Medical Education in India and Ukraine Imbroglio

In its landmark judgement in the TMA Pai case the Hon’ble Supreme Court had stated that providing education can no longer be considered a charity. It is a vocation, and therefore, some profit could be permitted but not profiteering. Our politicians and bureaucrats have taken no notice of it. India’s demographic profile makes it impossible for the Government to create requisite capacity on its own to train its young people, and thus, has to rely on the private sector. A study report by National Sample Survey Organisation (NSSO) indicates that 44.81 million students aged between 18 and 24 do not have the financial support to pursue higher education, especially in professional domains. The Government, by its policies has aided and abetted profiteering by private players adding to the woes of students. That has resulted in students seeking opportunities abroad.

Number of Seats in Medical Colleges

As per Government figures the country at present has one doctor for 1,511 people as against the WHO norms of one doctor for 1,000 people. However, the figures provided by NSSO (also a government agency) indicate that the country has 5 adequately trained doctors for 10,000 population. The latter figure seems to be more appropriate since it lays emphasis on ‘adequately trained’ doctors. Thus, as against 14 lakhs India has about 7 lakh doctors – a shortfall of approximately 7 lakhs. There are 88,120 seats for MBBS programmes in 132 government and 77 private medical colleges. Approximately 800,000 students compete for these seats through NEET-UG (entrance examination conducted by National Testing Agency). Considering the need for stringent requirements for entry into medical profession the aspirant to availability ratio of seats in medical colleges is not too critical. But there are two challenges: because of the reservation criteria the number of seats available for the general category candidates is not enough; and secondly, the cut off marks, in the NEET-UG, to make a candidate eligible for admission to MBBS programme, has been kept ridiculously low at 19% (138 out of a maximum of 720 marks). This results in those scoring low marks but having the capacity to pay exorbitant fees getting admission at the cost of meritorious students who do not have the capacity to pay high fees. Indian students prefer to go to countries like Ukraine because the admissions to their colleges are not merit based. There is no cut off limit laid down for the score in NEET-UG. Minimum 50% marks at the Plus 2 stage is adequate.

India has neglected the development of its education sector and medical education is no exception. Ukraine, with lesser population than Punjab and Haryana combined, has 15 medical colleges as against 9 medical colleges in the two Indian states. India needs to open up its medical education sector. The regulators need to be more effective and enabling. It is a well-known fact that the regulator in its previous avatar – Medical council of India – was a den of corruption. The Supreme court had to intervene and appoint a chairman to put its house in order. The new regulator – National Medical Commission (NMC) – would do well to shun the licence-permit raj, stay clear of the public vs private institutions controversy and create a level playing field. At the same time private medical colleges should ensure that profit making should not be their sole motive.

Fees Charged by Private Medical colleges

The tuition fees charged by private medical colleges vary from approximately Rs 50 lakhs to Rs 70 lakhs for the full programme. Hostel fees and other incidental expenses are additional taking the total cost to Rs 70 lakhs to Rs 1 crore. That is beyond the paying capacity of any middle-class family. On the other hand, most of the medical colleges in countries like Ukraine charge between Rs 20 to 25 lakhs for the full programme. Thus, students who are high in merit in NEET-UG, but are unable to secure a seat in a college in India, prefer to go abroad to pursue higher studies. Another cause of concern is the vast difference in the quantum of fees charged by different private medical colleges. Are the facilities being provided by different colleges so varied that justify such a huge fee-differential? In fact, this verges on to profiteering approved by the Government.

Quality of Education

The quality of education being provided by many foreign medical colleges has come under severe criticism. Medical colleges in Ukraine are ranked below Indian colleges in international rankings. But the quality of education provided in Indian medical colleges is also not up to the mark and medical degrees awarded by Indian universities are not recognised in countries like the USA and the UK. Medical students studying in Ukraine have to clear national level tests KROK 1 (after three years) and KROK 2 (after 6 years of study). But still, past data show that on their return only 17.09 % were able to clear Foreign Medical Graduation Examination (FMGE) that is mandatory to enable them to practice medicine in India. Success rate in FMGE of Ukraine-trained students is much below that from other countries – Bangladesh (38.68%), Ethiopia (35.71%), Belize (32%), Cuba (23.07%), Belarus (19.13%), Georgia (18.79%).

The licence-permit raj, coupled with corruption, has resulted in sub-standard quality of education being provided in Indian medical colleges. A decision has now been taken to conduct an ‘Exit Test’ to certify MBBS degree holders, both Indian and foreign trained, to enable them to practice medicine. Thus, the role of universities now is only to award MBBS degrees and the NMC, after the ‘Exit Test’, would provide certification to practice medicine. Medical colleges may now be more concerned with quality of education being provided because the performance of their students in the ‘Exit Test’ would have an impact on their brand value.

Implications for National Economy

Reportedly, there were 18,000 Indian medical students in Ukraine paying an average of Rs 25 lakh per student amounting to total financial outgo of Rs 4500 crores from the country. In addition, they paid for boarding, lodging and other incidental expenses. There are at least 10 other countries that attract Indian students for medical studies. Thus, on medical education alone, total financial outflow from India is approximately Rs 50,000 crores spread over 6 years i.e. approximately Rs 8500 crores annually. This could be better utilised for augmenting the infrastructure for medical education in the country.

Conclusion

Poor investment in medical education has been the root cause for students going to Ukraine and many other countries in such large numbers. That is not justified considering the below par standard of education in these countries. There is an urgent need to upgrade the medical education infrastructure in the country. Large hospitals, both in the private and public sectors, could be converted in to medical colleges to create additional opportunities for Indian students. Moreover, the country could start earning revenue by attracting foreign students to study medicine in India.