Hyderabad: Telangana’s Directorate of Services Health (DSH), which now oversees the state’s secondary healthcare system after its recent transformation from the Telangana Vaidya Vidhana Parishad (TVVP), is grappling with a severe staffing crisis, with 55% of doctor posts lying vacant. Of the 4,347 sanctioned posts, only 1,968 are currently filled, leaving 2,379 vacancies. This means that more than one in every two specialist positions in district and area hospitals remains unoccupied, significantly impacting healthcare delivery across the state.
Health experts said district hospitals are operating at less than half their sanctioned strength, placing enormous pressure on existing doctors and compromising access to care, particularly in rural and semi-urban areas. On World Health Day, the state govt is set to appoint 866 doctors, including 174 assistant professors and 692 civil assistant specialists (CAS). However, health experts cautioned that the recruitment drive may fall short of addressing the deep-rooted shortages. They pointed out that even if all 692 specialist posts are filled, 721 vacancies would still remain, indicating progress, but not resolution.
Overlapping recruitment
At the core of the issue, experts said, is a structural flaw in the recruitment process that has been repeatedly flagged but remains unaddressed. The 692 civil assistant specialist posts under DSH and the 174 assistant professor posts under the Directorate of Medical Education (DME) are being offered on the same day and in the same departments, with most candidates applying for both.
“Most aspirants have applied for both posts. If appointment orders for both assistant professors and CAS are issued simultaneously, the same candidates may receive orders for both positions,” said Dr Karthik Nagula, president of the Healthcare Reforms Doctors Association (HRDA).
Experts noted that assistant professor roles typically offer clearer career progression and higher professional standing, making them more attractive. As a result, many candidates are likely to opt for these posts and decline the CAS roles. “Candidates who secure assistant professor posts are likely to choose them, leading to CAS posts remaining vacant,” Dr Nagula said, estimating that over 100 positions could go unfilled due to the overlap.
Experts warned that this could significantly affect patient care and delay efforts to strengthen healthcare delivery in critical departments. Dr D Srinath, president of the Telangana Senior Residents Doctors’ Association (TSRDA), said the issue has been raised multiple times but continues to persist. Experts also flagged concerns that issuing both appointment orders simultaneously could result in avoidable vacancies, raising questions about the efficiency of the recruitment process.
Impact on patients
The consequences of these vacancies are most visible in rural areas, experts said. Primary Health Centres (PHC) and Basti Dawakhanas are largely staffed by MBBS doctors, who refer patients requiring specialist care to district hospitals. However, the absence of specialists at these facilities creates a major bottleneck. “If specialists are not available at district hospitals, it becomes a serious problem, especially for poor patients who cannot afford to travel to Hyderabad for treatment,” Dr Nagula said.
He added that, ideally, patients should receive care at secondary-level centres and be referred to tertiary hospitals only when necessary. Weak infrastructure and staffing shortages at this level disrupt that chain, placing an additional burden on higher centres and patients alike.
Suggestions for reform
In March, health minister C Damodar Rajanarsimha told the legislative council that around 10,000 posts across all health cadres had been filled over the past two years, with recruitment for over 7,000 more in the final stages. However, doctors and health experts have called for an integrated counselling process, allowing candidates to indicate their preference between assistant professor and the CAS positions before appointment orders are issued.
“If a candidate opts for one role, they should be excluded from the other to prevent duplication and ensure all vacancies are filled efficiently,” health experts suggested. Other recommendations include issuing appointment orders in phases, implementing an annual recruitment calendar, coordinating hiring across departments, and shifting from contractual to regular appointments to improve retention.
While the upcoming recruitment drive marks a step forward, experts stressed that without structural reforms, Telangana’s secondary healthcare system may continue to face critical gaps in staffing and service delivery.
