By Sreya Salim:
India’s medical education system is one of the largest in the world. The 381 medical colleges in the country produce about 45000 doctors annually. Ever since the first medical college was established in 1835 in Kolkata, the scope of health education in India has widened. From just 19 colleges and 1000 students in 1947, the sector has grown to house the largest number of medical colleges in the world. Many more are coming up in both the private and public sectors. However, little have these statistics done to better the state of public health in India. It is indeed a paradox that the country that has produced some of the best doctors and research papers in the world is home to more than 89 lakh unvaccinated children. Studies have shown that every seven minutes, a mother succumbs to death during childbirth in India. Basic health care in many villages is still a dream. Monsoon season has become synonymous to epidemics. Even preventable diseases have become nightmares in the Indian scenario. According to Indian Medical Journal’s 2013 report, our country needs about 600,000 more doctors to carry out healthcare related tasks. It was in this context that the government decided to increase the number of medical colleges in India. It may seem logical that more doctors would bring relief to an ailing health system. However, experts are of the opinion that matters are not that simple and require more serious thoughts and actions.
The government has been going on with programs to increase the number of medical colleges for a few years now. Health ministry has already planned 14 new medical colleges and has taken decisions to enhance the number of seats in six existing colleges around India. Many new private colleges have also been allowed. The government also plans to set up 200 more medical colleges over the next ten years thus increasing the number of MBBS seats by 10000. Though it has been proposed that this plan will pave the way for a better healthcare system, the concerns and questions raised by these reforms are many.
The lack of faculty in medical colleges is a problem that has been haunting the system for years. The disproportionate increase in the number of medical colleges has only aggravated the problem. With a large number of UG seats and very few PG seats, the issue is fast getting out of hands. Many medical colleges don’t have enough number of teachers to meet the MCI regulations. It is well known that many private colleges import doctors from various hospitals on the days of MCI inspection to pose as faculty. In government institutions, there is a large-scale transfer of doctors from one college to another. These make-do arrangements do harm to old and new medical colleges alike. Even though MCI has adopted physical measures like head counting to tackle this problem, little has these done to stop malpractices. While attempts have been made to make norms less stringent, it should be remembered that steps like these will only add on to the reduction in the quality of medical education and increased the workload of already overburdened doctors.
Another important problem is that most of the new colleges lack an adequate infrastructure to educate students. Setting up a medical education institution is far different from establishing an arts or science college. Many new colleges just don’t have enough patients or investigation facilities, let alone a proper lecture hall and record books. Even the new AIIMS-like institutes set up in Patna and Bhubaneswar have been reported to lack even basic infrastructure. Many colleges haven’t even completed construction or land acquisition but have started classes for students. Red tape delay and corruption have made matters worse.
Though India has more than 300 medical colleges, the fact that these are distributed in a skewed fashion has resulted in misdistribution of services. More than sixty percent of these institutions are located in South India, especially Kerala, Karnataka, Tamil Nadu, Andhra Pradesh and Maharashtra. Same applies to most of the new institutions coming up too. They are mostly concentrated in profitably potent areas. This is in spite of MCI’s regulation that for a medical college to be established there should be sufficient clinical load in that area. The clustering of colleges has led to a lack of availability of clinical material and faculty in many colleges. Moreover, most of the medical colleges serve urban areas rather than rural areas, leading to further deterioration of already ailing rural health system. It is high time we opened eyes to these problems.
Encouraging privatisation of medical education can have many unforeseen consequences. Increased participation of private giants will result in the commercialisation of education, increased gap between rich and poor and the formation of a cadre of money minded, robotic physicians. It is a well-known fact that many private colleges adopt illegal measures to get MCI recognition, including the import of people to pose as patients during MCI inspections. In the long run, the entire health system of the country is affected, and it is the common man who suffers. Ensuring the quality of private medical colleges and making accreditation restrictions more stringent has become the need of the hour.
Creating socially committed doctors should be the aim of medical education. It is high time India focused on quality rather than quantity. While opening new medical colleges may make headlines, it is important to realize that makeshift medical colleges will only worsen the condition of our already sick health sector. Many short term solutions like increasing the retirement age of medical college teachers, providing better incentives and channeling more funds have been proposed. However, it is important to seek a long-term solution. It is true that the healthcare industry needs more manpower. However, the fact that most of the young doctors who pass out prefer to work in foreign countries and cities should not be overlooked. Hence, better implementation of the present medical education programs so as to fill the gap in the rural health sector is necessary. According to Dr. P.K. Sasidharan, a leading physician and public health expert, increasing the number of medical colleges is useless unless and until a sea change occurs in our health policy. More attention should be given to decreasing the disease burden and increasing health awareness. Instead of focusing on creating more super specialists, strengthening of basic healthcare should be given more priority. The dream of basic healthcare can only be achieved through more innovative and well-planned strategies.
Just as too many cooks are said to spoil the broth, too many incompetent doctors will damage the healthcare system of the country. What India needs at the moment are a better health care policy and an army of young, efficient doctors to carry it out. Politicians and officials should realize that medical colleges made overnight cannot carry out the task of molding the young generation. Unless we open our eyes to facts, India’s healthcare industry will continue to suffer.