Why NPA should be made optional for JNIMS doctors
|
Dr Pahel Meitei Soibam
A Call for Equity, Autonomy, and Institutional Reform in Manipur’s Premier Medical College
In the intricate machinery of public healthcare, few policies have sparked as much quiet discontent as the Non- Practicing Allowance (NPA). Originally designed to compensate Government doctors for abstaining from private practice, NPA has morphed into a rigid, compulsory clause that often penalizes the very professionals it was meant to support. Nowhere is this paradox more visible than at Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal—the largest medical college and tertiary care centre under the Govt of Manipur.
This essay argues that NPA should be made optional for JNIMS doctors, not as a concession, but as a necessary reform rooted in fairness, autonomy, and the urgent need to retain talent in a chronically neglected institution.
The Original Intent of NPA—and Where It Fails
The Non-Practicing Allowance was introduced to ensure that Government doctors devote their full attention to public service, without the distraction or conflict of interest posed by private practice. In theory, it is a trade-off : doctors receive a financial incentive (usually 20% of basic pay) in exchange for exclusive service to the State.
But this model assumes a baseline of institutional support—adequate and timely salaries, adequate infrastructure, career progre- ssion, and professional dignity. In many parts of India, especially in the North East, these assumptions collapse under scrutiny. When doctors are underpaid, over- worked, and unsupported, enforcing NPA becomes less about ethics and more about coercion.
JNIMS: A Case Study in Systemic Neglect
JNIMS is the largest medical college under the Manipur State Government. It serves as a lifeline for thousands of patients and a training ground for future medical professionals. Yet, despite its strategic importance, JNIMS continues to suffer from chronic under-funding and administrative inertia. The consequences are dire:
Infrastructure Deficits
Departments operate in cramped, outdated spaces with unreliable utilities. Many departments do not have dedicated spaces for administrative office and ward. The campus, including the roads, is poorly maintained. The campus is prone to frequent flooding entailing closure of the entire hospital and medical college for many days together. Nothing concrete has been done for the same. Sports and recreation facilities are non-existent.
Equipment and Consumables Shortage
ICUs, operating theatres, and diagnostic labs often lack essential tools—from ventilators, monitors, ultrasound machines to reagents and disposables. Absence of AMC (Annual Maintenance Contracts) means machines and equipment rarely if ever get repaired. This forces clinicians to either improvise or refer patients to private centres, undermining the credibility of public health- care. Equipment for Bronchoscopy, Thoracoscopy and EBUS (Endobron- chial Ultrasonography) are not there. Basic lung function tests are not available.
Manpower Crisis
Faculty, nurses, and paramedical staff are stretched thin, with “lack of fund” being the usual barrier to recruitment of adequate number of health- care workers. Doctors routinely juggle clinical, aca- demic, and administrative roles, often without adequate support or recognition.
Employee Welfare Failures
· Delayed promotions and opaque career advancement policies demoralize staff and hinder retention.
· Irregular and inadequate salaries create financial instability and erode institutional loyalty.
· Limited access to professional development, wel- fare schemes, and recognition further isolates emplo- yees from National standards. These systemic issues not only undermine the quality of care and education but also diminish the dignity and motivation of the workforce. For an institution that serves as the backbone of Manipur’s public health system, such neglect is both unjust and unsustainable.
Professional Suicide for Super-Specialists
For super-specialist doctors—those who have spent over a decade mastering complex disciplines like Pulmonary&Critical Care Medicine, Cardiology, He-matology, Hepatology, Neurosurgery, GI Surgery, etc.—continuing in JNIMS under current conditions is tantamount to professional suicide.
· No advanced infrastructure : There are no high-end ICUs, cath labs, sleep labs, or interventional suites to apply their expertise.
· No procedural volume : Without patients requiring advanced interventions or the tools to perform them, specialists risk de-skilling.
· No academic stimulation: Lack of research support, conferences, or peer collaboration leads to intellectual stagnation.
· No recognition or growth : Promotions are delayed, and there’s little incentive to innovate or lead.
These doctors face a cruel irony : after years of sacrifice, training, and National-level certification, they are forced into roles that neither challenge nor utilize their skills. Over time, this leads to redundancy, burnout, and a quiet exit from the system—either through resignation or irrelevance.
Making NPA optional would allow these specialists to maintain their skills through ethical private practice, research collaborations, and procedural exposure—without abandoning public service.
Making NPA Optional: A Pragmatic Reform
Allowing doctors to opt out of NPA in exchange for the right to practice privately offers a balanced solution tailored to ground realities:
· Restores autonomy : Doctors can choose the path that best suits their financial and professional needs.
· Reduces attrition : Talented professionals are more likely to stay in Government service if they can practice their skills at centers having the required equipment and infrastructure, and can supplement income ethically.
· Improves service delivery : With better morale and financial stability, clinicians are more likely to invest in skill-building and patient care.
· Encourages accountability : Optional NPA can be tied to transparent declarations and ethical practice guidelines, ensuring public trust. This reform would not dilute public service—it would strengthen it by acknowledging the lived realities of Government doctors and empowering them to serve with dignity.
Countering the Arguments for Compulsory NPA
1. “Private practice distracts from public duty.”
This concern assumes that doctors will neglect their Government responsibilities if allowed to practice privately. But in reality, most doctors already work beyond sanctioned hours due to manpower shortages. Ethical private practice—outside duty hours and with full transparency—does not compromise public service. In fact, it can enhance clinical exposure and commu- nity trust.
2. “NPA ensures exclusivity and loyalty to the State.”
Loyalty cannot be legislated—it must be earned. When doctors face inadequate and irregular salaries, stalled promotions, and poor working conditions, enforced exclusivity breeds resentment, not commitment. Optional NPA respects individual circumstances while still rewarding those who choose full-time public service.
3. “Allowing private practice will create inequality among doctors.”
Inequality already exists—between those who can afford to stay in Government service and those who leave for better prospects. Optional NPA levels the playing field by giving doctors a choice: either accept NPA and refrain from private practice, or opt out and earn ethically. It’s not inequality—it’s flexibility.
4. “It will open the floodgates to unethical behavior.”
Unethical practice is a matter of regulation, not allowance. With proper oversight—such as mandatory declarations, time logs, and grievance redressal—ethical private practice can coexist with public service. Blanket bans only push practice underground, making it harder to monitor.
Academic Excellence Amid Adversity
Despite these challenges, JNIMS continues to produce competent medical graduates and postgraduates who serve all over the country. The faculty—many of whom juggle multiple roles—remain committed to teaching and mentorship. Students often excel in National-level exams and con- tribute meaningfully to research and community health initiatives.
This resilience is not accidental—it is the result of personal sacrifice, professional integrity, and a deep- rooted commitment to public service. Making NPA optional would honor this spirit rather than constrain it.
Complementary Reforms Needed
Making NPA optional should not be a standalone fix. It must be accompanied by structural reforms that address the root causes of institutional decay:
· Substantial increase in budgetary allocation, with ring-fenced funds for infrastructure, equipment, and consumables.
· Transparent and timely promotion policies, along with rationalization and regularization of salaries and benefits.
· Strategic recruitment and retention plans to address manpower shortages.
· Modernization of facilities, including digital health infrastructure, simulation labs, and research centers.
· Empowerment of faculty and staff through continuing medical education, leadership training, and welfare schemes.
These reforms would not only improve service delivery but also help transform JNIMS into a center of excellence capable of attracting and retaining top medical talent.
Conclusion: From Symbolic Allowances to Substantive Reform
The rigid enforcement of NPA in under-resourced settings like JNIMS reflects a disconnect between policy and ground reality. Making NPA optional is not a compromise—it’s a corrective measure that respects the dignity, autonomy, and lived challenges of Government doctors. It is a call to move beyond symbolic allowances and toward substantive reform. In a State where healthcare professionals continue to serve amid strikes, shortages, and systemic neglect, empowering them with choice is not just policy—it is justice.
NB: NPA is optional in many States like Assam, West Bengal, Madhya Pradesh, Chhattisgarh, Odisha, Tripura, etc.
The writer is a DM (Pulmonology & Critical Care Medicine) Associate Professor Department of Pulmonary & Critical Care Medicine, JNIMS, Porompat, Imphal East
A Call for Equity, Autonomy, and Institutional Reform in Manipur’s Premier Medical College
In the intricate machinery of public healthcare, few policies have sparked as much quiet discontent as the Non- Practicing Allowance (NPA). Originally designed to compensate Government doctors for abstaining from private practice, NPA has morphed into a rigid, compulsory clause that often penalizes the very professionals it was meant to support. Nowhere is this paradox more visible than at Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal—the largest medical college and tertiary care centre under the Govt of Manipur.
This essay argues that NPA should be made optional for JNIMS doctors, not as a concession, but as a necessary reform rooted in fairness, autonomy, and the urgent need to retain talent in a chronically neglected institution.
The Original Intent of NPA—and Where It Fails
The Non-Practicing Allowance was introduced to ensure that Government doctors devote their full attention to public service, without the distraction or conflict of interest posed by private practice. In theory, it is a trade-off : doctors receive a financial incentive (usually 20% of basic pay) in exchange for exclusive service to the State.
But this model assumes a baseline of institutional support—adequate and timely salaries, adequate infrastructure, career progre- ssion, and professional dignity. In many parts of India, especially in the North East, these assumptions collapse under scrutiny. When doctors are underpaid, over- worked, and unsupported, enforcing NPA becomes less about ethics and more about coercion.
JNIMS: A Case Study in Systemic Neglect
JNIMS is the largest medical college under the Manipur State Government. It serves as a lifeline for thousands of patients and a training ground for future medical professionals. Yet, despite its strategic importance, JNIMS continues to suffer from chronic under-funding and administrative inertia. The consequences are dire:
Infrastructure Deficits
Departments operate in cramped, outdated spaces with unreliable utilities. Many departments do not have dedicated spaces for administrative office and ward. The campus, including the roads, is poorly maintained. The campus is prone to frequent flooding entailing closure of the entire hospital and medical college for many days together. Nothing concrete has been done for the same. Sports and recreation facilities are non-existent.
Equipment and Consumables Shortage
ICUs, operating theatres, and diagnostic labs often lack essential tools—from ventilators, monitors, ultrasound machines to reagents and disposables. Absence of AMC (Annual Maintenance Contracts) means machines and equipment rarely if ever get repaired. This forces clinicians to either improvise or refer patients to private centres, undermining the credibility of public health- care. Equipment for Bronchoscopy, Thoracoscopy and EBUS (Endobron- chial Ultrasonography) are not there. Basic lung function tests are not available.
Manpower Crisis
Faculty, nurses, and paramedical staff are stretched thin, with “lack of fund” being the usual barrier to recruitment of adequate number of health- care workers. Doctors routinely juggle clinical, aca- demic, and administrative roles, often without adequate support or recognition.
Employee Welfare Failures
· Delayed promotions and opaque career advancement policies demoralize staff and hinder retention.
· Irregular and inadequate salaries create financial instability and erode institutional loyalty.
· Limited access to professional development, wel- fare schemes, and recognition further isolates emplo- yees from National standards. These systemic issues not only undermine the quality of care and education but also diminish the dignity and motivation of the workforce. For an institution that serves as the backbone of Manipur’s public health system, such neglect is both unjust and unsustainable.
Professional Suicide for Super-Specialists
For super-specialist doctors—those who have spent over a decade mastering complex disciplines like Pulmonary&Critical Care Medicine, Cardiology, He-matology, Hepatology, Neurosurgery, GI Surgery, etc.—continuing in JNIMS under current conditions is tantamount to professional suicide.
· No advanced infrastructure : There are no high-end ICUs, cath labs, sleep labs, or interventional suites to apply their expertise.
· No procedural volume : Without patients requiring advanced interventions or the tools to perform them, specialists risk de-skilling.
· No academic stimulation: Lack of research support, conferences, or peer collaboration leads to intellectual stagnation.
· No recognition or growth : Promotions are delayed, and there’s little incentive to innovate or lead.
These doctors face a cruel irony : after years of sacrifice, training, and National-level certification, they are forced into roles that neither challenge nor utilize their skills. Over time, this leads to redundancy, burnout, and a quiet exit from the system—either through resignation or irrelevance.
Making NPA optional would allow these specialists to maintain their skills through ethical private practice, research collaborations, and procedural exposure—without abandoning public service.
Making NPA Optional: A Pragmatic Reform
Allowing doctors to opt out of NPA in exchange for the right to practice privately offers a balanced solution tailored to ground realities:
· Restores autonomy : Doctors can choose the path that best suits their financial and professional needs.
· Reduces attrition : Talented professionals are more likely to stay in Government service if they can practice their skills at centers having the required equipment and infrastructure, and can supplement income ethically.
· Improves service delivery : With better morale and financial stability, clinicians are more likely to invest in skill-building and patient care.
· Encourages accountability : Optional NPA can be tied to transparent declarations and ethical practice guidelines, ensuring public trust. This reform would not dilute public service—it would strengthen it by acknowledging the lived realities of Government doctors and empowering them to serve with dignity.
Countering the Arguments for Compulsory NPA
1. “Private practice distracts from public duty.”
This concern assumes that doctors will neglect their Government responsibilities if allowed to practice privately. But in reality, most doctors already work beyond sanctioned hours due to manpower shortages. Ethical private practice—outside duty hours and with full transparency—does not compromise public service. In fact, it can enhance clinical exposure and commu- nity trust.
2. “NPA ensures exclusivity and loyalty to the State.”
Loyalty cannot be legislated—it must be earned. When doctors face inadequate and irregular salaries, stalled promotions, and poor working conditions, enforced exclusivity breeds resentment, not commitment. Optional NPA respects individual circumstances while still rewarding those who choose full-time public service.
3. “Allowing private practice will create inequality among doctors.”
Inequality already exists—between those who can afford to stay in Government service and those who leave for better prospects. Optional NPA levels the playing field by giving doctors a choice: either accept NPA and refrain from private practice, or opt out and earn ethically. It’s not inequality—it’s flexibility.
4. “It will open the floodgates to unethical behavior.”
Unethical practice is a matter of regulation, not allowance. With proper oversight—such as mandatory declarations, time logs, and grievance redressal—ethical private practice can coexist with public service. Blanket bans only push practice underground, making it harder to monitor.
Academic Excellence Amid Adversity
Despite these challenges, JNIMS continues to produce competent medical graduates and postgraduates who serve all over the country. The faculty—many of whom juggle multiple roles—remain committed to teaching and mentorship. Students often excel in National-level exams and con- tribute meaningfully to research and community health initiatives.
This resilience is not accidental—it is the result of personal sacrifice, professional integrity, and a deep- rooted commitment to public service. Making NPA optional would honor this spirit rather than constrain it.
Complementary Reforms Needed
Making NPA optional should not be a standalone fix. It must be accompanied by structural reforms that address the root causes of institutional decay:
· Substantial increase in budgetary allocation, with ring-fenced funds for infrastructure, equipment, and consumables.
· Transparent and timely promotion policies, along with rationalization and regularization of salaries and benefits.
· Strategic recruitment and retention plans to address manpower shortages.
· Modernization of facilities, including digital health infrastructure, simulation labs, and research centers.
· Empowerment of faculty and staff through continuing medical education, leadership training, and welfare schemes.
These reforms would not only improve service delivery but also help transform JNIMS into a center of excellence capable of attracting and retaining top medical talent.
Conclusion: From Symbolic Allowances to Substantive Reform
The rigid enforcement of NPA in under-resourced settings like JNIMS reflects a disconnect between policy and ground reality. Making NPA optional is not a compromise—it’s a corrective measure that respects the dignity, autonomy, and lived challenges of Government doctors. It is a call to move beyond symbolic allowances and toward substantive reform. In a State where healthcare professionals continue to serve amid strikes, shortages, and systemic neglect, empowering them with choice is not just policy—it is justice.
NB: NPA is optional in many States like Assam, West Bengal, Madhya Pradesh, Chhattisgarh, Odisha, Tripura, etc.
The writer is a DM (Pulmonology & Critical Care Medicine) Associate Professor Department of Pulmonary & Critical Care Medicine, JNIMS, Porompat, Imphal East