Open Forum
New Delhi, 30 March
2022
Medical
Education
MORE
SEATS, DOCTORS CRITICAL
By Dr
Oishee Mukherjee
The Modi government
has taken a number of steps to increase medical seats as well as availability
of doctors in the country. This is an assertion by Union Health Minister Mansukh
Mandaviya to the Rajya Sabha recently in reply to a written question. He said:
number of under-graduate medical seats increased by 75 percent in the past
seven years to around 89,875 in 2021-22 from 51,348 before 2014, while that of
post-graduate seats have risen by 93 percent i.e. from 31,185 seats to 60,202 during
the same period. However, the question that needs to be addressed is what about
the commercialisation of medical education which has accelerated and needs to
be checked.
At the same time, while
it’s encouraging that medical seats have risen, these continue to be meagre
compared to the increasing number of students opting for the profession. Subsequent
governments have also not taken cognisance of the fact that with the disease
quantum increasing rapidly as well as different types of bacteria affecting the
human body, there is need to increase the number of doctors significantly even in
the short term.
The steps taken to
increase the number of medical seats, as per the government, include a
centrally-sponsored scheme for establishment of new medical colleges by upgrading
district/referral hospitals, under which 157 new medical colleges have been
approved and 71 are already functional.Additionally, there is a centrally
sponsored scheme for strengthening or upgradation of existing State or
Central government medical colleges to increase the MBBS and PG seats, and a
central sector scheme for upgradation of government medical colleges by
construction of super specialty blocks.
A total of 75
projects have been approved and 55 completed. Under the Central sector scheme for
setting up new AIIMS, 22 AIIMS have been approved and under-graduate courses
have started in 19 of these. Further, for rapid growth in the number of allied
medical seats, the National Commission
for Allied and Healthcare Professions (NCAHP) Act, 2021 has been enacted and an
interim commission been notified.
Way back in 2018, the
Union Cabinet had approved a Rs 10,700 crore plan for 24 new medical colleges
with 10,000 under-graduate and over 8000 post-graduate seats. The Health Ministry
had earlier implemented a plan to set up medical colleges attached to 58
district hospitals.
Recently, the
National Medical Commission (NMC), the apex regulatory body for medical
education and ensuring lower the cost of medical education to encourage more
students to pursue careers in healthcare, announced that half the seats in
private medical colleges will be charged at par with government medical
colleges. If implemented, nearly 22,000 seats would become more affordable and
if added to over 46,000 government college seats would take the total number of
relatively affordable seats to over 68,000 or about three-fourths of the 90,675
MBBS seats currently available.
However, while the NMC,
has also laid down guidelines for fee fixation for remaining 50 percent, the
Act does not allow regulation of 100 percent. Even before the NMC’s decision,
most States already had fee regulatory committees headed by retired high court
judges to fix fees for private medical colleges. But this did not cover deemed
university medical colleges, which evaded regulation with court orders
upholding their position that State committees have no power over them being
directly under the UGC.
The NMC proposal may thus
motivate private medical colleges to charge whatever they wish for half the
seats. Members of the All India Forum Medical Graduates estimated given the
high costs, about 30,000 to 40,000 students enrol annually in under-graduate
courses in Russia, Belarus, Ukraine, China and other countries. Private
colleges in India charge MBBS students around Rs 10 to Rs 16 lakh fees annually
across the five-year course, whereas students pay about Rs 30 lakh for the entire
MBBS course in the above countries.
The government’s
response to this is that while large number of Indian students go abroad to
pursue MBBS and obtain foreign medical qualifications, they still need to clear
the Foreign Medical Graduate Examination to be registered as a medical
practitioner in the county. The question being why not have a fee structure
which dissuades students from studying abroad?
Besides, it has come
to light that State regulatory committees are quite ignorant what fee is
actually taken by private medical colleges. Though they may charge say around
Rs 20 lakh officially, it is learnt that students may have to cough up couple
of more lakhs to get a seat. The undersigned was informed by a student that the
only private medical college in Kolkata refused to accept the test he had taken
and sought a total of Rs 80 lakh for getting admission to an MBBS course! A
survey by the Health Ministry would do well to get a reality check.
Besides, it’s
critical that deserving candidates get access to these seats and that private
medical colleges are checked from ‘selling’ seats by ensuring strict
regulations and vigil. Moreover, big hospital groups must be asked to start
medical colleges attached to their hospitals. If the government offers land at
subsidised cost, another 5 percent seats should be reserved for the State
government at these colleges as per government rates.
Another anomaly that
needs to be checked is that number of private dental colleges in States are not
paying post-graduate students the mandatory stipend and force them to give false
statements of having been paid a certain amount. Students obviously would fear
repercussions if they reported the matter.
Insofar as doctors’
shortage is concerned, the projected increase is not enough in the near future.
The government needs to do more. For example dental students could be vested
with all powers as MBBS doctors, while those who have completed say four years’
education should be sent to rural areas to practise. An analysis has shown that
there is an acute shortage of doctors there and only 40 percent of MBBS seats,
almost all of these in government colleges, is affordable to a small segment of
rural families. The annual expenditure of the bottom 80 percent of families was
compared to the annual tuition fees for MBBS seats. Fees that amounted to 50
percent or less of a family’s annual spend was deemed affordable though it is
unrealistic to expect a family to spend 50 percent of its annual spend on the
medical education of a child.
While strides have
been made in the health sector, the government would do well to fine tune the
new system under NMC. It could consider raising further by 10 per cent the
medical seats to ensure more qualified post-graduate specialists are available
in the country. As per government data, India’s doctor-population ratio has
grown to 1:1700. However, as indicated by the World Health Organisation, a
doctor-to-population ratio of 1:1000 is urgently required.The Union Health
Ministry needs to meet the target, realistically.---INFA
(Copyright, India
News & Feature Alliance)
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