Issue of Medical Education & Doctor Patient Ratio in India

India is one of the fastest growing economies in the world and the most populated country as per latest report. In spite of rapid development achieved in other fields, the performance when judged on healthcare parameters remains poor. The Indian medical education system has been able to pull through a major turnaround and has been successfully able to double the numbers of MBBS graduate (modern medicine training) positions during recent decades. With more than 479 medical schools, India has reached the capacity of an annual intake of 67,218 MBBS students at medical colleges regulated by the Medical Council of India. The ideal patient-doctor ratio recommended by the WHO is 1000:1. Responding to this challenge, there has been a major thrust on increasing the capacity of graduate training programs (MBBS) at medical institutions across India. India has two systems of qualified, professionally trained, and registered medical doctors. The first one is the system of modern medicine introduced nearly 200 years back during British colonial rule and the other one is a system of traditional Indian system of medicine, previously neglected but now patronized and streamlined by the Government of India. Long before the Royal College of Surgeons came into being, students from far off lands were making their way to India’s Nalanda and Taxila universities to study medicine. It’s a rather sad state of affairs when the present medical colleges in India fail to provide the much needed healthcare for its 1.2 billion strong populations. Fixing the problems in the medical industry is crucial to the health and well-being of a country. India Today sat with a couple of experts to discuss the various issues plaguing medical education in India.
A recent study in BMJ quoted ‘India has one government doctor for every 11,528 people and one nurse for every 483 people’. That is one government doctor for over 11,000 patients. Though India has the highest number of medical colleges as a nation, the small graduating class strengths of 100-150 students create a major problem for a population of this size. The doctor goes on to remind us that around 79,000 MBBS students appeared for AIPGEE (All India Post Graduate Medical Entrance Examination) in 2019. The total number of seats available in one of the toughest national level medical exams held for MBBS students looking to pursue their dreams to be a MD/ MS/DIPLOMA is about 6200— including clinical as well as non-clinical specialisations. So less than 8 per cent of the total students get a chance to continue further studies and less than even 5 per cent will be considered as the best in their class, including all specialization like Dermatology, Orthopedics, Radiology, Cardiology, Ophthalmology, Surgery and many more. So the number runs barely into hundreds if we pick one of them.”
Whereas the acceptance rate at Harvard Medical School was 3.5 per cent in 2014, in Vellore’s Christian Medical College, it was 0.25 per cent in 2015. The All India Institute of Medical Sciences in New Delhi, ranked the best in the country by India Today for five years, accepts only 72 students for its undergraduate courses out of the 80,000 to 90,000 students who apply. “India has approximately 300 medical colleges producing 30,000-35,000 graduates every year, whereas the need is that of 500 new medical colleges, producing one million doctors every year. “In the system of evaluating doctors followed in India, anyone who is able to memorise a large amount of information can become a doctor. The fundamental exam pattern has remained the same-banking on rote learning techniques, while the humanitarian criterion is not taken into account. Would-be doctors are evaluated according to the answers they give in MCQ questions? These tests are more for memorizing skills rather than knowledge. India doesn’t follow the use of OSCEs (objective structured clinical exams) to test medical candidates. Thus, their clinical skills are not tested till they start practicing. “Students face question papers having questions which are more of knowledge based than on real clinical cases. One should expect to respond to questions based on clinical cases or various drugs than remembering achievements of a particular individual. Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated accordingly. Science fields are segregated from each other owing to an incomplete understanding of how different bases of knowledge can be put together for better implementation. New domains of medical science are also barely touched upon. Students study in a teacher-centric pattern, which doesn’t employ technology as much as foreign countries.
A 2012 study in India funded by the Bill and Melinda Gates Foundation stated that “training in and of itself is not a guarantor of high quality” regarding the medical education in India. The market has been flooded with doctors so poorly trained they are little better than quacks. Teachers for medical institutes are selected based on their degrees and not their clinical experience. This cuts down the effectiveness of the knowledge they can impart to the students. Moreover, no teaching training is provided and teaching innovations are also lacking. “The salary given to a full time government college professor, at least in Mumbai, needs to be rationalised. The lower salary ensures that only the poorest talent is available, because the more talented will go in for a private practice. In government hospitals a constant threat of transfer also remains. A 2010 report on the HRD ministry’s website showed the disparity in the opportunities for medical education in the various states of the country. Only four states – Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu – account for about 1.3 lakh out of nearly 2.4 lakh medical seats across India.
It is not possible to create one breed for doctors to cater to every sort of issue in a country as big as India. While some doctors need to be trained in providing the right kind of healthcare in rural sectors, others would need to be familiar with the latest medical technology for the most complicated surgeries. MBBS students specialise in certain fields to be able to get a job and thus, research is neglected. However, amid the specialisation craze, students miss out on learning about all these aspects. Colleges must take the responsibility of familiarising students with all the different sides of medical studies. A change in the law in the 1990s made it easy to open private schools and so, many such medical institutes cropped up in the country, funded by businessmen and politicians, who had no experience of running medical schools. While there were 100 government medical colleges and 11 private medical colleges in 1980, now, the government schools have doubled while the private institutes have increased twenty-fold, according to MCI. Though this practice was implemented to solve the issue of the grave lack of doctors, it commercialised medical education to a great extent. So, even if a student lacks the mettle required to become a doctor, if he has money, there is no problem.
A simple seat in Radiology can cost you multiple crores easily, which will only increase as you go for better colleges providing better placements. A middle class family usually has to mortgage their home in order to make sure that their child is able to continue in achieving his dream. This makes earning money one of the major priorities of a student passing out from such medical colleges. When these students go into private practice, they are prone to carry out socially wasteful practices and diagnostics in order to earn the money spent in getting the medical degree. Moreover, the current government regulation state that private medical colleges must be built on at least 20 acres of land. Thus, many private colleges are built in rural areas, where it becomes very difficult to recruit good, qualified, full-time doctors because of the difficult living conditions and low pay scales. “The cities fare better when it comes to healthcare. Few doctors will practice in rural India because their earning power is limited and facilities of good school or medical expertise is poor. There are around 47,000 Indian doctors practicing in the US and around 25,000 in the UK. This makes India the largest exporter of doctors in the world. But even this scenario comes with its own problems. “There are very few medical courses recognised by MCI if you plan to seek education abroad. Most of these courses are from some of the leading nations like USA and UK, which in turn cuts short number of returning doctors by a substantial number. “The other avenues remain China and Russia for students who have to pass a simple exam on return for registration.
Fraudulent practices and rampant corruption in the medical education system needs to be looked at immediately. Paying bribes in the form of “donations” in order to gain admission to medical colleges is a very common and popular practice. Fake degrees can be so easily procured that the Indian Medical Association estimates 45 per cent of Indian medical practitioners-700,000 doctors-to be unqualified and lacking formal training. The many private medical schools frequently charge under-the-table for admissions, in addition to the high college fees. The illegal capitation fees may range from 25 lakhs to a crore. The Medical Council of India (MCI), which is supposed to maintain “excellence in medical education” is itself surrounded with controversy as its ex-president faces bribery allegations. There are numerous other lawsuits that the MCI faces and these cases carry on for years. The MCI regulations have certain loopholes which ensure that even colleges which lack proper facilities or infrastructure get accreditation. Thousands of medical graduates from India go abroad to practice in countries like United States, Britain, Australia and Canada, but they all require prior training before beginning their practice. Moreover, regulatory documents show that in Britain and Australia, it is medical graduates from India who lose practicing rights way more than any other foreign-studied doctor. There have been reports of a doctor grabbing a scalpel and slashing a patient’s stitches and other reports of sexual assaults on patients. Thus, it needs to be said that the success of doctors don’t only depend on college training but also on their attitude and personality. A couple of years ago, a student from a rural government medical college in Ambajogai, Swami Raman and Teerth Rural Medical College, posted a letter online alleging that there were no clinics or lectures for the students, that pigs and donkeys roamed around the unsanitary hospital conditions, that one had to bribe officials to pass exams and that students graduated “without even attending a single day.”
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