IIn India, the internship—known as the Compulsory Residential Rotatory Internship (CRRI)—is a one-year training period after medical school. Interns rotate through major departments to gain experience and earn their medical license.

After completing my medical studies in Ukraine and passing the Foreign Medical Graduate Examination in India, I joined a prestigious medical college for my internship. Excited to start, I knew little of the challenges that lay ahead.

My First Posting: Dept ‘O’
Assigned to the department ‘O’ for a month, we were two interns rotating duties. This meant picking up the duty phone at 7 a.m., working nonstop until 7 a.m. the next day, handing over the phone, continuing to work during the day, and finally resting around 6 p.m. The cycle repeated the next day, effectively making it a 36-hour duty. The real test came when one of us had to attend a week-long palliative care training, leaving the other to handle a 7-day continuous duty alone.

During those seven days, I was responsible for:
Sending blood samples early in the morning.

Arranging blood for surgeries.

Preparing the ward for grand rounds, including updating investigation sheets and ensuring hand sanitizers were at each bedside.

Preparing PowerPoint presentations on medical topics – for which I got an appreciation I still cherish

Responding to frequent calls from residents and ward staff.

Running to the casualty ward to assist with patient procedures.

Transferring instruments and arranging blood for night surgeries.

Inserting urinary catheters, and acting as a liaison between staff and residents.

There were no official breaks, no sleep time—nothing. By the seventh day, I developed a bad cough. That night, my senior asked me to hand over the duty phone. Reluctantly, I did. I slept that night and started my next rotation in the department ‘E’ the following day. Feeling dizzy, I asked for a half-day leave, but my request was denied. The Head of Department told me, “Since you are feeling better sitting, you can sit and see the patients.”


Looking back, I lost 10 kg during the first 30 days of my internship. Both soles of my feet were torn, and I could barely walk. However, I’m proud of that week. It gives me the strength to tackle any task today. Whenever I face something difficult, I remember that week and think, “Compared to that, this is nothing.” And, when I dislocated my knee a few years later, the same department took such good care of me.

Fast forward 4 years, I got a chance to do my postgraduate studies in Radiology in Christian Medical College, Vellore. Things were quite different this time around. I was asked to sit and speak to a consultant. The politics of making the resident sit in the first year itself can take up an article, as this is still not practiced in many departments and institutes in India. During my residency, except for a few postings, the work time was fixed – around 8 hours a day, and I had a week off. Prescribed leaves could be taken any time of the year and it had to be written in a diary and no one asked why I was taking that leave. Residents were treated with respect, duty rooms were there and the general conversation itself was very cordial. We had conferences, festivities and celebrations round the year and there were feedback sessions every few months with the head of the department. This culture helped us grow, and in turn made us treat our juniors well when we became seniors. So, if a good culture and environment can be instilled in a workplace, chances are that it will be followed for years to come.

Has Anything Changed?
Curious to see if things have improved in the past few years, I asked Muthu, currently an intern in a medical college in Puducherry, about his experience.

A Gruelling Internship
“My internship has been challenging, with long, continuous duties that can stretch up to 36 hours, often without proper rest facilities or hygiene standards. Limited access to essential protective gear, like gloves, adds further strain. Attendance policies are also a burden, expecting us to clock in on a usual schedule despite an irregular work cycle, making adequate rest difficult. I believe improvements are needed: after a 24-hour shift, interns deserve a day off, adequate refreshment breaks, and set meal timings. Enhancing these aspects would make a significant difference in maintaining both our energy and effectiveness as interns.”

A Comparison with the United States
Wondering if this situation is unique to India, I reached out to my friend Dr Sneha, who completed her postgraduate studies at a leading institute in the United States.

Sneha’s Experience
“My usual day starts at 7 a.m. and ends at 5 p.m. I have on-call duties once or twice a week, from 7 a.m. to 8 p.m. They give preference to work-life balance! It’s not easy, though, as days are hectic.

For me, electronic documentation was time-consuming. Sometimes, the time spent on a patient is less than the time spent typing their history. Dictation software was available but not on all computers, and it didn’t always understand our pronunciation, which made the job twice as difficult. Maybe now things are easier with updated computers and softwares. One good thing is we had mandatory weekdays off and two weeks of vacation per year, which isn’t common here.”

Voices from Medical Associations
To understand the broader issues, I spoke with Dr. Jeban Bruce MD, Joint Secretary of IMA Marthandam, and Dr. Shanthi A.R., Secretary of the Doctors’ Association for Social Equality (DASE).

Dr. Jeban Bruce Highlights Key Issues

Uniform Distribution of Colleges: India has 726 medical colleges, mostly clustered in the South. The doctor-patient ratio there is approximately 300:1, exceeding the WHO recommendation of 1000:1. This makes job opportunities challenging for new interns. Uniform distribution of colleges would help.

Central Cadre of Medical Officers:
Proposes annual recruitment of medical officers to serve in remote areas with doctor shortages.

Opposition to the National Exit Test (NExT):
The proposed NExT exam questions the academic standards of the National Medical Commission (NMC) curriculum. Instead, the NMC should focus on surprise inspections and strict monitoring of colleges.

Safety and Well-being of Doctors:
Junior doctors and interns are vulnerable to violence. Ensuring efficient work schedules, safe shelters, mental health counseling, and career opportunities is essential.

Higher Budget Allocation:
Public health is crucial, but the central government allocates only around 1% of GDP, much lower than in developed countries.

Reinstatement of Indian Medical Services (IMS) Cadre:
Health care administration should be led by professionals with medical knowledge and administrative skills.

Fixed Schedule for Examinations:
Unpredictable and delayed exams jeopardize medical education for young interns and postgraduates.

Dr.Shanthi A.R. Addresses Safety and Work Conditions

Unsafe Working Environment:
Medical students face long hours, unrelated work assignments, and abuses.

Formation of Security Teams:
Hospitals should have dedicated security teams to protect interns, residents, patients, and staff.

Internal Complaints Committees (ICC):
Institutions should have an ICC to address sexual harassment, with members’ names and contact information displayed prominently.

Work Environment Improvements:
The NMC studied and came out with the fact that these young doctors are having mental stress. In Spite of that, NMC recently said that the PG Residents can be allowed to work for 72 hours in a week, and not more than 24 hours at a stretch. This should be changed and the residents should not be made to work more than 8 hours per day or 48 working hours per week. They should be provided eligible leave and compulsory weekly offs.

Abolition of District Residency Program (DRP):
The DRP forces residents to serve in new places without proper facilities, affecting their safety and academic schedule.

Stipends and Safe Hostels:
Residents should receive adequate stipends on time, and hostels should be safe and near the campus.

Formation of Welfare Boards:
Demand for welfare boards for doctors and medical students at state and national levels.

Mental Health Concerns
Dr. R. Dhivya Karoline MD, a consultant psychiatrist practicing in Tirunelveli has this to say about the mental well-being of trainee doctors in India.

Dr. R. Dhivya Karoline MD on Mental Health
“In this modern era, the working environment for postgraduate residents poses many threats to their mental health. Work hours are ill-defined, and residents are expected to be available round the clock. Responsibilities are huge, and any error is not tolerated. Work-life balance is poor, especially for those who are married or have children.

“Improper sleep, poor eating habits, less physical activity, less leisure time, low pay, and fewer benefits contribute to their stress. Residents are not immune to mental illness; depression is a major reason for suicides among medical professionals. The stigma even among medical professionals makes it harder for those in need to seek help.

“Simple measures can help: regular surveys on mental health, approachable seniors, adequate rest, avoiding back-to-back on-call duties, stress management workshops, and fostering a supportive environment.”

What should be done?
There’s much room for improvement in the working conditions of interns and residents in India. It’s essential for the National Medical Commission, along with the central and state governments, to take steps to ensure a safe and healthy working environment for our future doctors. More than these, there should be a movement within the healthcare community to treat the interns and residents with dignity and respect and an overall change in the attitude and mindset of the doctors in the community to achieve this.