New Delhi, April 14: The Centre is considering at least one year of compulsory rural service for fresh MBBS graduates but some doctors are not amused.

The government has realised that doctors? refusal to serve in villages is a major hurdle to improving healthcare there. It is considering tough rules to grant fresh graduates the licence to practise only after they have served a year or two in a rural centre.

Health minister Anbumani Ramadoss has been publicly speaking about this though nothing has been finalised.

?We are looking at compulsory tenure of service in rural areas for all medical graduates so that the rural health centres are manned,? he recently told medical school authorities.

?We have not yet finalised the scheme and will do so only after consultations with the medical council,? the minister said.

Ramadoss felt that the doctors ?should give back something to the poor in the country? as ?they get subsidised medical education?.

?The thought is excellent but the government must do its homework first and work out a methodology for implementation,? said Sanjiv Malik of the Indian Medical Association (IMA).

The association has not been amused with Ramadoss?s public views on health sector reforms. Many doctors were furious that the minister did not talk to the IMA before speaking about testing doctors every five years to renew their licence.

?Of course, doctors should serve in rural areas; it is our moral and social responsibility to do so. But first, there must be infrastructure in place,? Malik said.

On paper, many states have the rule that all fresh graduates must have a rural stint but most do not enforce it strictly. As a result, most rural health centres go unmanned or doctors make an occasional appearance.

The general feedback is that most doctors forced into rural tenures gather at the district health centre because lack of sanitation and water plagues the rural unit, making the going tough for the mostly urban middle-class medical graduates.

?Young doctors cannot go to rural health centres where there are no facilities, sometimes not even bandages, let alone drugs, and waste their time,? Malik said.

?It is not nice for a person in his position to shoot his mouth off without first doing the necessary homework,? he said of the minister?s public statement.

The IMA feels the government, which recently launched the rural health mission, should put its money where its mouth is.

?All this talk of rural health is very good but there should be well-equipped clinics and hospitals to cater to the rural public. Why does the government not have an All India Institute of Medical Sciences-type facility in a rural area?? Malik asked.

The IMA member demanded to know if the Centre was willing to spare funds to build the infrastructure. If the government showed the way, the private sector would follow, he said.

Instead of harping on a compulsory tenure, the authorities should upgrade health centres to enable professional practice, Malik said.

Then, doctors, both fresh and experienced, will need no persuasion to serve in rural areas, he said.