Medical Education in India and Associated Issues – Explained, pointwise

Introduction

Among the Indians waiting to be evacuated from Ukraine following the Russian invasion, majority are students who had been pursuing medical education from Ukraine. According to the Ukraine’s Ministry of Education and Science, there are around 18,095 Indian students in the country. In 2020, 24% of Ukraine’s overseas students were from India. This article will discuss the issues that compel Indians to go abroad for getting their medical degree, issues with the present medical education system in India and the remedial steps to improve the condition of medical education in our country.

What is the current status of Medical Education in India?

There are nearly 90,000 MBBS seats in the country in around 540+ medical colleges . This comes to one medical college for every 2.57 million people (The number is 1 College for every ~ 1.7 million in the US) and 65 seats per 1 million of population. According to the President of the Medical Assessment and Rating Board, under the National Medical Commission, India is expected to have 100 medical seats for 1 million population very soon i.e., the capacity is expected to be enhanced by 50%.

Many medical colleges have limited facilities and the traditional model of postgraduate medical education offers woefully inadequate opportunities. These are 6,000 MD/MS seats and 16,000 seats via the Diplomate of National Board qualifications each year.

Traditionally, the most sought-after international destinations for medical education were the U.S., the U.K. and a few west European countries. However in the last few decades, Russia, China and Ukraine have been able to offer more affordable and quality education to Indians. 

What factors pull the students to pursue medical education abroad?

Affordability: Medical education in Ukraine, Russia and China is more economical than private medical colleges in India. The cost of graduating in medicine in Ukraine is around INR 15-20 lakh for the entire duration of six years. In India, fees of private medical colleges can range between INR 50 lakh to Rs 1.5 crore for a 4.5-year course. A range of other charges are added on to the fees, such as hostel and mess charges, development charges and examination fees further adding to the cost.

Entrance Requirements: Many foreign universities either don’t have an entrance examination unlike Indian colleges or the level of examination is very easy to clear in comparison to the NEET-UG examination e.g., many students traveling to Ukraine, Russia or China score less than 20% in the NEET-UG exam. The cut-off for India, even in private colleges, is around 60%.

Global Exposure: The exposure and exchange programs of European countries are better than India. It allows students to study diverse health systems at minimum cost.

Flexibility: Universities in Ukraine follow the European Credit Transfer System. It allows students to change institutions in Europe during their course.

What are the other shortcomings in Medical Education in India?

Lack of seats: Ukraine has one medical college for every ~1.7 lakh people compared to 25.7 lakh people in India. There is intense competition in India and many aspirants are unable to pursue their dream careers. Further there is a dearth of affordable government colleges.

Poor Quality of colleges: There has been mushrooming of poor quality colleges which lack proper infrastructure — land, laboratories, equipment, and trained faculty at the postgraduate level.

Poor Teacher Student ratio: The ratio is not up to the mark in many private colleges in India while a better teacher student ratio is provided in the European colleges. 

Low passing rate of FMGE:  All those who graduate from foreign medical education institutions are required to take a licentiate exam before they can practice medicine or pursue higher medical education in India. The test is called Foreign Medical Graduates Examination (FMGE). It has a very low pass percentage, e.g., in 2020 only 16.48% applicants passed it.

Lack of research and innovation: The medical research and innovation needs an added push as there haven’t been many ground-breaking research here.

What are the adverse impacts of these shortcomings?

Undermines Right to Health: High cost of education directly translates into high cost of medical treatment. Many people are unable to afford and access quality healthcare due to higher costs thereby jeopardizing their right to health.

Poor condition of Rural Healthcare: India’s huge population still continues to be predominantly rural, but most of the trained medical doctors, paramedics and nurses gravitate towards cities. The rationale is better living conditions, pay and infrastructure e.g., according to a research paper published in the National Medical Journal of India, 74% doctors work in urban areas, density of physicians is 13 per 10,000 population in urban areas and only 3 in rural areas.

Very few quality professionals choose primary care, or work for low and mid-level service providers or opt for teaching. All of which could be beneficial for rural healthcare.

Exclusion of the Marginalized: The paucity of seats coupled with high fees in private colleges shatters the dream of many poor people to make a career in healthcare.   

Shortage and Quality of Personnel: The lack of seats in comparison to the population size translates into shortage of doctors. The doctor patient ratio of 1:1655 in India as against WHO norm of 1:1000 clearly shows the deficit of MBBS. Further the quality produced from namesake medical colleges is often below the required standards.  

Deteriorating Empathy: Students who invest INR 50 lakhs- 1crore in education often become greedy to recover their investment. They lack the desired trait of empathy to serve the poor and mainly focus on monetary rewards. 

Coaching Culture: The poor quality of teachers induces students to take support of coaching institutes. This puts an additional monetary burden on them and erodes their trust in the Indian Medical Education system.

Brain Drain: Considering the low passing rate of mere 16.5%, many prefer to settle abroad and serve for foreign citizens.

Proliferation of Quacks: The people who study medicine but are unable to get into a good college or complete their degree often become quacks. A 2016 WHO report on the health workforce in India had stated that 57.3% of those practicing allopathic medicine did not have any medical qualification.

What steps have been taken by the Government?

National Medical Commission (NMC): The National Medical Commission has replaced the Medical Council of India with the purpose of reforming the medical education in India. The Commission has a goal of ‘curbing outlets of malpractice and boosting visibility, accountability and quality in the governance of medical education‘. The Commission intends to improve the number of medical seats available and lower the cost of medical education to encourage more students to pursue careers in healthcare. 

Restructuring medical licensing systems, ranking medical colleges, and standardizing entry requirements at medical schools across the country are all essential reforms under the NMC.

To promote the NMC objective, four mutually independent and autonomous committees have been established: (a) The Undergraduate Medical Education Board; (b) The Postgraduate Medical Education Board; (c) The Medical Assessment and Rating Board; (d) The Ethics and Medical Registration Board. 

Competency-based medical education (CBME): The Medical Council of India (MCI) launched the globally recognized CBME for MBBS students in 2019. The CBME curriculum seeks to step away from a content-based syllabus and more towards one that is more practical and aligned with the country’s increasing health demands.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): 22 new All India Institutes of Medical Sciences (AIIMS) were developed under this initiative, and MBBS classes have already commenced at 18 of the new AIIMS. 

The National Exit Test: By 2023, the National Exit Test (NEXT) will be the substitute for the  National Eligibility cum Entrance Test (NEET)  and would be necessary for all MBBS grads and international medical grads. NEXT aims to make the medical education system more transparent, accountable, and consistent.

What further steps are desirable?

First, the private sector should be encouraged, along with cooperation from States, to set up more medical colleges and hospitals locally. This would ensure that aspirants remain in India.

Second, the Government should increase the healthcare spending to 2.5% of the GDP as envisaged by Economic Survey 2020-21. It is currently a ~1- 1.15% of the GDP. The Government needs to make health care the centrepiece of its economic rebuilding.

Third, the Government should ease procedures for establishing medical colleges and provide incentives for a health-care ecosystem to develop in rural areas. 

Fourth, the curriculum should be updated as per changing times. It should have more practical training and competency based skill development. The institutions should capitalize on e-learning and facilitate infrastructure to support it.

Conclusion

The WHO argues that universal health coverage is not possible without an adequate volume of educated and trained professionals to deliver quality healthcare services. Hence, the process by which health professionals are educated, trained and supported throughout their careers becomes extremely crucial for a nation. The crisis in Ukraine has brought this issue to the forefront, even the Prime Minister of India has called for expansion of medical education in India in his recent remarks. Hopefully the present crisis can provide the necessary impetus in this regard.

Source: The Hindu, Indian Express, The Times of India, The Times of India, Financial Express, India Today.