Are doctors from the complementary and alternative systems of medicine less equal than their allopathic counterparts? Public sector doctors' experiences of recruitment from two Indian states.

Abstract

Background: Complementary and alternative systems of medicine, which include Ayurveda, Yoga, and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homoeopathy (AYUSH), play a significant role in the Indian healthcare system. Despite many efforts to integrate and mainstream AYUSH, there are significant inequities that disadvantage AYUSH doctors compared to their allopathic counterparts. In this paper, we examine the recruitment-related experiences of contractual AYUSH doctors and make some side-by-side comparisons with those of contractual allopathic doctors from two Indian states.

Methods: This study, on which this paper reports, is set within a larger qualitative study conducted in India to examine the experiences of public sector doctors with Human Resource Management systems. We conducted semi-structured interviews with 61 participants, including 33 frontline doctors and 28 policy actors. We employed purposive sampling to select doctors from two states. Data collection occurred from February to October 2019. Thematic analysis, utilizing the Framework Approach, was applied to organize and synthesize qualitative data based on themes identified from the data. We also developed job histories from the interviews with the doctors to explore their experiences with the recruitment system. The quantitative data gathered through job histories were analysed using frequencies and triangulated with the narrative accounts provided by the doctors.

Results: The paper reports the discontent of AYUSH and allopathic doctors with the recruitment, but this was consistently worse for AYUSH, especially in State 1, in several ways. One, there were significant discrepancies in salaries and allowances between AYUSH and allopathic doctors. Two, AYUSH doctors experienced stagnated career progressions and high job insecurity. Three, the system sabotaged AYUSH doctors' expectations of progressing to regular recruitment in State 1. And four, AYUSH doctors perceived the system to be highly inequitable and unresponsive towards their concerns, particularly in State 1, with critical implications for health services.

Conclusion: This paper highlights the extreme form of inequity perceived and experienced by the contractual AYUSH doctors. The policy and institutional environment surrounding AYUSH integration is weak, and there is a significant failure of institutions to meet the expectations of these doctors. Additionally, there are insufficient translations between policy and practice, leaving larger questions about holistic integration and the inclusion of AYUSH unresolved. Our findings suggest that the subtle nuances discussed in the paper indicate a bias toward allopathic doctors, which may further lead to the marginalization of AYUSH.