Directorate General, Medical Services

Central Armed Police Forces, NSG & ARs

Sub:- Proposal for Residency scheme for 200 bedded Referral
hospital

f '

GOI vide order GOI order No. 27012/33/2003-PF.lll, dated 02.09.04

has 1s.9netioned a 200 bedded Referral hospital for CAPFs under ITBP (
Annexure-A) . This hospital will cater to the tertiary care requirement of 9
lac CAPF personnel and approximately 27 lac dependents. The hospital is
under construction by NBCC and is likely to become functional by Jan,
2014. ~overnm~nt vide order UO No. 11-27012/33/2003-PF.111 (pt.l)
dated 0,8.08.2006\(Annexure-8) has sanctioned following 16 specialists for
this hospitak:-- -- "
1.
2.

3.
4.
5.
6.
7.
8.
9.
10.
11:
12.

13.
14.
15.

16.
L

Medicine
Surgery
Gyn.& Obs.
Anaesthesia
Radiology
Pathology
Paediatrics
Orthopaedics
Psychiatry
Eye
ENT
CTVS
Neurosurgery
Neurology
Nephrology
Gastroenterology

01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01

..,.-"'along with a post of dental surgeon and 10 GO MOs (details as per

Annexure-A).
02
Currently the nucleus of the Referral Hospital is functioning in Base
Hospital, ITS Police, Tigri, New Delhi with regular specialists from fields of
Orthopaedics, Obs.&Gynae.,ENT, Ophthalmology, Psychiatry and
Paediatrics. Services of GDMOs with PG qualifications are being utilized
for Surgery, Anaesth~sia and Radiolgy. Efforts are on to fill up remaining
posts through MOSB-2013.
03
With only a single authorized specialist for each specialty, there is a
major limitation in providing round the clock services of a
specialty/department .In the absence of round the clock services.
emergency patients may have to be referred to other hospitals. Also,
whenever a specialist proceeds on leave/duties/courses/seminars etc his
department will cease to function and the equipment purchased for the
department will also remain unutilized.
04
To overcome this problem, the services of Junior and Senior
Residents is proposed to be availed as per existing practice in other
tertiary/non-tertiary care hospitals of similar bed strength.
05
Residency Programme is a Service-Cum-Training Programme. A
Resident doctor has to function as the junior most staff member in their
respective departments to gain training and give services to the patients.
They are the first level managers of specialty departments. A Resident
has to carry out emergency duties, continuous patient care, on-call duties,
duties as junior consultant to other departments, etc. Thus individual

patient care will improve, resulting in the overall betterment of health care
system and achievement of better standards in the field of health care.
The duties of all the postgraduates will be defined based on the prescribed
norms and strict compliance will be ensured by the Medical Superintendent
and HODs of the Department.

06.
In view of the above It is essential to introdu~ residency scheme in
200 bedded Referral Hospital. The Residency.,Scheme issued by the
Central government under its letter dated June5, 1992 (Annexure C) .In
this regard it is submitted that as on date there is no provision for
residency scheme in any of the Composite Hospitals in CAPFs and the
current proposal seeks introduction of tenure based residency scheme for
200 bedded Referral Hospital.
07.
The current proposal seeks approval for introduction of
residency scheme i.e. Senior resident (non-academic) and junior
residents (non-academic) in the 200 bedded referral hospital, ITBP.
08.
Conditions of engagement to the posts of Senior and Junior
Resident (Non Academic) are primarily governed by the Residency
Scheme all over India, In case of the Referral Hospital, identification of the
following number of posts of JR & SR has been made based on the actual
and projected workload and in consultation with various specialists
Department

-~ye

ENT

SR
posts
Recom
men de
d
01
01

Patholog~

Radioloqy
Psychiatry
Paediatrics

01
01
02

--

1--

Orthopaedics

02

Gynae.& Obs

03

Surgery

03

Medicine

04

-Anaesthesia

Dental

03

21
01
Neurolog~
01
Neurosurgery 01
Gastroenterolo 01

1--CTVS

Remarks

Posts Remarks-1
JR
Recommen
ded
----------

OPD-01
NICU-01
OPD-01
OT/Ward-01
OPD-1
Labour
Room/OT/Ward-02
OPD,-1 Casualty02
OPD-01
Casualty/ICU-3
OT-01
Casualty/ICU/paed
ICU-02

--

--------

-------

--

02
04
--

02

04
---------

04
05

----------------

-!

02

01

25
01
01
01
01

-----------

----~----

------- ------- -~-----

QV

Nephrology
~Total

01
05

26

---h~-----

01
05
30

- - - - - --- 1------- ...

'----.

-~~=J

Justification:!09.
Resident seats has been determined, department-wise with
!reference to estimated service loads, manpower requirements of
;specialists, and the clinical facilities actually available The number of seats
lhas been fixed with the above in view. While projecting the same,
!consideration has been taken of the criteria being followed by the Govt
i Hospitals of GNCTD vide revised recommendations for creation of
l posts/staff norms in 100 bedded hospitals of Health and family welfare
j Oepart~ent of GNCT Delhi dated 24.7.2010( Ann~)(ure-0)
1

'.\\[ c

-----

SR posts
Sanctioned posts
staff
Rec
norms for for Dr Hedgewar
om
Arogya Sansthan,
100
me
bedded
200
nde bedded
GNCTD,
din hospitals Hospital,
of GNCT Delhi
RH
Delhi
dated

I Department
i
I

~
j

i!
l

24.7.201
0

01
01

Eye
ENT
Pathology
Radiology

01
01
Paediatrics 02
Orthopaedi 02

Psychiatry~

cs

& 03
Gynae.
Obs.
03
Surg_ery
04
Medicine
Anesthesia 03
'
Dental

Comparat~v

e study

NA

NA

01

1-c

Gastroente
rology

01

Nephrology 01

---

06
05
05

09

04

05
06
06

05
08
10

04
05
02
01

Specialty
not
available
Specialty
not
available
Specialty
not
available
Specialty
not
available
Specialty
not
available

Neurosurg
ery

---- -----

02
04
02

01
01

--+----- f - - - - - -

06
04

33

Neurology

1---

01
01
01
04

21

'

01
01
01
02

I'

'

CTVS

JR posts . - - - - : _ j
Sancti
Pos staff
norms oned
ts
Rec for 100 posts
bedde DHAS,
om
200
d
me
bedde
hospit
nde
din als of d
GNCT Hospit
RH
a/,
Delhi
GNCT
dated
24.7.2 D,
Delhi
010
~---------

--

-- - - --1-----

25
49
Forensic and skin
are
departments
not available in RH
Specialty not available

01

Specialty not available

01

Specialty not available

01

Specialty not available

01

Specialty not available

01

~---

20

40

--

05
30

------

NA

------- - - -

05
26
Total
Note.- The SRs/JRs for super spectalttes wt/1 be engaged only after the
departments start functioning
10
Frqm the above comparison it can be deduced that the number of
senior residents for 100 bed hospitals has been taken as a benchmark for
'

- L-.

! the

200 bed hospital and comparatively the requirement has been

and has been kept to bare minimum. For those departments
l which are not available at GNCT of Delhi 100 bedded hospitals but
provided for 200 bed referral hospital, the bare minimum requirement has
1been projected.

I assessed

j
~

111.
For Benchmarking purposes Dr. Hed~~ar Arogya Sansthan Govt.
of NCT of Delhi Karkardooma, ( Annexure D,) was also taken into
1consideration which is a 200 bedded hospital and do not have any super
i specialty services but do provide services of all other specialties except
j psychiatry. The hospital has 24 specialists sanctioned for these
! specialties, and also has a sanctioned strength of 51 SRs and 40 JRs.
l Even though Referral hospital is meant to provide more services and the
! sanctioned strength of specialists are much lower than the Govt. of NCT,
Delhi hospitals, the requirement projected for residents has been kept
j much lower..

i
!

! 12.

Functional Justification:
The hospital expects an average OPD of 300-350 patients per day,
; majority of the cases requiring secondary /tertiary care OPDs for all the
j specialties will be available on all working days. This hospital expects an
( average 80% bed occupancy on a routine basis. All essential services at
i tertiary care level will be provided in each specialty. Requirement of all
! major and essential equipments to run a State of Art 200 bed super
specialist hospital has already been projected and is expected to be ready
! by Dec.2013 ..

113

Casualty and Emergency Service

1. Duty doctor to be made available for 24 hours

2. Specialist doctors will be available on call

I
I

j.

3. 24 hours emergency services/labour room/maternity services

4. Surgeons and anesthetists will be available for conducting round the
clock emergency operations
.~

5. The requisite number of specialists/SRs are calculated on account

of limitation posed by the hours of work stipulated under Para 13 of
the residency scheme of Govt of India where it holds that "the
continuous active duty for resident doctors will not normally exceed
12 hours per day. Subject to exigencies of work the resident
doctors will be allowed one weekly holiday by rotation. The resident
doctors will also required to be on call duty not exceeding 12 hours
a time. The junior residents should ordinarily work for 48 hours
p~r week and not more than 12 hours at stretch subject to the
ccmdition that the working hours will be flexible as may be decided
by the medical superintendent, keeping in view the workload and
availability of doctors for clinical work."

,."""-

at

6. The number of SRs in specialties like Surgery/Orthopedics/

Anaesthesia/medicine is on the basis of shift duties required for
providing emergency medical/surgical care including operations to
be conducted in emergency.
7. Deptts. Of Gynaecology,& Paediatrics, need more residents than
others based on workload in their specialties like round the clock
labour room/elective OT requirements/Paediadtric ICU/nursery/ etc .
. 8. In the Departments like Eye/ENT/Pathology/Radiology etc the no. of
residents has been kept to bare minimum on account of patient
load.

.14.
The duties of Junior Residents shall be patient care
.The norms of patient care by Junior Residents shall include, but not
limited to the following:Each Junior Resident shall be given the charge of a specific number of
patients in a unit or ward by the Unit Chief/Senior Faculties and he/she
has to plan and execute the requisite patient care in concurrence with
Unit Chief /Senior Re~ident on duty if required.
Examination of the patient and formulation of a diagnosis.

!!
!

i
I

i
I
r

Planning and implementing the treatment protocol. It will be

inconcurrence with Unit Chief/Senior Resident I Faculty Members
onduty if required.
Ensure that the Medical Records of the patients are kept in proper
Order
Nursing and Paramedical Staff are to be under the supervision of the
Junior Residents alsp in patient care. They are bound to execute orders
/instructions of the Resident in this regard.
Declaration of deaths and issuing Death certificate in wards.

In case of death in medico legal I complicated cases, declaration and

certification of death should be done by the Senior Resident
(nonacademic) or faculty member on-duty only.

!l
t

II
l

r
f

'l

Junior Residents are not permitted to issue wound certificates, medical

certificates, treatment certificates or any other medico legal certificates.
Junior Residents of Non-clinical departments shall adequately support
the clinical services of the institution. Duty hours and working pattern
shall be similar to clinical departments. They have to provide the
necessary laboratory and other ancillary services in time.
They shall involve in research activities and inter-departmental clinical
discussions, journal clubs, seminars and other academic programs.
The Junior Residents shall involve in research activities

I
!

l15.

Will have to work in other departments as per requirement I feasibility

Any other regimental duties as required
Senior Residents (Non-Academic)
The duty of Senior Residents (Non-academic) will include patient
care, teaching, research and handling of medico legal responsibilities.
Senior Residents (Non-academic) will be actively involved in
patientcare and teaching with concurrence of senior staff members or
unit chief.

All Junior Residents, House surgeons, nursing staff and paramedical

staff will be under the supervision of Senior Residents also in patient
care. They are bound to execute orders of the Senior Residents.

The Senior Residents (Non-academic) shall involve in research

activities.
16 The norms of patient care by Senior Residents(Non-academic)
shall include, but not limited to the following:
Each Senior Resident (Non-academic) shall be given the charge of a
specific number of patients in a unit or ward by the Unit Chief or
Senior Faculties;

I
I

Examination of the patient and formulation of a diagnosis.

II .
l .

Planning and implementing the treatment protocol. lt will be done in

concurrence with the Unit Chief if required.
Ensuring that the Medical Records of the patients care are kept in
proper order.

ln case of death in medico legal I complicated cases, declaration and

certification of death should be done by the Senior Residents(Nonacademic) on-dt,Jty only.
Writing or issuing wound certificates, medical certificates, treatment
certificates or any other medico legal document is the responsibility of
the faculty member or the Senior Resident (Nonacademic).

l.
l

Senior Residents of Non-Clinical pre-clinical and para-clinical

departments shall adequately support the clinical services of the
institution. Duty hours and work pattern shall be similar to clinical
departments. They have to provide the necessary laboratory and
other ancillary services in time. They shall involve in research
activities and interdepartmental discussions, journal clubs,
conferences and other academic programmes.

Will have to work in oiher departments as per requirement/ feasibility

!
!
I

I~ 7
l

Any other regimental duties as required

Cost Benefit Analysis

1?
The financial implication on creation of Assistant Commandant
(fl{tedical officer) is Rs. 6,21,320.00 per Annum and a JR will also get
s"'me
emoluments but junior residents will be on contract basis.
l
i

19
Similar is the case with Senior residents. The financial implication
for creation of post in Specialist Cadre will work out to be Rs. 7,46,310.00
per annum. There is no difference between pay drawn by SR and
Specialist for first two years.

'i

20l
But these regular posts are entitled for timescale promotion etc
whereas residents are appointed for a fixed tenure i.e. 3 years maximum
in the case of senior residents and one year maximum for junior residents.

21 ( Creation of posts of regular specialists will have a additional

financial implication of Rs. 1,06,05,410.00 in a 10 year period owing to
promotion of the specialist to next grade while expenditure on a senior
resident for the same period .will be Rs. 76,41,228.00 with net difference of
Rs ;29,64,182.00. In other words creation of resident posts will save Govt

'

I!

.-

:t ~

I!exchequer Rs. 2,96,418.00 per annum on an average over a regular

Iappointee (Annexure- E )

122

Similarly

appointr~ent of a regular MO vis- a-vis junior

resident will
12,00,680.00
!over a 10 year period due promotion i.e. Rs. 1,20,068.00, on an average
i per annum savings.(annexure- F )

Icause state exchequer a additional financial burden of Rs.

!
j 23

Availability is another deterrent factor on regular appointment.

A brief Summary of cost benefit analysis of regular MOs vs junior
1
1Residents----------- ..
Savings per
Net
Expenditure
Expenditure
!PerMO
on
annum
on pay and on pay and Variation
an
average
other
other
1
allowances
allowances
for Ten years
for one year
'
considering
promotion
etc
-'
74,13,880.00
6,21,320.00
~Regular
MO
12,00,680.00 1 ,20,068.00
62,13,200.00
6,21,320.00
. Junior
i Resident
.-bnef Summary of cost benefit analysos of regular Specoahst vs Senoor

~~esidents:i

--

7,46,310.00

Net
Expenditure
on pay and Variation
other
allowances
for Ten years
considering
promotion etc
1,06,05,410.00 -

7,46,310.00

76,41,228.00

Expenditure
Per
Specialist/ on pay and
other
, Resident
'
allowances
for one year
\r--c----

, Regular
Specialist
Junior\
Resident
l
~'

l24

29,64,182.00
l i '\
i I ''

Savings per
annum on
an avera ge

\-.

--

2,96,418.

~-

The idea behind introducing tenure based residency scheme is to

I provide round the clock specialty services to the needy patients and for the

l this more than 01 specialist is required.

It is pertinent to mention that while

200 bedded referral hospital has only been sanctioned 16 specialists
! including 5 super specialist posts while GNCT Delhi hospitals with only 100
I bed strength has got sanctioned posts 21 specialists. (Annexure D)

i the

iI

25

Financial Implications

Recurring Expenditure per annum on creation

26
SR .In 200 bedd ed ref erra I hosp1ta
. I WIu be as un der:Per annum
No'of posts
c ategory
expenditure
single
on

J unior Residents

s enior Residents

vera II
xpenditure

127

56

Recurring
financial
per
implication
annum
__
~ost
1 ,86,3~.600.0Q__
6,21,320.00
1,94,04,060.00
7,46,310.00
3,80,43,660.00
-~----------

In view of above factors, it is proposed that 30 posts of Junior

(non-academic)
and 26 posts of senior residents (non-

i Residents
~

30
126

of 30 posts of JR & '2.6

academic) may be sanctioned for creation at Referral hospital under tenure

based residency scheme of India, in view of day to day functional
; requirement of the hospital with an overall recurring financial implication of
3,80,43,660/- (Rupees three crore eighty lac forty-three thousand six
hundred sixty only) per annum under ITBP. There is no matching saving
for this proposal. These posts are ad-hoc in nature.
(-,~

)4!'=~:;y'\~1.3-

(Dr. A.K. Dhawan)

ADG (Medical), CAPFs, NSG & ARs

'

JS (P-11), MHA

ADG (Med) File No. 11 013/4/Estt-VII/132/2013-

el-l.,

Dated:(;~

"t

I.J