IN 2010, as a member of the Governing Board of the Medical Council of India, I along with five eminent doctors conceptualised the concept of NEET to address the difficulties in attending multiple entrance exams. However, our main intent was to address the corruption and establish meritocracy in the selection process. When the students with 110 marks out of 720 got admitted to medical colleges, I admitted our failure.
Interestingly, even when I was seeking admission to a medical college 50 years ago, both medical and engineering admission process were not transparent. Today, admission to an engineering college is clean and transparent, not because people decided to become honest. Since the main requirement of an engineering college is a building; as the demand increased, there was mushrooming of engineering colleges providing more seats than required.
For about 1 lakh medical seats if 24 lakh students apply, no matter what we do, corruption and scandals cannot be avoided. For you to understand the value of a Post Graduate medical seat, a few years ago the capitation fees for MD in Radiology was in excess of Rs 5 crore, whereas in the rest of the world, Post Graduate medical education is free. For transforming Indian healthcare, passionate children from poor families must become doctors. Most of the outstanding doctors with magic in their finger generally come from deprived background.
Why elitist affair It costs about Rs 600 crore to build a new medical college and over Rs 150 crore per year to maintain it. On the contrary, you can buy a medical college in the Caribbean training doctors for the USA for Rs 14 crore. None of the Western countries requires 10 acres of land, one million square-feet buildings, centrally air-conditioned auditorium and a full-time clinical faculty. The often-quoted shortage of medical teachers is due to the distorted definition of a medical teacher to create the shortage. According to the Medical Council guidelines, most of the well-known heart surgeons of India cannot teach heart surgery.
The two solutions
First, medical colleges with the intake of 50 to 150 students simply cannot reduce the cost of education. We must follow the model of Western countries by expanding the existing medical colleges. Kings College London has an annual intake 450 medical students. Indiana University Medical School, USA, has intake of over 360 students. The University of Melbourne medical school, Australia, has an intake of 340 students. So, 705 existing medical colleges should be given additional 100 seats owned by the Government. This will give additional 70,500 medical seats at very little cost. Additional students should complete their pre-clinical studies in the existing massive infrastructure available. However, for clinical studies, medical colleges should adopt a Government hospital. This will dramatically convert the sleepy Government hospitals as a vibrant institute. Like in the West, practicing medical specialists should be recognised as honorary teachers as it was when I was a medical student.
Foreign currency loss
Secondly, every year about 25,000 Indian students join overseas medical colleges in China, Russia, and other countries with poor infrastructure. Sadly, India loses over Rs 15,000 crore of precious foreign currency as these students spend about Rs 50 to 75 lakh for education. Most of these students come from middle-class families. It is the dream of these parents to make their children doctors and pull them out of drudgery. After all the sacrifices made by them by selling assets or borrowing money to make their children doctors, just about 16 per cent of them pass the qualifying exam to practice in India.
By recognising 500 large Indian hospitals, which are already conducting Post Graduate training under the National Board as ‘National Medical Colleges’, we can add 50,000 additional Government-owned seats and save precious foreign currency and prevent thousands of middle-class families from bankruptcy. Passionate senior specialists should be recognised as honorary teachers to address the shortage of faculty and reduce the cost of medical education.
Common exit exam
Upon completing the medical course, graduating doctors should be appearing for a common exit exam for both graduates of Indian medical colleges and ‘National Medical Colleges’. We must replace the ‘Inspector Raj’ to ‘student skill appraise’. The most important component of the ‘National Medical College’ is that 50,000 additional medical seats should be owned by the Government and the fees should be affordable to the working-class families. Selection and allotment of seats must be done by a Government body, and the students simply show up with admission cards, like how it is today for PG seats under the National Board.
Many large trust/private hospitals will be delighted to become a ‘Medical College’ to attract talented faculty, resident doctors to care for their patients and reduce the salary burden. Historically, only the hospitals which are academic institutions maintain leadership position long-term.
National Exam Board
In 1975, when the Post Graduate medical education was in crisis, the Indian Government created a parallel body to the then Medical Council of India, called the ‘National Board of Examination’ for Post Graduate medical education for meritorious students. Today our Government can create a parallel undergraduate medical education under the National Board as ‘National Medical College’ for poor meritorious students.
With 120,500 additional Governmentowned seats added to the existing 55,905 seats in Government medical colleges, the Government will own 176,405 medical seats. When there is an abundance, corruption declines. It’s the time to talk about the cost of medical education bankrupting middle-class families. I believe in our Government’s ability to navigate this agenda which will usher the dawn of meritocracy in medical education.
