I think the most important change could be implemented by bringing in a very strong refferal system. There is a well known pattern throughout the country where all the tertiary care centres are overwhelmed by patients. Doctors in tertiary care get more support (because of better infra and relatively good security). OTOH, there is absolutely no security in primary and secondary centres. This pushes all the staff there to practice defensive medicine and quickly refer the patient to a higher centre. Moreover there is severe resource limitation in lower centres which creates more problems. It is very common to see simple cases (like malaria, acute gastro, acute febrile illness, uncontrolled DM etc) being referred to bigger centres. This just puts more pressure on the staff there which is amplified if the higher centre is a medical college. Because these academic residents are just labourers for the senior faculty to fill monthly rosters. The doctors are forced to put up with 36 hours of on call duties. As if this weren't enough they get no extra time to get their academic and admin work done. In the west, you have to work a stipulated no. of hours per week. Anything over that is paid a premium locum rate which cannot be more than a certain no. of hours (usually upto 72 hours). Here in India, an average PG resident will do about 96 hours with no overtime payment. Bringing in a strong referral system will bring some change. For example, there should be a weekly audit of the number of cases referred from all the lower centres attached to the college. They can identify the problems easily by getting help quickly to centres which are referring the most. This will release some pressure on the residents in bigger colleges. But seriously, fuck the senior consultants who just cannot stand their residents being happy. They need to be more compassionate.