In Tamil Nadu's flagship government hospitals, monitors in cardiac theatres beep with relentless urgency. Patients keep coming, waiting lists keep growing. But the surgeons who are supposed to be there are missing.
Widespread vacancies across hospitals
At the Government General Hospital in Chennai, five of six chief cardiac surgeon posts are vacant, along with six of 14 assistant positions. At the nearby Omandurar Multispecialty Hospital, two of four assistant posts are unfilled. At Kalaignar Centenary Hospital, all four assistant professor roles are held by doctors still serving their postgraduate bond, and only one of the two associate professor posts is filled.
The shortages extend beyond the capital. Tirunelveli Medical College Hospital has one professor and no assistant professors in cardiac surgery. In Thanjavur and Trichy, all such posts are vacant, government surgeons said. Kilpauk Medical College, Dharmapuri and Villupuram hospitals function without chief surgeons, relying on a single assistant surgeon each.
Young doctors deterred from specialising
The strain has begun to deter younger doctors. The problem is twofold: few government doctors want to specialise in cardiac surgery, and few specialists outside are willing to join government service. The state reserves 50% of super-speciality seats for in-service doctors, but demand is faltering. Of Tamil Nadu's 415 seats, about half are earmarked for government doctors. This year, the state selection committee (SSC) declared 215 seats vacant but received only 170 applications. After two rounds of counselling, nearly 140 seats — including those in cardiology, neurology, nephrology and neurosurgery — remained unclaimed. Cardiovascular and thoracic surgery was among those that fared worst.
Punitive bond requirement
At the centre of the problem is a bond requirement that many doctors describe as punitive. In-service candidates pursuing super-speciality training must sign a 50 lakh bond and commit to serving the government until retirement, backed by three sureties — two government employees of equal or higher rank and one family member. "Getting sureties is not easy, and forcing doctors to stay without adequate incentives is unfair," said Dr A Ramalingam, general secretary of the service doctors and postgraduates association.
Recruitment efforts fall short
Earlier this year, the state sought to address shortages by recruiting specialists in "scarce specialities" such as obstetrics and gynaecology, geriatrics and cardiac surgery. The Tamil Nadu Medical Services Recruitment Board called for applications for 20 cardiac surgeons but appointed only one. Officials said some candidates failed the mandatory Tamil test, others lacked qualifications, and some did not attend interviews. "There was no incentive for doctors to join," said Dr K Kolandaisamy, former director of public health. He noted that earlier, non-service postgraduates and super-specialists were offered government jobs if they passed an exam, ensuring a steady pipeline. "Once we stopped this, scarcity increased in some specialities," he said.
