Saving the Saviours: Rethinking Resident Duty Hours in India

Introduction

The resident doctors in India often face systemic exploitation and inhumane working conditions. Despite forming a crucial backbone of the healthcare system, their labour and work remain significantly undervalued. Hospital systems are often understaffed and underdeveloped, with an overwhelming patient load due to India’s large population. As a result, all clerical and non-clerical work falls directly under the supervision of the resident doctors. The average working hours of resident doctors consist of 80-100 hours, with 36-hour shifts.

Prolonged work hours leave them with no personal time to take adequate rest, often less than 6 hours, before being called for the next shift. This leads to the development of anxiety disorder, depression, impacting cognitive abilities and hand dexterity, which can even lead to medical errors or negligence. Moreover, multiple studies shows, 53% increase in medical errors due to sleep deprivation, while significant sleep deprivation caused a 97% increase in medical errors.

Furthermore, these resident doctors are not only forced to perform a 36-hour no-rest duty but also respond to the academic pressure, which only makes things arduous. They have also been systematically ignored and neglected for many decades, with little to no improvement in their condition. From 1985 to 2026, when the demand was first raised to unify the central residency system, the Ministry of Health and Family Welfare issued Notification No. S-11014/3/91-ME(D) on 5 June 1992, which capped resident doctors’ working hours to a limit of 12 hours per day and 48 hours per week.

However, this notification stayed on paper with no real implementation and was systematically sidelined. Even in 2023, the National Medical Commission’s Post Graduate Medical Education Regulations under Chapter V 5.2 (ii) vaguely mentioned the “reasonable working hours”, with no further notification explaining what “reasonable hours” are, leaving resident doctors in a grey area, just like their protection status. The matter requires exigent attention now in lieu of a recent PIL filed in the Supreme Court by the United Doctors Front seeking swift action to provide a clear status and humane, regulated, fixed working hours.

The Inhumane Working Conditions of the Resident Doctors

Although the awareness of mental health and occupational stress has gradually increased, these issues continue to receive inadequate attention in the case of Indian resident doctors. Studies show that resident doctors are stigmatised for seeking psychiatric help. The overwork experienced by resident doctors is also rooted in the medical culture practised by senior doctors who justify 80-100 hours of work per week and 36-hour-long shifts as a tradition of the good training process. As per the MGM Journal of Medical Sciences, 74% of resident doctors admitted to working more than 24 hours continuously without adequate rest. The senior doctors delegate the majority of the workload to the resident doctors, while simultaneously engaging in private practices for additional income.

Extensive working hours and high burnout are major contributing factors in the increase of suicide rates among resident doctors who struggle to keep up with the demanding professional life. Reports on suicide rates among medical professionals in India from 2010 to 2019 reveal a total of 358 suicide deaths. These are only the reported deaths that made it to the headlines of top newspapers. India lacks comprehensive data on suicide deaths with detailed reasons and descriptions, unlike those available in developed countries. A report was released by the National Task Force in June 2024, which revealed over 150 suicides committed by medical students linked with institutional apathy and chronic stress due to excessive workload.

These reports demonstrate that the continuous exploitation of resident doctors affects their mental health and is detrimental not only to them but also to the patients they treat.  Moreover, it’s reported that high stress and sleep deprivation lead to a high risk of medical errors and negligence. Data suggests junior residents make 36% more serious medical errors, and surgical residents make twice as many technical errors due to continuous 24-hour shifts. Resident doctors receive only a modest stipend, despite all the hard work and overnight shifts, which is usually inadequate. This further adds to the mismanagement of sustaining oneself in this profession. With no clear protection and blurred guidelines, they are left to struggle on their own. Looking at the magnitude of the problem, there is an urgent need to save the saviours.

The Right to Disconnect and the Ambiguous Status of Resident Doctors

The Right to Disconnect Bill, 2025 (hereinafter ‘‘Bill’’) was recently presented in the Lok Sabha as a Private Member’s Bill by MP Supriya Sule. The Bill aims to give employees a legal right to disengage from work communications post their working hours. In the case of application to resident doctors, the first question that needs to be addressed is, who are resident doctors as per the law? Due to their varied roles, they have been left at a crossroads; on one hand, they are trainees and students, on the other, they are salaried employees and service providers of hospital ecosystems.

According to the National Medical Commission’s Post-Graduate Medical Education Regulations, 2023 (PGMER), postgraduate medical students have to work as “full-time resident doctors” who are physically present in the recognised institutions (Regulation 13). They get a stipend, have a set roster, do night duties and take emergency calls, and are always under the institution’s authority for discipline and evaluation. The nature of training for these residents is not just characteristically observational. In actuality, they render essential services in the hospitals. However, their status is never fully confirmed because it remains tethered to academic enrolment. Even their remuneration, in terms of stipend, is assumed to be a part of this exact training. Most importantly, their progression is not linked with contract renewals but with passing of examinations.

This hybrid role has led to a lot of confusion in terms of the protections that may be available to such residents. Nevertheless, it is important to note that courts have treated resident doctors as subjects whose working conditions are subject to judicial scrutiny. For instance, the ongoing case of United Doctors Front v. Union of India before the Supreme Court, which seeks to enforce time limits for resident doctors’ duty hours, rests on the underlying assumption that they have the right to decent working conditions,  not merely academic safeguards.

However, the Bill specifically applies to ‘employees’ of companies and societies. Resident doctors are remunerated, carry out their assigned work under supervision, and are controlled within an institutional framework. By way of a purposive interpretation, especially with regard to the regulation of working hours, they can be considered as employees for whom the Bill provides protection; that said, such status endowment inherently lies in the grey area and is subject to contestation.

Even after presuming their conflicting status to be akin to an ‘employee’ designation, the framework of the Bill does not fit well with the nature of residency. The Bill operates on the basis of clear (Clauses 7-10) work hours, negotiated windows for contact (Clause 9), and a right to refuse after-hours communication disregarding disciplinary action in that regard (Clause 7(b)).

Residency, on the other hand, entails working according to rotating rosters, being on-call, and attending to emergency patients, which often extends beyond regular working hours. Reports of doctors being on duty for extended periods show that such emergencies are one of the ways hospitals operate, discrediting such incidents as being merely episodic or exceptional. Moreover, the Bill gives flexibility to encompass urgent requirements of presence to be dictated by a ‘Charter of Individual Entity’. This is to be reached by a mutual agreement between the employer and the employee to determine the hours outside of work, when work-related contact can be established (Clause 8). This framework, however, fails within hospital hierarchies. This is because the underlying assumption of bargaining parity is negated in such structures, where the residents are evaluated by seniors, and their advancement depends upon institutional recommendation.

The Bill seems to be a progressive step in such work cultures where the work cycles are usually predictable, and employment relations are rather horizontal. This falls in contrast to the core nature of residency that operates primarily on emergency spillovers and rigid command structures. With deeper analysis, it can be inferred that peculiar conditions of residency not just result in ambiguous statutory coverage but rather represent a greater, but covert, incompatibility of the Right to Disconnect framework itself.

Comparative Regulation: Industrial Embedding vs. Residual Safety Governance

Australia gives a plausible model for solving the complexity at hand. The model explicitly terms the residents as ‘employees’ in the Medical Practitioners Award 2020 (hereinafter “Award”) determined under the Fair Work Act 2009. The award clearly draws out the working hours and also devises overtime multipliers, rostering arrangements, and minimum rest breaks. The essential thing to note lies in the fact that this award is not merely advisory in nature, but rather acquires a binding enforcement before the Fair Work Commission. Herein, as working time becomes part of wage-setting machinery, fatigue automatically becomes controlled by cost-internalisation.

The rationale of India’s Occupational Safety, Health and Working Conditions Code, 2020 (hereinafter “OSHWC”) differs from the above-mentioned Award. It is a general safety statute for workers, who are defined as persons engaged in skilled or technical work for hire or reward. By this criterion, residents do not emerge as a natural fit for that category. The applicability, though debatable, cannot be guaranteed owing to several reasons. The residents are engaged through postgraduate medical education regulations, and their stipends are considered as part and parcel of their training. This leaves their status oscillating between the labels of students and that of service-providers. Moreover, the void becomes all the more visible with lack of any authoritative judicial determination about resident doctor protections under the Code.

Even if residents were to be considered as workers, OSHWC still falls behind when it comes to actual enforcement because it is structurally a misfit for the medical field. Firstly, the Code is framed in accordance with a traditional shift-based work arrangement model. However, the residents coordinate their work through rotations and sudden emergency cases, which often overlap between academic and clinical arenas. Although the Code lays out maximum daily and weekly work hours, it fails to account for legal implications in the case of on-call time and continuous patient care, leading to cumulative fatigue.

The juxtaposition of differential treatment of the same concern becomes glaringly stark in both countries. Australia places junior doctors in a special industrial regime that primarily considers them as employees and furthermore controls working time by means of binding wage instruments. India, on the other hand, treats resident labour as an element of a residual occupational safety framework, the extent of which is doubtful, and the very design is inappropriate for hierarchical and emergency-driven clinical systems.

Conclusion and Reform

India’s resident duty hours regulation is not entirely dormant but remains structurally inchoate. This vagueness lies within an even deeper classificatory ambiguity. Resident doctors are abandoned in law because of their conflicting status. Therefore, making the ascertainment of their working-time difficult, it is doubtful that the OSHWC, which covers workers, can be used to protect them. Although state-level initiatives are indicative of the authorities’ readiness to take action, these actions are still occasional and have no legal basis of country-wide consensus.

Therefore, the reform must be industry-specific rather than a sole continuation of the general safety provisions. Firstly, PGMER should consider changing the phrase ‘reasonable working hours’ to a clearly defined maximum average weekly limit, for instance, 48 hours within a reference period, along with obligatory daily and weekly rest breaks. The European Working Time Directive offers a tried and tested framework for drawing up such limitations without compromising the training requirements.

Secondly, there should be insertion of a clarificatory provision, either through an amendment or a delegated notification, to explicitly include resident doctors within the protections of strictly limited statutory working-time regardless of the trainee designation. Such a clarification is necessary as it serves a dual purpose: first, it resolves the doctrinal confusion surrounding the status of resident doctors, and secondly, it activates the right to enforce such protections explicitly.

Thirdly, only industry-specific regulations can determine the appropriate legal treatment of on-call time and emergency spillovers. These rules, likewise, should also define the consequences for breach, encompassing the wage-based disincentives. Australia’s Medical Practitioners Award 2020 works as a prime example of how a clearly defined working-time framework can become a legally binding mechanism in medical training situations. This can help streamline rostering, overtime, emergency requirements, and rest periods.

Finally, there must be an independent monitoring and complaint mechanism in place. It is of utmost importance that the same remains outside of the hospital hierarchy. It is because the residents are assessed by the same authorities that decide their rosters. This external forum or regime may set up a specified number of audits for checking compliance and ensuring enforceability. Such an arrangement would ensure that the grievances are addressed to an impartial body, thereby mitigating the conflict of interest inherent in hospital hierarchies.

Though constitutional protections under Articles 21 and 23 of the Constitution of India remain to work independently of any specialised labour protection, without fixed limits, conversion rules, and sector-tailored enforcement, resident duty hours will continue to be managed from the perspective of the institutions, and goodwill of the organisations, rather than being driven by strict legal implementation.

---

This article has been authored by Sirjandeep Kaur and Lakshita Agarwal, Associate Editors at RSRR. It is a part of the RSRR Editor's Column Series.