The state of medical education
According to data released by the Medical Council of India, there are 606 recognized medical colleges that offer MBBS degree in the country. Of these, 46 medical schools are under reputable universities and 276 are private medical schools. Every year, about 1.5 million students sit for the All India pre-medical entrance test to pursue undergraduate medical courses in government and private institutes, but only eight lakhs become eligible for the admission – while 45,000 students obtain places in government medical schools, 40,000 of them find places in reputable private medical schools. Others must either explore their options in countries that offer affordable medical training or choose another career. According to reports, around 20,000 to 25,000 students go abroad to study medicine every year in countries like Russia, Ukraine, China, Philippines, Georgia and Kyrgyzstan, where medical education costs between Rs 20 and 45 lakh, unlike in India where it can cost between Rs. 60,000 to 2.5 lakh in government colleges and between Rs. 40 lakhs to Rs. 1.5 crore in private colleges – a distant dream for most Indians.
A report published in 2019 indicates the dire need for doctors and healthcare workers in India. It says the doctor-to-population ratio in India is 1:1456 – unevenly distributed between urban and rural areas – compared to the 1:1000 required by WHO standards.
The Reasons Behind Huge Fees
The reasons for high fees in medical colleges are the mandatory infrastructure requirements and the high costs of colleges due to scarcity. Every medical school approved for MBBS admissions, as per the guidelines, should have 23 notified departments, an on-premises teaching hospital, laboratories, and hostels, to name a few. Additionally, colleges with 150 MBBS students annually must have a functional 330-bed hospital operational for at least two years. In addition to this, an air-conditioned central library of at least 1,000 square meters and one percent of the prescribed minimum books must be journals. Hence, it costs more than Rs. 400 crores and it takes at least five years to build a state-of-the-art government medical college which will further require quite a large sum of money for annual maintenance. In the case of private institutes, this can go up to unimaginable sums.
Developing medical education in India
To ensure that India continues to produce trained doctors and healthcare workers, it needs to increase the number of its medical colleges at an affordable cost. Over the past two years, many lessons have been learned from the global pandemic for policy makers, doctors and researchers. Now is the time to act. MCI should double the number of students in existing medical schools without compromising quality. It should also relax the strict standards set for the establishment of medical schools to pave the way for the establishment of more medical institutions for future doctors. In November 2020, the National Medical Commission’s decision to remove the minimum land requirement of 20 acres for general areas and 10 acres for metropolitan cities was a welcome step.
When it comes to encouraging private investment in medical education, we need to relax certain hospital infrastructure conditions and focus on the availability of clinical equipment for student training. In addition, a cost and revenue sharing model between private and public hospitals should come into effect to reduce the cost of setting up hospitals. There is a need to include practicing doctors, DNB graduates as faculties to expand the teaching fleet. To improve the cash flow of medical colleges, low-cost and long-term loans should be provided to entrepreneurs to establish medical colleges by establishing long-term financing agencies. A special tax exemption for investments in the establishment of a medical school could also bring a new influx of funds into this sector. Last but not least, the government should introduce urgent reforms in the medical sector to prevent the migration of Indian students to study medicine abroad, and it should also provide low interest loans to students who enroll in medical schools.
The government has already realized the importance of improving the quality of education and training for doctors and health care workers, and has taken some key initiatives in this regard. But still, there is a long way to go. In all likelihood, affordable medical education will set the tone for an ecosystem where health care is also affordable, as future doctors would like to give back what they received. This feeling will lead to the creation of an affordable healthcare system where even an ordinary person can study medicine and get good medical care. Remember, the health of the nation comes even before the wealth of the nation.
Dr Anant Pandhare, Medical Director – Dr Hedgewar Hospital – BAVP
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