State of healthcare like medical students, up in the air

Education Health

Private medical education remains largely unaffordable, students swarm to countries like Ukraine, while the healthcare system in India suffers.

Sumy, Ukraine, is located 1500 kilometres (km) from Hungary, 1300 km from Romania, 1250 km from Poland, 700 km from Belarus, and 155 km from Belgorod, Russia. As of Monday, almost 700 Indian students remained stranded there.

One of those 700 students is Sarthak (name changed), a final year Bachelor of Medicine and Bachelor of Surgery (MBBS) at Sumy State University. He is eagerly waiting for the Russian authorities to allow his passage through their border. “A humanitarian corridor through Russia is our only way out,” he said. He came from India to Ukraine five years ago to study medicine. Earlier, he had tried getting into a government medical college in India through National Eligibility Cum Entrance Test (NEET). “Private colleges were asking for donations, it was too costly,” he said. Since all other doors were closed he went to a foreign country to study medicine.

“About 10 to 15 percent of qualified students get a seat in an Indian medical college,” said Harish Nalawade, Public Policy associate to the Minister of Health and Family Welfare and Medical Education, Karnataka.

India has about 605 medical colleges amongst which 317 are either government run or run by a society. The total number of seats offered in these colleges is about 90,825. More than a million NEET aspirants compete for these seats every year. In 2021 alone 15,44,275 students appeared for the exam amongst which 8,70,074 qualified it.

In some foreign countries medical education could cost Rs. 35 lakhs for the whole course while in India it ranges from Rs. 10-15 lakhs per annum in private colleges, Harish added. He said that the government is restricted by resources. In the 2020 Niti Aayog report, the government admitted that they do not have any funds to direct towards the medical education sector and asked the private sector to invest through public private partnership (PPP).

Recently, at a webinar on Union budget announcements on health sector Prime Minister, Narender Modi had also asked for private investors to enter in the medical education sector in a big way.

Effect on healthcare

The overall quality of medical education is poor. Dr. Arjun Mavaji, a healthcare expert said, “Today, an intern who has completed his MBBS cannot insert an Intra-Venous line or dress a wound.” This is because of lack of practical exposure, he added. At one end, there are medical college hospitals with less than 10 percent occupancy while on the other hand there are government facilities over-flooded with patients. Harish said that due to this the doctors are not trained to deal with patients in masses.

Harish explained that there are shady private colleges in India where the quality of education is questionable. Students from foreign medical colleges also complained of poor quality classes. Aditya from Rajasthan is a student of Jinan University Guangzhou, China. He came back to India two years ago due to the pandemic. Since then his classes have been shifted to the online mode. “The teacher just reads through the slides. Most of the students don’t even attend the classes. There is no practical teaching, everything is theory based,” he said

In another instance, Anil (name changed) from Haryana, a final year MBBS student at University Guangzhou, China, also had to come back to India due to the Covid-19 pandemic. He lives in Lucknow, away from his family as he awaits approval for his internship from the Nepalese authorities. He is not eligible to do internship in India as he couldn’t clear the Foreign Medical Graduates Examination (FMGE), necessary for foreign medical graduates to start their practice in India. In 2020 less than 15 percent and in 2021 less than 24 percent students cleared the exam.

Due to this Anil’s graduation is stuck, “The college had asked us to complete the internship to get the degree,” he said. If he was in China this wouldn’t have happened as the internship is a part of their course itself.

In 2020, 14.68 percent and in 2021, 23.83 percent of students who appeared for FMGE cleared the exam.

Dr. Abhimanyu from Himachal Pradesh cleared the FMGE after coming back from China amid the Covid-19 pandemic in the final year of MBBS. FMGE is conducted twice every year in June and December. “In China medical education can range from Rs. 2.5 lakh per annum to Rs. 5 lakh per annum, while one of my friends is paying Rs. 85 lakh at a private medical college in India,” he said.

Vicky Vignesh came back from Ukraine to India last week. “I was on the last flight, it is like a miracle,” he said. Since he too does not have a license he goes to his uncle’s clinic in Hosur, Tamil Nadu for observation. “The total cost for studying in Ukraine was Rs. 35 lakhs. A private college in India would have cost me a couple of millions more,” he added.

Whether it is Sarthak, stuck in Ukraine, Vicky, who hopped on to the last plane, Abhimanyu, who cleared FMGE or Anil, who couldn’t, they all have something in common. All of them went to a foreign country to pursue MBBS as they found it unaffordable at private medical colleges in India.

Dr. Mavaji highlighted, “Of course, there is shortage of medical seats.” Medical education is expensive in India so students are finding alternative ways. “There is no ROI because of low pay for a junior doctor or a junior specialist in a corporate  hospital,” he added

There is a trend now, to go outside for higher studies, said Dr Basil, Nodal officer, Bruhat Bengaluru Mahanagara Palike (BBMP). Even though there are openings for medical students in private medical colleges, students are migrating to other countries to settle there for a better standard of living. The culture, facilities and nature may attract students to move out, he added

The seats for super speciality courses are limited but still some percent of these MBBS graduates are absorbed into multidisciplinary hospitals offering such courses. Harish said that the government had made it compulsory for medical graduates to work in rural areas but many find a way to avoid that by opting for a fellowship elsewhere like in a foreign country

According to rural development report in 2020 there was a shortfall of 76.1 percent specialists at the community health centres (CHC). There was a shortfall of 78.9 percent of surgeons, 69.7 percent of obstetricians and gynaecologists, 78.2 percent of physicians and 78.2 percent of Paediatricians at CHCs. Average rural population covered by a single CHC also exceeded its upper limit by 43 percent and stood at 1,71,779, leading to an increased amount of pressure on the healthcare staff.

A cluster of private colleges could bring down the cost of medical education but PPP has its drawbacks, Harish said that lack of regulations can lead to reduction in quality education. One example of a PPP disaster is the super speciality OPEC Hospital in Raichur, Karnataka. It was funded by the Organization of petroleum exporting countries (OPEC) and run by Apollo Hospitals Enterprise Ltd for 10 years. “It didn’t succeed as there wasn’t any oversight from the government regarding the transfer of ownership once the contract ended.” said Harish.

We can learn from western countries, Dr. Basil said that the culture of scholarships and part-time jobs must be popularised in the country and the government must allow it. This would make private education more affordable. If not, “India soon will face a shortage of good medical practitioners and it may affect our health system,” he said.

To enhance the workforce in rural areas, the Karnataka government is planning a programme called, Hardship Allowance, said Harish. Under this the doctors would be paid over and above what the private hospitals are offering.

Dr. Mavaji suggested an alternative to FMGE. He said that there could be a six-month-long internship and skill assessment for students who do MBBS from foreign countries. “Let’s give them a fair chance, even students who study MBBS in India might not be able to pass the exam.”

Educational technology (EdTech) bloom led to the development of education tools. Citing the example of National Institute of Mental Health and Neuro Sciences (NIMHANS), Harish said, “What started as a source of information for students can be used between universities to exchange research and knowledge enriching one another.” He added that this could lead to quality education through shared resources.