LAHORE: The protesting doctors have offered that they were ready to withdraw certain demands earlier made by them and considered ‘unrealistic’ by the provincial health mangers if a serious dialogue is initiated by the provincial government with regard to a service structure for medics.

Differences over total financial propositions of Rs423 billion as proposed by the protesting doctors for their service structure have almost brought to a stalemate the dialogue between the health department authorities and the organisations representing medics, it is learnt.

YDA Punjab office-bearer Dr Mudassar Khan said medical organisations had already conveyed to the health authorities that they were ready to drop some of the demands including official residences for all doctors and cars for the medics serving in BS-20 and BS-21 if a serious dialogue was initiated.

He alleged the health bureaucracy was deliberately giving a wrong impression about the agitating doctors to mislead the Punjab government.

The total financial impact of the budget demands made by three bodies -- Pakistan Medical Association (PMA), the Punjab Chapter of Young Doctors Association (YDA) and the Medical Teachers Association (MTA) -- for all four cadres of the doctors was calculated by a team of health authorities, a source said.

According to the health department, the estimated cost of Rs423 billion for the proposed service structure for the doctors was hundred times more than the total development and non-development budget of the Punjab health department for the fiscal year 2012-13 which was Rs52.6 billion and around 60 per cent of the total outlay of the provincial government’s budget which was Rs782.86 billion.

It said of the total estimated budget, only the official residences for all doctors required Rs359 billion while chauffer-driven cars demanded by medic along with fuel would require Rs4 billion.

The ‘shocking’ statistics had come under discussion in the meetings held between health department officials and the representatives of protesting doctors some days ago.

Health special secretary Dawood Bareach told Dawn the financial incentives demanded by the representatives of protesting doctors were unrealistic. The demands came despite the Rs4 billion incentives package dispended by the government to elevate the salary structure of the doctors last year.

He said the Punjab government had given a sufficient salary raise to doctors through the Health Professional Allowance (HPA), including Rs15,000 for BS-17 doctors, and Rs10,000 for BS-18 and above doctors.

They were already getting Rs4,000 monthly Non-Practicing Allowance (NPA) for medics in BS-17 and BS-18 and Rs6,000 for those in BS-19 and above.

He said the young doctors working in three categories -- House Officers (HOs), Postgraduate Trainees (PGs) and Medical Officers (MOs) -- have been getting salaries more than the employees working in other government departments in the same grade like engineers.

Mr Bareach claimed at present an HO was getting Rs24,000, PG Rs42,500 and an MO Rs44,000 as stipend.

The doctors have expressed their reservations on the existing service structure.

In the proposed service structure, a copy of which is available with Dawn, the doctors have demanded four cadres, including General Cadre (PMO, APMO/APWMO, SMO/SWMO, MO/WMO etc ), Teaching Cadre (professor, associate professor, assistant professor, senior registrar), Specialist Cadre (chief consultant, senior consultant, consultant) and Health Management Cadre (medical superintendent/Medical Director, Director/Director Dental, EDO, director general/etc, additional medical superintendent/DHO/DHO, dental/ additional director/etc, deputy medical superintendent/DDHO/deputy director/ deputy medical superintendent dental etc).

It also demanded recruitment of all doctors on permanent basis through Punjab Public Service Commission (PPSC) on a regular basis for all cadres and no recruitment below BS-18.

Salary Structure: The doctors demanded readjustment of allowances in addition to current salary.

Under the proposed service structure, they demand HPA and teaching allowance should be equal to the running basic salary of a doctor. The teaching allowance should apply to teachers of both clinical and basic departments.

Under the post graduate increments it demanded five advance increments for doctors who had acquired major post graduate diploma/degree, including FCPS, MS, and MD, two advance increments for doctors having minor post graduate diploma/degree, including MCPS, DCH etc. NPA should be twice the running basic salary of a MBBS or BDS doctor, Risk Allowance should be equal to the running basic salary of a doctor, Emergency Allowance should be equal to the running basic salary of each doctor working in emergency, Senior Post Allowance should be 20 per cent of the running basic in BPS 20 and above, House Requisition should be on the basis provided for federal employees, Conveyance Allowance should be 30 per cent of running basic salary and Medical Allowance should be 30 per cent of the running basic salary.

They demanded increase in paid seats of HOs, making them equal to the number of graduates in the same institution and creation of paid PGR seats in new teaching hospitals.

The doctors demanded stipend of an HO equal to initial take-home salary of an MO (BS-18), and stipend of a PGR equal to initial take-home salary of a medical officer (BS-18).

Other demands: The medics demand that all the PGs and HOs should be entitled to free health care services in all institutions of Punjab.

The proposed draft said all the contract employees (including those working for PRSP) should be regularised and provided pay protection which should be given in the form of basic pay instead of personal pay/allowance.

For an on-call doctor, pick-and-drop facility should be provided by the health institution concerned, besides a cell phone, so that the doctor could stay in touch with the hospital.

A reasonable budget should be provided to the institution for Continuing Medical Education (CME) activities for the doctors.

All the mandatory training courses/workshops should be financed by the government/institution for all doctors.

They demanded interest-free loans for all regular doctors working in BS-18 and BS-19.

They also gave recommendations and policies guidelines for each of the four cadres, besides establishment of Human Resource (HR) Centres at all the public sector health facilities and a Health Service Academy.

According to the proposed service structure, Punjab province should be divided in four zones A, B, C & D.

It was proposed that all the established teaching institutions of the province should be categorised in Zone-I, the four newly established teaching institutions and all the district headquarters hospitals (DHQs) in Zone-II, all the tehsil headquarters hospitals (THQs) and all basic health units (BHUs) and rural health centres (RHCs) located within the 20-kilometer radius of the THQs in Zone-III and all other BHUs should be categorised in Zone-IV.

It has proposed hundred per cent of the basic salary for the doctors working in Zone-II, 150 per cent of basic salary for those in Zone-III and 200 per cent of basic pay as incentive for the doctors in Zone-IV.

Special incentives should be given to those working in ‘hard’ and far-flung areas, the draft said.