In the wake of Indian students’ return, PM Modi initiates changes; states and private sector chip in
The return of thousands of Indian medical students from war-torn Ukraine galvanized the Narendra Modi Government into action. It immediately announced a series of steps that, in the long term, would not just help the country meet such crises but also reform the field of medical education. “My effort is that every district has one medical college. Probably, there will be more doctors produced in 10 years than the last 70 years,” Prime Minister Modi said, reassuring the people of India.
Our students go to small countries despite having a problem with the language, he said. “Billions of rupees are going out of the country. Can’t our private sector come into this field in large numbers? Can’t our state governments make good policies in giving land for this, so that maximum doctors are ready with us, paramedics are ready?”
Prime Minister Modi asked while reiterating his Government’s commitment towards reforms in the medical education sector and the setting up of medical colleges.
It is heartening to note that the Government’s actions match its promises including the one to make education in private colleges affordable as can be gauged from PM Modi’s tweet, “We have decided that half the seats in private medical colleges will be charged at par with Government medical colleges.”
State governments seem to be following suit. They are taking steps to not only help the displaced students from Ukraine but also to look into what the PM sought from them. Haryana Chief Minister Manohar Lal Khattar, in a quick action, announced that medical students who had completed their courses in Ukraine will be given internship opportunities in the state.
All this was occasioned by Russia’s attack on Ukraine; it highlighted, among other things, the inadequacy of medical education infrastructure in India that forces a large number of Indian students who want to become doctors to look for education in other countries. Over the years, Ukraine and Russia have emerged as the main centers of medical education and attracted thousands of students from our country. This was the reason that among the 20,000 Indians stranded in the war-torn European nation, most were medical students.
Sadly, medical education in India has not kept pace with the growing requirements. For instance, the World Health Organisation prescribes the doctor-patient ratio to be 1:1000, whereas ours is 1:1655. In comparison, Qatar has 7.7:1000, the highest in the world. In Cuba, it is 6.7:1000, Spain 4.9:1000, Switzerland 4.0:1000, Australia 3.2:1000, and China 1.5:1000.
The Modi Government has been cognizant of this fact for some time. India aims to achieve a doctor-patient ratio of 1:1000 by 2024, Dr. Vinod K Paul, Member, NitiAayog, said in October last year.
This, however, will not be easy. According to the National Medical Commission (NMC), the top regulator for medical education, there are 605 medical colleges offering around 91,000 MBBS seats a year. Modi government has increased the MBBS seats to this number from just 54,348 in 2014. This is commendable but there is a clear dearth of seats with just 5.5% of aspirants getting admission to a medical college. About 1.6 million students wrote the National Eligibility cum Entrance Test (NEET) for MBBS admissions last year. That is, there are more than 16 aspirants for a medical seat. So, this huge demand-supply mismatch is a major cause of youngsters going abroad for a degree in medicine.
“Billions of rupees are going out of the country. Can’t our private sector come into this field in large numbers? Can’t our state governments make good policies in giving land for this, so that maximum doctors are ready with us, paramedics are ready”
The cost of education is yet another factor at play. Little more than half of the medical colleges are run by the government. The remaining are in private hands, many among which are owned by unsavory characters and powerful politicians; where there are reports of seats being sold at high prices, often as high as Rs 1 crore. But even on a routine basis, in a private medical college, a student could pay anywhere between Rs. 50 and 70 lakh for an MBBS degree.
In comparison, medical education in countries such as Ukraine, Belarus, Russia, Georgia, Armenia, the Philippines, Trinidad & Tobago, and even China is cheaper, sometimes even as low as one-third of the rates prevalent in private medical colleges in India. Further, there is no requirement of clearing any entrance examination to get admission to these medical colleges.
A medical degree from an overseas institution, however, is not enough. The returnees have to clear a Foreign Medical Graduate Examination, which makes them eligible to practice in India. Only about 10-20% of students who take this exam pass it and are allowed to join the profession in India. Yet, there is no going back on students wanting to get medical degrees from colleges abroad.
2020 saw the maximum number of students write the Foreign Medical Graduate Exam (Source: National Board Of Examination) With Indian students going to get medical degrees from colleges in foreign countries, forex reserves get adversely affected. The loss is estimated in the region at $1 billion per annum. This is based on the assumption that about a lakh students are studying overseas, each of them shelling out Rs 5-6 lakh a year. Thankfully, the private sector has been quick to respond to the Prime Minister’s call. Mahindra Group Chairman Anand Mahindra tweeted, “I had no idea that there was such a shortfall of medical colleges in India. @CP Gurnani could we explore the idea of establishing a medical studies institution on the campus of @MahindraUni?”
Gurnani is CEO and managing director of Tech Mahindra. The Mahindra University, which has a campus in Hyderabad, offers undergraduate and postgraduate courses in engineering, law, management, liberal arts, etc. Hopefully, others from India Inc. will respond positively to PM Modi’s call for improving medical education. But, as mentioned earlier, it won’t be easy. On the government’s part, it is making efforts towards upgrading many district hospitals into full-fledged medical colleges. The addition of seats requires more investment in creating requisite infrastructure, which seems to have lacked the pace needed.
A developing country like Namibia spends 9.4% of its GDP on education, but India spends only 3.5% of its GDP on education which pales against developing countries where this figure goes above 5% in most cases. Even within this, about 45% of the budget outlay is for engineering colleges like IITs and NITs, and very little is left for other disciplines including medical education.
Investment isn’t the only problem ailing the growth of medical education in India. Good quality education requires experts with deep experience and research behind them. Faculty shortage is yet another issue that needs to be tackled. It is difficult to find faculties in clinical and non-clinical disciplines. The government needs the policy to incentivize experts to teach and train future doctors to give patients in India world-class treatment. Faculty up-skilling programs also need to be introduced more aggressively.
However, the authorities concerned will have to be cautious that quality does not get compromised in an endeavor to augment quantity. In other words, capacity addition has to go hand in hand with the maintenance of standards.
At the same time, they have to ensure that regulation does not become stifling that discourages private parties from investing in medical education. With the formation of the National Medical Commission, the Government has already ensured that the institutional mechanism is in place. The private sector is also showing interest in building the medical education infrastructure. The ground is ready.
India often responds energetically to crises. The food problem of the 1960s resulted in the Green Revolution; the acute economic crisis in 1991, in liberalization. There is no reason that a similar success story cannot be repeated in the domain of medical education.
Low-cost, yes; quality, no
The National Eligibility Entrance Test (NEET), formerly the All India Pre-Medical Test, is the qualifying test for MBBS and BDS programs in Indian medical and dental colleges. It began in 2015 and is conducted by the National Testing Agency. It is a tough test. One in 16 or 17 students clear NEET. That explains the rush to overseas colleges.
Sources told Blitz India that the maximum number of students who are taking admission abroad is only because of low-cost education, not for quality medical education. Students with medical degrees from foreign colleges have to clear the Foreign Medical Graduate Examination (FMGE) that is required to get a license to practice in India. The reason is that the quality of medical education in China, Ukraine, Russia, etc., is not up to the mark. But students with medical degrees in Australia, Canada, New Zealand, the UK, and the US are exempted from FMGE.
As per the data from the National Board of Examination, between 2012 and 2018, as many as 97,639 Indians who earned their MBBS degrees from foreign universities appeared for FMGE, but only 16,097, or 16 percent, cleared it.
To improve medical education, the Narendra Modi Government replaced the erstwhile regulator, the Medical Council of India, with the National Medical Commission (NMC). The NMC was constituted by an act of Parliament, which came into force on September 25, 2020. The NMC is mandated to lay down policies for high-quality medical education and the regulations thereof. It will also ensure coordination among autonomous boards and compliance by state medical councils.
NMC: The new regulator
With the erstwhile regulator, the Medical Council of India, proving ineffectual, the Narendra Modi Government replaced it with the National Medical Commission (NMC). This was done at the recommendations of the Niti Aayog. The NMC was constituted by an Act of Parliament, which came into force on September 25, 2020.
Headed by Dr. Suresh Chandra Sharma, the National Medical Commission is a 33-member body that regulates medical education and medical professionals. The Commission grants recognition of medical qualifications gives accreditation to medical schools, grants registration to medical practitioners, monitors medical practice, and assesses the medical infrastructure in the country.
The NMC is mandated to:
(a) lay down policies for maintaining high quality and high standards in medical education and make necessary regulations;
(b) lay down policies for regulating medical institutions, medical researchers, and medical professionals and make necessary regulations;
(c) assess the requirements in healthcare, including human resources for health and healthcare infrastructure, and develop a road map for meeting such requirements;
(d) promote, co-ordinate and frame guidelines and lay down policies by making necessary regulations for the proper functioning of the Commission, autonomous boards, and state medical councils;
(e) ensure coordination among autonomous boards;
(f) take such measures, as may be necessary, to ensure compliance by state medical councils of the guidelines framed and regulations made under this Act;
(g) exercise appellate jurisdiction with respect to the decisions of the autonomous boards;
(h) lay down policies and codes to ensure observance of professional ethics in the medical profession and to promote ethical conduct during the provision of care by medical practitioners;
(i) frame guidelines for determination of fees and all other charges in respect of 50 percent of seats in private medical institutions and deemed to be universities which are governed under the provisions of this Act;
(j) exercise such other powers and perform such other functions as may be prescribed.
“I had no idea that there was such a shortfall of medical colleges in India. @CP Gurnani could we explore the idea of establishing a medical studies institution on the campus of @ MahindraUni?”