Private Practice or Public Duty? Rajasthan Draws a Clear Line for Medical College Heads
Some healthcare professionals may feel that banning private practice reduces financial opportunities for senior doctors who have spent decades building their reputation. Others may argue that teaching duties are an essential part of medical leadership and restricting them could distance administrators from academics.
Private Practice or Public Duty? Rajasthan Draws a Clear Line for Medical College Heads
The landscape of healthcare administration in India is shifting, and Rajasthan now stands at the center of a decisive move that signals how state governments are beginning to rethink medical leadership. The Rajasthan government has introduced firm guidelines that ban private practice for principals and superintendents of government medical colleges and their affiliated hospitals, pushing senior medical administrators towards a future where leadership is treated as a full-time responsibility rather than an additional duty. As patient numbers grow, disease patterns shift rapidly, and the expectations placed on government hospitals multiply every year, the state appears to be asking a simple but uncomfortable question. Can anyone truly lead a large medical institution while dividing their time between public duties and private practice? This question has been circulating for years, but it takes a bold step to draw a hard line, and Rajasthan has done exactly that.
According to the Rajasthan Medical Education Department, the decision is intended to ensure that those who stand at the top of the healthcare pyramid give uninterrupted focus to managing institutions that increasingly resemble bustling cities in themselves. Government medical colleges today handle complex clinical workloads, tight academic schedules, major hospital expansions, and the constant pressure to meet the standards set by the National Medical Commission (NMC). In such an environment, the state believes leadership must stay present, visible, and deeply involved. The new guidelines also clarify that principals and superintendents will not be permitted to spend more than a quarter of their work time on teaching duties. Even though teaching is at the heart of medical institutions, the state argues that top administrators must have the space to think, plan, execute, and respond to the daily challenges that shape the delivery of healthcare services.
Medical Education Secretary Ambrish Kumar emphasized this reality in his conversation with the media, explaining that medical colleges need leaders who treat their administrative roles with full commitment instead of juggling multiple professional pursuits. His remarks echo a sentiment shared by many healthcare professionals who have seen firsthand how administrative gaps can slow down patient care processes, delay decisions, and affect the functioning of clinical departments. For years, medical leadership has been viewed as a position that doctors “take on” rather than “grow into,” creating a structure where some of the most crucial decisions are made by professionals who are stretched across multiple responsibilities. Rajasthan’s latest guidelines seem to challenge this long-standing tradition by insisting that leadership demands undivided attention, especially when public healthcare institutions are expected to meet rising demands with limited resources.
As the state moves towards this new model, the guidelines present a detailed framework for selecting principals and superintendents. Eligibility requires candidates to be senior professors who comply with NMC norms, ensuring that leadership is entrusted to professionals with academic strength, clinical experience, and institutional understanding. Interestingly, if a suitable candidate is not available within the same college, applications will now be invited from other government medical colleges.
To maintain fairness in appointments, the selection process will be conducted through an interview led by a committee headed by the Chief Secretary. Transparency has been a long-standing demand within medical governance discussions, and a senior-level committee adds credibility to the process. The government has set the maximum age limit at 57 years, signaling that leadership must be handled by professionals who still have the energy to navigate the continuous demands placed upon them. Experienced candidates are expected to have at least three years of work as a superintendent or additional principal and two years of experience as a head of department. These requirements create a leadership pipeline where administrators have spent meaningful time at different rungs of institutional responsibility before taking charge of an entire college or hospital.
The appointment period will be for three years initially, with extensions depending on performance. This performance-based approach hints at a future where accountability becomes a natural part of medical administration. It sends a message that leadership positions are not ceremonial posts but dynamic roles that require tangible contributions. Administrators cannot take their responsibilities for granted, as their continuation depends on measurable work. The state appears to be trying to shift the culture from one of static authority to one of continuous leadership evaluation. In the healthcare sector where outcomes depend on the quality of decisions made at the top this move brings administrative discipline and patient-centric accountability into stronger focus.
The guidelines also clarify the role of additional principals, with each institution permitted to have a maximum of five. Their duties cover academic operations, research coordination, and clinical services management. This structure distributes responsibilities across multiple senior administrators instead of concentrating power and workload in one office. For large medical institutions, this kind of functional division is not a luxury but a necessity. Patient care cannot be compromised because a single administrator is overwhelmed. Medical colleges are now being recognized as institutions that require teams, not solitary leaders running from office to wards to seminars in a continuous loop of overwork.
From the viewpoint of hospital management, the new guidelines align with the need to improve operational efficiency. As the healthcare sector becomes more technology-driven with electronic health records, digital monitoring, automated systems, and structured quality evaluation, leaders need time and clarity to understand and adopt these tools. Managing a modern hospital requires daily oversight of emergency care, ICU functioning, biomedical equipment, diagnostics, manpower deployment, procurement cycles, infection control, and patient safety audits. These responsibilities are not minor. They demand leaders who remain available throughout the working day, capable of taking decisions at the moment they are needed. Healthcare rarely waits for anyone, and medical leaders cannot treat administration as an optional activity.
However, it is important to acknowledge the concerns that may arise. Some healthcare professionals may feel that banning private practice reduces financial opportunities for senior doctors who have spent decades building their reputation. Others may argue that teaching duties are an essential part of medical leadership and restricting them could distance administrators from academics. These concerns deserve honest attention. Leadership roles must be attractive enough to draw capable professionals who bring passion, discipline, and insight. States will need to ensure that administrative compensation and working conditions reflect the demands of these roles. Without proper support systems, overburdened administrators may struggle to maintain enthusiasm and efficiency. Medical governance reforms must be paired with staff support, adequate resources, and infrastructure improvements.
In a world where healthcare demands rise every single day, leadership must rise with it. Rajasthan has taken a firm step in that direction, urging the rest of the country to reflect on what it truly means to lead a medical institution and what price leaders must be willing to pay for the privilege of being at the helm of public healthcare.
Sunny Parayan
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