doctors have left the system from July 2015 until December 2017 through voluntary resignation. As on January 5 this year, there are 262 doctors in the country.

Tashi Pem said the WHO doctor population ratio standard is 1:1,000 to work out doctor shortage. It was observed that about 449 doctors would be short based on the existing population.

With the population growth rate of 1.6 percent in the next five years, 100 more doctors would be required in addition to the current gap. To meet this gap, 30 government scholarships are allotted for MBBS every year.

There are around 330 students studying MBBS currently, who are expected to fill the gap in the next 11 years. “This illustrates that there is critical shortages of doctors,” Tashi Pem said.

Yangchen C Rinzin