For months now, the media has been relentlessly following the developments in Ukraine, with horrific reports of missile attacks and inhuman consequences on innocent civilians. Homes have been destroyed; families displaced with nothing they can call their own. For a brief period, these reports, included stories of medical students from India inadvertently caught in the crossfire, desperate to reach the safety of their own country. Their plight soon faded from the front pages; but the serious problems that emerged, had far reaching consequences that most of us are totally unaware of. One industrialist, admitting that he was unaware of the problems, declared his intention to start a medical college under the CSR scheme. So, what exactly is the problem, and why has it not caught public attention before?
It stems from the fact that healthcare in general, and medical education in particular has been a subject of sublime neglect. This is reflected in the measly allocation of around 1% of GDP by successive governments since independence. A fallout of this has been in medical education and the demand-supply gap for medical seats in India. Every year, more than 20,000 students are estimated to leave India to study medicine in China, Russia, Ukraine and the Philippines. More often than not, they struggle to cope with language issues, culture shocks and harsh weather conditions. As if this was not enough, they often have to deal with unforeseen contingencies, such as in Ukraine today and in China in 2020. Whilst the Ukraine story has been sudden, dramatic and often poignant, this is certainly not the first time, students have had to deal with such grave emergencies. Two years ago, following the pandemic lockdown, medical students in China had to rush back home after their universities were shut interrupting their studies, with no future plans in sight. They are now restricted to on-line studies with no practical training program; and therefore, not eligible for recognition here. Most of these students are forced to seek medical education abroad because of the extremely disproportionate supply and demand situation for medical education in India, resulting in astronomical fees in private medical institutions beyond the reach of the average middle-class aspirants. It is no surprise that most of the private colleges have politicians with vested interests running them.
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About 1.6 million students took the National Eligibility-cum-Entrance Test (NEET) in 2021, and 0.87 million of them cleared it. There are only 150,000 seats in about 700 medical colleges across the country, as stated by PM Modi to the Ukraine returnees. But according to the MoHFW, there are just over 90,000 seats in about 550 medical colleges, of which 276 are privately-run. With such a demand-supply gap, is it any wonder that the cost of private medical education, in a sellers’ market, can go up to Rs 1 crore? Those who do manage a seat in a government college can expect an expenditure of up to Rs 3 lakh. These issues can only be addressed with an increase in the number of seats.
In a letter to PM Modi, Mamata Banerjee suggested that those students who, based on NMC guidelines, are eligible for internship, should be accommodated in government medical colleges and paid a stipend on par with local candidates. Students in various stages of their studies should be allowed to get admission to the equivalent level in private medical colleges against the existing seats.
These colleges should be allowed to increase the number of seats to accommodate the students at State quota fees. The NMC currently mandates that only those students who qualify for the National Entrance Eligibility Test (NEET-UG) would get admission into medical colleges. Many of the Ukraine returnees do not meet this requirement.
Mamata Banerji suggested that the relevant guidelines may be relaxed as a very special case to accommodate these students. These suggestions fell victim to politics rather than better sense prevailing.
The problem in the Philippines, where more than 10,000 students are studying, is slightly different, and one that is hardly talked about; there being no war or pandemic there. The NMC, which currently regulates medical education, in a communication to the Indian Embassy in the Philippines, reversed an earlier MCI decision. The Philippine Bachelor of Science course known as BS Biology of 18-24 months duration, will no longer be accepted as a part of medical education in India. Hence it cannot be added onto the linked 48-month-long course that follows, leading to the MD. If the BS course is excluded, the MD course of the Philippines gets reduced to 48 months and falls short of the mandated minimum duration of 54-months for an MBBS course to be recognized in India. This renders the whole Philippine system of medical education invalid for approval and registration in India.
Those students who have already been admitted to the MD programme before November 18, 2021 will not be affected. All others will no longer meet the required criteria. Medical education in the Philippines costs Rs.25 lakh to Rs.30 lakh; with many students having already paid a substantial portion of this amount. Hence the NMC should have implemented its new rule, prospectively, so that those already in the system are unaffected. PILs have been filed, and hunger strikes underway. Legal experts say that several provisions in the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021, may not stand judicial review as they are unfair and discriminatory. It remains to be seen what solution eventually emerges from the courts.
(The writer is a founder member of VHAG)
