Is medical education in a state of flux? The erstwhile MCI steeped in corruption and inefficiency was disbanded. National Medical Commission ordinance was brought in to replace MCI albeit with a nudge from the SC in 2017. Now five specialized doctors monitor the medical education.
Apart from a dearth in seats, infrastructure, hospital facilities, nurses, doctors in almost all the specialisations, there is a dearth of research as well, which is a major obstacle that must be overcome, to improve medical education. In the absence, most ideas and innovations are based on assumptions, traditions, and taken-for-granted notions of what should work. Given the vast resources spent on health care, the lack of investment in the study of medical education is puzzling and problematic. A revamp of curriculum is seriously called for.
If the Urban medical facilities need improvements and augmentation, the rural medical facilities are not sufficient to even cater to basic needs. A Primary Health Centre (PHC) sanctioned for a rural area needs at least one doctor for it to be functional. For the 33 of the 36 regions, more than 8500 posts are vacant.
To a question on the number of medical doctors available in the country, the government said that as on September 30, 2017, there were 10,41,395 doctors registered under different state medical councils. The then Minister of State for Health and Family Welfare, said, “Assuming 80% availability, it is estimated that around 8.33 lakh doctors may be actually available for active service.” Whereas WHO recommends one doctor per 1,000 people of the population, the number actually available is one doctor per 1,597 persons. Almost 5 lakhs more doctors would be needed to meet the WHO standards. Currently with an enrolment of 67,532 students for the MBBS programme, how many years would it take to even match the requirements? Is this an unsurmountable paradigm when we know that more than 10 lakh people apply for those seats? Leading cardiac surgeon Dr Devi Shetty lamented once, that a “first-world regulatory structure” won’t work in a country such as India with “third-world infrastructure”. We need to reinvent our needs vs the regulation.
In 2017, the number of specialists like Surgeons, Obstetrics and Gynaecologists, Physicians & Paediatricians required for Community health Centres to be fully functional was 22,496, but only 4,156 positions were filled. No hospital is complete without nursing staff. Whereas the nursing staff sanctioned to work in the PHCs & CHCs was 77,956, more than 11,500 posts are vacant. Why do these posts lie vacant? Attrition rate for nurses is 50% with most going abroad. Besides what is the career progression for them? How does a nation progress when its health sector flounders?
There are extremely rigid requirements when it comes to medical education which has proved counterproductive. Every additional regulation adds to the cost. It is estimated that Rs. 400 Cr is required to build a medical college in India. How many such medical edifices can be created and who will create them? Is this the de facto standard? Offshore medical schools in the Caribbean train students from the United States and Canada who intend returning home for residency and clinical practice after graduation. Most offshore schools are dual-campus programs with basic sciences being completed in the Caribbean, while clinical clerkships completed at teaching hospitals in the United States, Canada, and the United Kingdom. One needs to retrofit the resources for optimal use and bring down the cost of education if the national healthcare has to reach the last mile.
Most of our medical colleges train to be doctors in suboptimal numbers. A mere 100 are trained to be doctors with more than 140 faculty required to train them. A comparison with the global standards reveals 10 times the students trained with the same numbers of faculty. A complete relook may bring down the stakes benefitting a whole new generation.
Current medical education in the country is truly an elitist affair. With the cost reaching the skies, children from poor families cannot dream of becoming doctors. Rich children opt for radiology, dermatology and other specialisations so that they can go home by 5 pm. With no commitment to the medical oath, they take. Many of them opt for practice abroad or pursue higher education there, leaving the country’s rural health centres high and dry. The brain drain phenomenon is also seen among the engineering students who pass out of the elite engineering colleges like the IITs, but here the control regime was disbanded many years back. Capitation fees is unheard of today. We need to change the rules of the game so that children with a fire in the belly, even if they are poor, could study medicine.
Why should PG education cost 2 Cr to 5 Cr, to become a specialist? It is high time we increased the number of PG Medical seats in the country. In the US, they have 20,000 undergraduate seats and 40,000 postgraduate seats. Even then doctors from India or any other country can go to the US and get a specialist degree. For more than 63,000 undergraduate seats across the country, we have only 14,500 PG seats. Is the scarcity not artificial that promotes elitism? All over the world, higher medical education is free of cost. Can we too do this?
60% children are born in rural India. Why should every 12 minutes, a pregnant lady die during child birth? Why should more than 3 lakh children die the day they are born? Why must 1.2 million children die before they celebrate first birthday? What kind of health care system are we running? Whereas we need 2 lakh gynaecologists, we have less than 50000 and half of them do not practice obstetrics because they do not want to be woken up at night and most of them live in cities. Against a need of 2 lakh anaesthetics, have less than 50000. When we need 2 lakh paediatrics to care of all the children coming, we have less than 50000 and against at least 1.5 lakh radiologists, we have less than 10500. No wonder the neo natal mortality is so high.
We need to liberate medical, nursing and para medical education from the clutches of the elite. For this, we do not need fantastic budgetary allocations. A will to serve in the true spirit and a few regulatory changes will do the trick.