Featured Analysis

Residency in Nepal
A Training or an Exploitation?

Medical residency is supposed to represent the most important phase of a doctor’s professional transformation. After years of medical education, a resident doctor enters the hospital not only as a learner but also as a physician responsible for patient care. It is the stage where knowledge meets real clinical responsibility.

However, in Nepal, the experience of resident doctors has become a subject of serious debate. Are residents receiving structured postgraduate training, or has the system turned them into an overworked workforce under the label of “Medical Students”?

8 min read
MedicoNepal
2083 Ashadh 12
Editorial
Residency in Nepal

The Reality of backbone of Nepal’s hospitals:

Resident doctors are among the most important groups working inside Nepal’s hospitals. They are present in government hospitals as well as medical college hospitals, managing patients, assisting senior doctors, handling emergencies, and continuing hospital services. As described by doctors involved in recent discussions, hospitals heavily depend on resident doctors for daily functioning. They are often the first doctors who examine patients, provide emergency care, and remain involved in continuous patient management.

Yet despite this responsibility, their position remains complicated. They are legally considered students, but their daily duties resemble those of full time doctors. This contradiction has become the centre of the ongoing concern.

When training becomes endless duty:

A major complaint raised by resident doctors is the extreme workload during residency. Doctors have reported working continuous shifts lasting 36 hours and, in some situations, even longer. Many have described weekly workloads reaching around 100 hours.

The issue here is not only the number of working hours but also the impact on learning and wellbeing. Residency is supposed to be a period of advanced training, academic growth, and development of specialist skills. But when doctors spend most of their time covering hospital duties, questions arise about whether they receive enough time for study, preparation, research, and rest.

The experience described by one resident physician tells us about the physical toll of such schedules. After completing a prolonged duty, he recalled waking up believing it was morning, only to realize he had slept through the evening after returning from a 36-hour shift. He described feeling feverish, physically exhausted, with swollen feet, burning eyes, dizziness, and overwhelming fatigue, yet having to return for conferences, rounds, and another duty soon afterward. During busy rotations, residents may barely find time to rest, eat, or reply to family and friends.

One resident doctor described avoiding a specialty choice because of the fear of having to endure extremely long duties during residency. The concern is simple: a doctor who is exhausted from continuous duty may struggle to learn effectively.

The financial contradiction:

Another major issue raised by resident doctors is the difference between their workload and their financial support.

According to reports, resident doctors in private medical colleges have received stipends that doctors argue do not match their responsibilities. Some reports mention monthly payments around Rs. 25,000–35,000 (in some Private Medical Colleges even after official agreement for government level stipend) or Rs. 48,000 as per government scale.

At the same time, postgraduate medical education requires doctors to invest significant time and effort. This creates a difficult situation: doctors who have already completed years of medical education find themselves working intense hospital duties while receiving compensation they consider insufficient. The argument raised by doctors is that residency is not simply classroom learning. Residents actively contribute to patient care and hospital services.

The problem of being called only a student:

One of the strongest criticisms from resident doctors is the classification of residency itself. Doctors argue that calling them only “students” ignores the reality of their role.

Because, a resident doctor is not only reading textbooks. They examine patients, make clinical decisions under supervision, participate in emergencies, and contribute directly to healthcare delivery. Because they are placed between student and employee status, many believe they fall into a gap where they carry professional responsibilities without receiving equivalent recognition.

As one may argue that the doctors should not be treated as students merely to avoid recognising their labour.

The personal cost of residency:

The pressure of residency is not limited to working hours. Doctors have spoken about mental stress, sleep deprivation, and emotional exhaustion.

Medical professionals have also highlighted concerns regarding psychological pressure during training, including situations where doctors feel trapped because leaving residency may involve financial penalties or career consequences. For many young doctors, residency becomes a period of sacrifice; it could be missing festivals, family events, and personal time.

For a resident doctor, important moments such as Dashain and Tihar celebrations often become difficult because hospital duties continue. The reality of medical service is that illness does not follow holidays. Hospitals must function. Patients require care. But doctors argue that service should not mean ignoring the basic needs of those providing that service.

Maternity leave and workplace rights:

Another concern is the lack of adequate leave provisions for resident doctors, particularly female doctors. Reports have highlighted situations where female residents continue their demanding training without proper maternity leave arrangements. Doctors argue that postgraduate medical training should respect basic workplace rights, including maternity protection and reasonable working conditions. They emphasize that becoming a specialist should not require sacrificing fundamental rights.

Why doctors are leaving Nepal:

The struggles faced during residency are connected to a larger issue: doctors leaving Nepal. Many young doctors describe frustration with low pay, limited career growth, difficult working environments, and uncertainty about the future. Some doctors who complete their obligations in Nepal eventually seek opportunities abroad, where they believe they can find better professional growth, working conditions, and recognition. The concern raised by Doctors is that Nepal invests years in producing doctors, but the system fails to retain them. When doctors leave, the healthcare system loses experienced professionals.

Senior Doctors and their opinions:

Senior consultant doctors express their views on residency working hours, and let me tell you; it primarily isn't supportive. They argue that since they used to undergo intense and harsh residency training with no virtual breaks, it is completely doable and the new generation doctors should follow the same. They have an inclination towards a common thought "the more you break during residency, the better consultant you'll be".

But do all senior consultants say so? No. Absolutely not. There are others that suggest redevising the residency program according to the generational need and scientific duty norms. And, for those doctors, I personally have immense gratitude. The chain breakage of "I did it, so you should be able to do it" from those senior doctors will always be appreciated.

Let me make this unpleasantly clear. A senior, no matter the field; if he says "I suffered this, so you should suffer too" will never be a good senior. At least, not in 2083!

How is it in the West?

According to the ACGME, which sets standards for accredited residency programs in the United States, residents may work up to 80 hours per week, averaged over four weeks. A resident may provide up to 24 consecutive hours of clinical care, with an additional up to 4 hours permitted only for patient handoffs, documentation, and educational activities—not for accepting new patients. Residents should generally have at least 8 hours off between scheduled shifts, and after a 24-hour in-house call they must receive a minimum of 14 hours free before returning to work. They are also required to have one full day free of all clinical and educational responsibilities every seven days, averaged over four weeks, and overnight in-house call should occur no more frequently than every third night, also averaged over four weeks.

The demand for reform:

Resident Doctors have been raising complaints and demands since some time. Approximately a year ago, Nepal witnessed a nationspread Doctor's protest for same stipend across all hospitals, for which a final agreement was made, and the resident's salary was equally government level for all private and government medical colleges.

With this, Now, Residents are aggressively demanding a scientific duty hours, suitable enough to not let residents burn out, and include their training exposure in a balanced way. The central demand is that residency must become a genuine training system rather than a system dependent on overworked doctors.

So, Training or exploitation?

Residency will always be demanding. Medicine itself requires dedication, discipline, and sacrifice. Doctors understand that hospitals cannot stop functioning. Patients cannot wait. But the debate in Nepal is not about avoiding hard work. It is about whether the current system creates better specialists or simply depends on exhausted young doctors to keep hospitals running.

A resident doctor should graduate with knowledge, skills, and professional confidence; not burnout and disappointment. The future of Nepal’s healthcare system depends not only on producing more doctors but also on creating an environment where doctors can learn, work, and remain committed to serving the country.

We hope the government and the medical authorities devise a systemic and scientific training hours, applicable according to the speciality demand that protect's resident's mental and physical health, and also get enough for a sufficient training and exposure.

Editorial Note: This article is written by MedicoNepal with ideation from the articles mentioned below. The residency struggles and relevant information presented in this article are informed by personal experiences, discussions with resident doctors, and the referenced articles.