The rape and murder at RG Kar Medical College underscore the need for leadership in medical education and research in India

Based on her research on gender inequalities in Indian medical culture, Julie Davies, Emily Yarrow And Kamal Gulati argue that for Indian medical education and practice to become safe for women, more focus should be placed on training staff in organizational and systems thinking so that they can drive the required changes.

On August 9, 2024, a 31-year-old second-year trainee doctor at RG Kar Medical College and Hospital in Kolkata was raped and murdered while sleeping in a seminar room after a 36-hour shift.

Immediately thereafter, doctors' protests broke out across the country and on August 17, over a million doctors took part in a 24-hour strike. The Indian Medical Association (IMA) described the killing as barbaric and demanded special security measures for doctors in a letter to the Health and Family Welfare Minister. The incident highlighted the lack of security for doctors and safe spaces for women. In response, India's Supreme Court has set up a national task force to make state-level commitments to tighten security for doctors in government hospitals.

India is the world's fastest growing economy and is aiming for universal healthcare and aims to be the third largest economy by 2027. President Modi's vision of Viksit Bharat@2047 The aim is for India to be a developed nation by 2047. As part of this vision, the Government of India's Nari Shakti policy for women-led development is committed to improving the lives of women in the country. A key principle of the World Health Organization's global strategy on Human Resources for Health: Workforce 2030 is the elimination of gender-based violence, discrimination and harassment.

In India, there has been limited success in achieving these women's empowerment goals. The World Economic Forum's Global Gender Gap Report 2024 ranked India 129th out of 146 countries. The endemic gender-based violence in India shows that the country still has a long way to go, be it in terms of the quality of life of its citizens or in terms of the UN Sustainable Development Goals, the success of which depends on India.

Will we see real action and implementation of laws to protect women? In 2013, the government passed the Prevention of Sexual Harassment (POSH) of Women in the Workplace Act, which defines sexual harassment, establishes a grievance procedure, and outlines the responsibility of employers to ensure safe working environments for women, including rest facilities. However, this had little impact. In 2019, a bill on the protection of health workers and clinical facilities (prohibition of violence and damage to property) was drafted to protect health workers and hospitals, but it never came into force.

Our experiences working on gender inequalities in leading medical schools in India and UK business schools, and most recently on a joint project examining the impact of these biases on doctors in India and the UK, give us particular insight into these challenges. What does this tell us about the working conditions of doctors and attitudes towards female doctors when their life expectancy is shorter than that of the general population? Why are laws protecting women not strictly enforced? What can doctors and their representatives do to achieve a decent working life and support universal health coverage and gender equality?

Our proposal is to integrate medical leadership throughout medical school education and into the professional lives of physicians to provide them with an understanding of the need for systems leadership and skills to change the systems in which they work. However, addressing short-term problems in working conditions also requires building a system that can better regulate itself.

Medical elitism in India

Kiran Kumbhar, who practiced medicine in India and is now a historian at the University of Pennsylvania, says doctors in India have a “unique victim mentality with the elitism and sense of entitlement that comes with it.” The medical profession is highly valued and desirable. However, public discourse focuses on corruption among doctors. The lack of investment in public health and huge demand have led to violent attacks on doctors and harsh working conditions. Zero-tolerance policies similar to those in the UK NHS should be introduced to improve the doctor-patient relationship and mitigate the sources of frustration and anger that lead to patients and their families verbally and physically attacking doctors .

Diverse leadership

Our research on physicians in two leading medical schools and hospitals in India confirmed the challenges of huge patient numbers and relentlessly demanding working conditions. Despite health management training programs, hospitals are predominantly run by male physicians who have no formal leadership training. The result is a lack of strategic thinking and implementation as well as a focus on clinical expertise and academic medicine. Additionally, as in many parts of the world, there are more women than men in medical schools, taught by fewer female professors. Furthermore, women are largely excluded from decision-making in boardrooms and medical leadership positions, a situation that can weaken representative policy-making and improve gender equality in higher education.

Development through organizational learning and leadership

If the working lives of doctors, particularly the lives of women doctors, many of whom are too afraid of the consequences of speaking out, are to be improved as part of India's goal of being a developed country, then a formal Medical Leadership Development Training and Physician Involvement Needed Meaningful action in leading organizations is critical. This could be achieved through closer links between business schools and medical schools and between social and medical sciences, for example by studying medical leadership in India and England. A renewed interdisciplinary focus on research projects and collaborations around UNSDG five (gender equality) and eight (decent work and economic growth), possibly under the auspices of the UK-India Education and Research Initiative (UKIERI), could also inform developments in this area advance area.

We hope that an effective law to protect doctors is on the horizon. We will read with interest the upcoming report on plans to improve the safety, working conditions and well-being of doctors in India. Ultimately, current workplace regulations are inadequate and need to be strengthened through effective and robust legislation and sectoral attitudinal changes to ensure a holistic approach to worker protection.

The content generated in this blog is for informational purposes only. This article reflects the views and opinions of the authors and does not reflect the views and opinions of the Impact of Social Science blog (the Blog) or the London School of Economics and Political Science. Please read our comment policy if you have concerns about posting a comment below.

Photo credit: PradeepGaurs on Shutterstock.