Why do Indian students have to go to these countries to study medicine? Doctors speak to Monarose Sheila Pereira about their views.

With the war between Russia and Ukraine many Indian medical students were stranded in these countries. What ails the Indian medical education system?  

Dr. Rajiv Kovil, Diabetologist and foot specialist

India has the oldest medical education system yet dawdles behind compared to other countries. Multiple reforms need to be brought about to observe a positive change. The quality of education needs to observe an upsurge. A dearth of qualified individuals in medicine is discerned and this can be colossally attributed to the discrepancy of the demand and supply ratio of the medical institutions and students respectively.

Besides, the exorbitantly charged fees add to the pressure. To procure a seat in a government institution is again a gargantuan task since government college seats are only allocated to elite students who successfully tread through the NEET examinations. On the other hand, private medical institutions have fees too high to enable the middle class to afford the expenses. Due to limited resources, parents cannot rule out the colleges apt for their children. A lack of efficient skillset is another hindrance to appoint lecturers in medical institutions. Besides, the scenario of research has also retrograded - adequate infrastructure, trained faculty, e-learning systems are prominent shortcomings observed.

Also, the system is not student-supportive, which propels them to opt for studies abroad in places such as Ukraine, Russia and China and so on as they offer students passing the Foreign Medical Graduate Examination since the pass-rate is low it acts as a sword hanging on their careers.

It needs to be acknowledged that the medical industry should never be run with a commercial intent and if we do so we shall hugely fail in screening out deserving candidates. Hence the amalgamation of all these factors could lead to a situation where healthcare personnel could still remain inefficient and would have to acquire further-skills to be employable. MBBS is a lucrative career option even today, but the rates of admission have been declining because of the aforementioned reasons. Bad distribution of these institutes, insufficient faculty, obsolete curriculum, lack of required training material are other limitations to be dealt with.

Dr. Malcom Fonseca, Genealogist

In 1986, the Maharashtra Association of Resident Doctors (MARD) held a strike against the Government’s move to allow ‘Capitation fee’ Medical Colleges to come up. They were young idealists. 35 years later, today, private medical colleges (capitation colleges), mostly run by politicians, are well entrenched into the system. Preoccupation with monetary gain prevailed over quality. Post-independence, 35% reservations were made to improve the lot of the downtrodden castes. 70 years later, today, the reservations figure is 90%. Political exigencies prevailed over quality and merit (which is only 10% now).

Young doctors now are faced with a Hobson’s choice - gain precious clinical experience in a public hospital/medical college and live in abysmal conditions versus pay for your seat and live in comfort while gassing about clinical situations you will never encounter. We needed to listen to the young idealists in 1986. We still can do it now. We need to pay attention to QUALITY and not play politics with the medical education system. NOW! 

Dr. Saloni Paranjape, Consultant Anesthesiologist

Seats in a government medical college are extremely limited in India. There are approximately an equal number of seats in private medical colleges, but the exorbitant fees mean they are out of reach of the common man. Not all private medical colleges have good faculty and attached super-specialty hospitals, so some seats remain vacant or impart sub-par training. Government medical colleges in many states like Maharashtra and Karnataka have compulsory service bonds to complete after MBBS requiring 1-2 years of service in an urban/rural area, or a penalty of 20+ lakhs to be free of the bond.

The problem is never the 1-2 years of service; it's in the infrastructure. Why would a doctor want to sit in a rural area with no facilities, just to refer patients to higher centers? If infrastructure were better, doctors would anyway want to work there and gain experience. Postgraduate seats are even more limited, so doctors choose to go abroad and specialize and practice there, never to return (since violence upon doctors is also a reality in India), depriving India of talented doctors.

Dr. Mukesh Batra, Homeopath

According to the World Health Organization (WHO), India ranks 184 out of 191 countries in health spending. As per a recent Mint article, in 2020-21, India spent 1.8% of its gross domestic product (GDP) on healthcare. Data shows that India has 1.4 beds per 1,000 people, 1 doctor per 1,445 people, and 1.7 nurses per 1,000 people. There are only 541 medical colleges in the country. In order to bridge the gap, the Government needs to upscale the number of institutions as well as the quality of medical education available in the country. By enabling more doctors and nurses to graduate every year, we will be able to ease some of the burden on the existing healthcare workforce. This would go a long way towards a Bimaari Mukt Bharat.

Dr. Anupriya Alagesan, Anatomy, Assistant Professor

Gone are the days when becoming a doctor was the first career option for every child in India. Now the aura around the medical profession has dimmed as it has become overwhelmingly demanding, commercialized and an increase in legal issues. The government is still struggling to meet the demand for a doctor patient ratio of 1:1000, as is recommended by WHO. Hence to cater to this demand the government has allowed more government and private medical colleges to open. This gives an illusion of an increasing number of medical professionals, but the ground fact being that the quality of medical education has been compromised to such an extent that qualified quacks are produced.

The newly revamped Competency Based Medical Education (CBME) is a well-planned curriculum with lots of importance given to clinical based education, self-directed learning and structured assessment methods. The sessions on AETCOM trains a medical student in attitude, ethics and communication skills. In spite of this, there is lack of execution by many medical colleges due to lack of infrastructure, less faculty members, less salary, over demanding workload and last but not the least the pandemic.

The Indian medical system is renowned from our ancient times, but we have yet to be on par with other countries. It’s high time the governing bodies of the medical system reassess the quality and take a stand in executing it efficiently.