Medical education in India needs urgent remedy: Evacuation of students in Ukraine highlights shortcomings and shortages : The Tribune India

Seema Sachdeva

“AND AFTER THAT? That was the only thought in the mind of third-year MBBS student Tanishq Sharma from Delhi as he returned safely from Ukraine after the country was attacked by Russia. Tanishq had achieved 95% marks in Class 12, but his National Eligibility-cum-Entrance Test (NEET) ranking was not good enough to qualify him for admission into a government college in India. “Fees at most private colleges in India are between Rs70 lakh and Rs1.5 crore, while the same course can be taken abroad for Rs20 lakh to Rs30 lakh,” he says. Another Indian student, Rubal Thakur from Shimla, who had just three months of the six-year MBBS course to complete, shudders thinking about the logistics of completing the course or how much more he will have to spend to graduate here. Her only hope is that the Indian government will grant a special allowance and help them complete their studies in India. The uncertainty of the situation is more biting than the extreme conditions he endured to reach Romania on foot from his university.

The estimated 20,000 students who have been stuck in the war-torn country have exposed the inconvenient reality of expensive private medical education in India.

That various governments have not given enough attention to streams other than the medical and non-medical fields is evident from the growing number of students appearing in the NEET-UG (2021) as well as the JEE Mains every year.

Ministry of Education figures indicate that out of a total of 84,649 MBBS seats, no less than 16,14,777 candidates registered for the NEET (UG) exam in 2021. Among them, 8,70,074 qualified. Thus, 90 percent of students who passed the test, calculated on a percentile basis, will not get a place. The limited number of places makes it difficult for all qualified students to study the subject. Of the 562 medical colleges in India, 286 are public and the rest private. While education in public colleges is heavily subsidized, MBBS course fees in private colleges vary. In Punjab, private medical education is quite regulated by the state government, but the same cannot be said for many other states.

Fee structure

The difference in the fee structure of public and private colleges can be gauged from the notification issued in September last year by the Punjab government regarding the admission fee structure under the NEET-UG. According to the notice, the tuition fee for the first year in public colleges would be 1,58,000 rupees, increased by 10% every year for five years. The total comes to nearly Rs10 lakh. Meanwhile, the fee for the first year of a private college under government quota is Rs3,68,000, while that under management quota is Rs9,45,000. At the end of the fifth year in a private college, a student would therefore have paid nearly Rs15 lakh under the government quota and nearly Rs50 lakh under the management quota. The fee for the NRI quota is $110,000.

This fee structure is simply the tuition fee that the student pays regardless of any other expenses including accommodation fees, maintenance fees, exam fees, registration fees, etc.

The fee structure in many private medical colleges, mostly reputable universities, in Pune, Chennai, Maharashtra, Bengaluru, etc. exceeds Rs1 crore.

Dr Sandeep Puri, Director of Dayanand Medical College and Hospital, Ludhiana says, “We understand that the fees in private colleges are still very high even though the Punjab government has regulated them a lot. However, with the strict standards that colleges must follow with respect to infrastructure requirements as mandated by the National Medical Commission, it is very difficult to break even unless the medical college has a full-fledged hospital like ours. The solution lies in increasing the number of seats in government as well as private colleges within the existing infrastructure and adding more staff and shifts to the current facility.

“Many medical students leave the country after studying at publicly funded colleges, which is a huge waste of taxpayers’ money. There should be at least a three-year bond to serve in India before a student leaves the country. It would also help stem the shortage of doctors,” he adds.

Dr Anil Bhardwaj, a medical practitioner in Chandigarh, believes that the massive population and lack of focus on the health sector are responsible for too many students competing for very few seats. “Tempted by cheaper medical training abroad, many students prefer to be admitted there. However, upon their return to India, many of them cannot pass the Mandatory Foreign Medical Graduates (FMGE) Examination, which brings them back to square one and they cannot practice medicine. Most of them end up becoming hospital administrators or running private clinics,” says Dr. Bhardwaj.

It is compulsory for medical students who have studied in other countries to obtain authorization from the FMGE to practice medicine in the country. Qualified candidates must complete a one-year internship in a registered hospital in India. The exam, which is held by the National Examinations Board (NBE) twice a year, has a very low pass rate. Last year, out of 41,739 students who showed up, just 9,948 passed the multiple-choice test.

Dr. Kamaldeep Dhaliwal from Malerkotla sat his FMGE exam in June last year after graduating in 2020 in Ukraine. His compulsory internship is over and now he wants to apply for an MD but again there is a huge amount of Rs30-35 lakh in a private medical university that he might have to lose.

“My father is a farmer. We don’t have that kind of money. My fees in Ukraine were $4,800 for two semesters, to be paid in three installments, which allowed students like me to go there. Add to that the $1,000 each in hostel and mess fees where we had Indian food, and we ended up spending less there than at a university in India,” says Dr. Dhaliwal.

Satvik Dharmaik from Upper Shimla, who interned at GMCH-16, Chandigarh, after completing his six-year degree in China, agrees. “I would often be mocked by other trainees that I was an ameerzada (rich kid) since I studied abroad. Frankly, there were hardly any options. When I took my test d 2016 entry, there were only two public medical colleges in Himachal, my score of 450 out of 720 was not enough to get me admitted into a government college, although many students with lower grades mine got admitted to better colleges because of reservation policy.

Develop other flows

Dr. Pyare Lal Garg, former registrar of Baba Farid University of Health Sciences, Faridkot, believes that the problem lies in the fact that “we have not developed other branches except medicine and engineering”. Most parents want their children to become doctors, regardless of their child’s interest in the subject, he says. “Until more employment opportunities are created in other fields, students will remain under pressure to study only science subjects.” Dr. Garg also suggests the need to integrate medical education with health services. “Ideally, each district should have a medical school attached to the local public hospital. Governments must review medical education without bias and regulate private medical education. The country’s spending on health services and medical education must be much greater to bear fruit for future generations.

According to the WHO Global Health Expenditure Database released in January, India’s current health expenditure (percentage of GDP) is 3.01. While most developed countries spend more than 10% on their health services, India’s health expenditure is lower than our neighboring countries: Pakistan (3.38), Nepal (4.45) and Sri Lanka (4.08).

According to Dr Jeyaraj D Pandian, Principal of Christian Medical College, Ludhiana: “Public health funding is too low even for existing facilities. Rather than investing in new colleges, the government must strengthen its current facilities”. Starting a new college with a hospital and infrastructure requires capital expenditure of at least Rs 600 crore-Rs 800 crore, he says. “The fruit at hand is to strengthen the district hospitals and associate the faculties of medicine with them. The increased number of lower cost places will help reduce the fee structure for MBBS students, while the super-specialty hospital in each district will be a bonus for locals. A win-win for all,” he concludes.

A recent WHO report mentions that India needs at least 18 lakh doctors, nurses and midwives to reach the minimum threshold of 44.5 health workers per 10,000 population in 2030. The increase in the number of seats as well as more medical colleges will also accelerate India’s efforts to reach the WHO-recommended ratio of one doctor per 1,000 people, while integrating more qualified medical professionals into the workforce . A radical makeover is an absolute necessity.

SHARING SEATS

Government quota

The state government controls some private college seats in its state. Mainly 50% of total seats, government quota seats in pvt college provide subsidized medical education to all grades including reserved.

Management quota

The management quota is a government-authorized mechanism provided to a private/minority college or reputable university to admit students at unsubsidized fees. 50% of the total number of seats, these also include NRI seats.

NRI quota

15% places are reserved for NRI students. Overseas Indian citizens, people of Indian origin and foreign nationals are also eligible.

50% The number of places for which the fees in private medical schools and reputable universities should be at the same level as the fees in public medical schools

562 Total Medical Colleges in India

286 Government colleges

276 Private colleges

NEET (UG) 2021

84,649 Total number of MBBS seats

16,14,777 Registered candidates

8,70,074 Qualified

Helen D. Jessen