Medical education in India needs an urgent cure: Student evacuation in Ukraine highlights inadequacies and shortages

Seema Sachdeva

“WHAT AFTER THIS?” That was the only thought on 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 scored 95 per cent marks in Class 12, but his rank in the National Eligibility-cum-Entrance Test (NEET) wasn’t good enough to get him admission in a government college in India. “The fee in most private colleges in India is between Rs70 lakh and Rs1.5 crore, whereas the same course can be done abroad for Rs20 lakh to Rs30 lakh,” he says. Another Indian student, Rubal Thakur of Shimla, who had barely three months of the six-year MBBS course left to be completed, shudders to think about the logistics of completing the course or how much he’ll have to spend more to get a degree here. His only hope is that the Indian government will make a special allowance and help them complete their degree in India. The uncertainty of the situation is more biting than the extreme conditions he endured to reach Romania by foot from his university.

The nearly 20,000 students who got stuck in the war-torn country has highlighted the inconvenient reality of expensive private medical education in India.

That various governments have failed to give enough attention to streams other than medical and non-medical fields is evident from the increasing number of students appearing in the NEET-UG (2021) as well as JEE Mains each year.

The figures of the Ministry of Education state that for a total of 84,649 MBBS seats, as many as 16,14,777 candidates registered for the NEET (UG) examination in 2021. Of these, 8,70,074 qualified. Thus, 90 per cent of the students who qualified the test, calculated on a percentile basis, won’t get a seat. The limited number of seats makes it difficult for all the qualified students to study the subject. Of the 562 medical colleges in India, 286 are government and the rest private. While education in government colleges is highly subsidised, the fee of the MBBS course in private colleges varies. In Punjab, private medical education is fairly regulated by the state government, but the same cannot be said of many other states.

Fee structure

The difference in the fee structure of government and private colleges can be gauged from the notification issued September last year by the Punjab government regarding the fee structure for admission under NEET-UG. According to the notice, the tuition fee for first year in government colleges would be Rs1,58,000, increased by 10 per cent every year for five years. The total comes around to nearly Rs10 lakh. Meanwhile, the fee for first year of a private college under government quota is Rs3,68,000, while that under the management quota is Rs9,45,000. By the end of the fifth year in a private college, thus, a student would have paid nearly Rs15 lakh under government quota and nearly Rs50 lakh under the management quota. The fee for the NRI quota is $110,000.

This fee structure is merely the tuition fee which the student is paying irrespective of any other expenses, including hostel fee, maintenance charges, examination fee, registration fee, etc.

The fee structure in many private medical colleges, mostly deemed universities, in Pune, Chennai, Maharashtra, Bengaluru, etc, goes upward of Rs1 crore.

Dr Sandeep Puri, principal of Dayanand Medical College and Hospital, Ludhiana, says, “We understand that the fee in private colleges is still very high, even though the Punjab government has regulated it a lot. However, with the stringent norms that the colleges have to follow regarding the infrastructure requirements as mandated by the National Medical Commission, it is very difficult to break even unless the medical college has a full-fledged running hospital like ours. The solution lies in increasing the number of seats in government as well as private colleges within the existing infrastructure framework and by adding more staff and shifts to the present facility.”

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

Dr Anil Bhardwaj, a practising doctor in Chandigarh, feels the massive population and lack of focus on health sector, is responsible for too many students competing for very few seats. “Tempted by cheaper medical education abroad, many students prefer taking admission there. However, on their return to India, a lot of them are unable to clear the mandatory Foreign Medical Graduates Examination (FMGE), which brings them back to square one and they are unable to practice medicine. Most of them end up becoming hospital administrators or managing private clinics,” says Dr Bhardwaj.

It is mandatory for medical students who have done their degrees in other countries to clear the FMGE to practice medicine in the country. The qualified candidates have to undergo one-year internship from a registered hospital in India. The examination, which is conducted by the National Board of Examinations (NBE) twice a year, has a very low pass percentage. Last year, out of 41,739 students who appeared, barely 9,948 cleared the multiple-choice paper.

Dr Kamaldeep Dhaliwal from Malerkotla cleared his FMGE examination in June last year after completing his degree in 2020 from Ukraine. His mandatory internship is over and he wants to now apply for MD, but again, there is a massive amount of Rs30-35 lakh in a private medical college that he might have to shed.

“My father is a farmer. We don’t have that kind of money. My fee in Ukraine was $4,800 for two semesters, to be paid in three instalments, which made it feasible for students like me to study there. Add to it the $1,000 each of hostel and mess fee where we got Indian food. We ended up spending lesser there than in a college in India,” says Dr Dhaliwal.

Satvik Dharmaik of Upper Shimla, who has been interning at GMCH-16, Chandigarh, after his six-year degree from China, agrees with him. “I would often be taunted by other interns that I was an ameerzada (rich brat) since I studied from abroad. Frankly speaking, there was hardly any option. When I took my entrance test in 2016, there were only two government medical colleges in Himachal. My score of 450 out of 720 wasn’t enough to get me admission into a government college, though many students with lesser marks than me got admission in better colleges due to the reservation policy.”

Develop other streams

Dr Pyare Lal Garg, former Registrar of Baba Farid University of Health Sciences, Faridkot, feels that the problem lies in the fact that “we have not developed any other branches, except medicine and engineering”. Most parents want their children to become doctors irrespective of their child’s interest in the subject, he says. “Till the time more job opportunities are created in other fields, students will remain under pressure to study science subjects only.” Dr Garg also suggests a need to integrate medical education with health services. “Ideally, every district should have a medical college attached to the local government hospital. Governments need to revisit medical education without any biases and regulate private medical education. The country’s spending on health services and medical education needs to be much more to bear fruits for later generations.”

According to the WHO Global Health Expenditure database released this January, India’s current health expenditure (percentage of GDP) is 3.01. While most developed countries spend more than 10 per cent on their health services, India’s spending on health is lesser than even our neighbouring countries: Pakistan (3.38), Nepal (4.45) and Sri Lanka (4.08).

Says Dr Jeyaraj D Pandian, principal, Christian Medical College, Ludhiana: “Government funding in health is too little even for the existing facilities. Rather than investing in new colleges, the government needs to strengthen its present facilities”. Starting a new college with hospital and infrastructure requires an investment expenditure of at least Rs600 crore-Rs800 crore, he says. “The low hanging fruit is to strengthen district hospitals and attach medical colleges with it. The increased seats at a lesser cost will help reduce the fee structure for MBBS students, while the super-specialty hospital in every district will be a bonus for the 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 achieve the minimum threshold of 44.5 health workers per 10,000 population in 2030. The increase in seats as well as more medical colleges will also speed up India’s efforts to achieve the WHO-recommended ratio of one doctor per 1,000 population, while bringing in more trained health professionals into the workforce. A radical makeover is a dire necessity.

SEAT SHARE

Government Quota

The state government has control over some seats of a private college in their state. Mostly 50 per cent of the total seats, the government quota seats in pvt college offer subsidised medical education to all categories, including reserved.

Management Quota

Management quota is a government-authorised mechanism provided to a private/minority college or deemed university to admit students at unsubsidised fee. 50 per cent of the total seats, these include NRI seats too.

NRI Quota

15% seats are reserved for NRI students. Overseas Citizen of India, Person of Indian Origin & Foreign Nationals are also eligible.

50% The number of seats for which the fee in private medical colleges and deemed universities should be at par with the fee in government medical colleges

562 Total medical colleges in India

286 Government colleges

276 Private colleges

NEET (UG) 2021

84,649 Total MBBS seats

16,14,777 Candidates registered

8,70,074 Qualified

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