Is the education imparted by the Government Medical Colleges in the State capable of equipping medical students to become good doctors? Has the recent flow of doctors in hordes from Government Medical Colleges to private medical colleges affected the quality of education? And will these colleges continue to maintain their teaching and research standards in the future also? Experts in the medical field were doubtful if this profession could attract new teaching talent and maintain the same standards set by their proficient predecessors.
Amidst all this, the State government has revised the pay packages of the teaching faculty in medical colleges in the State. While raising the salaries, the government has instructed them that they shall not conduct private practice from September 15. The working hours has also been enhanced by another three hours. The government, in effect, is asking the doctors to devote more time to the patients and academics.
After the hike in salary, a lecturer in medical college will get a total salary of around Rs.32,000, senior lecturer Rs.36,000, assistant professor Rs.51,000, associate professor more than Rs.77,000 and professor just over Rs.85,000. (The salary includes patient care allowance and non-practicing allowance).
Rakesh Kumar Jha, chairman of the Kozhikode Government Medical College Union, says the recent hike announced by the State government would help in attracting new talents. But the vacancies for teachers in medical colleges must be filled, so that doctors could focus on the teaching side, he says.
Deepak S., a neurologist, says the hike will be beneficial for medical college teachers as it will attract mostly people to this profession. Dr.K.V. Prabhakaran, district secretary of Indian Medical Association and former district president of the Kerala Government Medical College Teachers Association (KGMCTA), says that the new hike was not as much as KGMCTA had demanded, but was satisfactory.
Dr. Prabhakaran says that the doctors can devote more time to teaching and research once the private practice is abolished. Representatives of the Kerala Medical Post Graduate Association (KMPGA) also welcomed the latest hike which will attract talented persons, but said that the doctors joining could focus on teaching only if the vacancies of teachers were filled and sufficient doctors are there to handle the patient rush.
P.K. Sasidharan, Dean of Faculty of Medicine, University of Calicut and former State president, KGMCTA, says that as per the information available, the recent pay hike announced by the government will benefit the teaching profession in the long run. But the pay packet will be meaningful only if the new package covers all the benefits enjoyed by faculty members of Central Government medical teaching institutions like AIMS and PGI, Chandigarh, which include allowances for attending conferences, free-furnished accommodation and lots of other benefits.
Some of the MBBS students say that they were unaware of the real impact of the extension of working hours of faculty members. It is not yet known clearly whether the out-patient timings would be extended or if the afternoon hours be devoted to teaching.
Retirement age
If one were to consider problems in government medical colleges apart from the complaints of inadequate pay structure, staff shortage certainly comes into picture. Representatives of KMPGA say the first priority should be to fill up the vacancies. The service of retired doctors should be extended for a few years, so that their expertise could be utilised. Now the patient-doctor ratio is not maintained. The number of teachers does not increase with the increase in number of students. Also, doctors are less in some colleges where patients are more.
Even though the postgradaute students have been renamed as junior residents, their responsibilities have not been lessened. They will be on call 24 hours a day. They observe that the new working hours from 8 a.m. to 4 p.m. for doctors is welcome but they could devote time to teaching only if sufficient staff is available.
A third-year student of Kozhikode Government Medical College says that staff shortage is the main reason for the decline in standards of education, even though these colleges are well ahead of private colleges in terms of academics.
Mr.Jha says that the staff pattern that most departments in government medical colleges are following is similar to the pattern that existed 50 years ago. Meanwhile, during these 50 years, the student strength has gone up from 50 to 200 and the number of patients has increased three times. “In most Government Medical Colleges, teachers make students of third, sixth and eight semester sit in one class due to shortage of staff. And in the class, teachers would often focus on helping out final year or eighth semester students. This prompts some of the third and sixth semester students to bunk classes,” Mr. Jha says.
Lack of facilities
Mr. Jha also points out the futility of setting up big buildings as hospitals while these are short of equipment and other facilities. Proper facilities should be provided, he says.
Conducting bedside clinics is not possible in crowded government medical college hospitals as students will not have enough space to stand. There would be many patients lying on the floor in these hospitals.
A MBBS student points out that the number of Out Patient (OP) cases is so high in these colleges that doctors are unable to take classes. “Classes by senior faculty classes are very rare due to this reason,” he says.
Dr. Sasidharan says that the government should take steps to strengthen the primary health centres, taluk hospitals and other hospitals so that the concept of government medical colleges as tertiary care centres is realised.
Now all patients flock to medical colleges, but if the facilities in other government hospitals are increased, it will lessen the flow to the medical colleges.
Dr. Sasidharan says that government should have a health policy that aims at prioritising health care facilities and not disease care facilities. “The current medical curriculum that we have now does not produce doctors for our society; all are driven after specialisation leaving hardly anyone to look after health care, primary care and emergency cases. There is an urgent need for a policy change to bring out more people-friendly family doctors and introduction of a referral system,” he says.
Dr.Sasidharan says that for this to happen, current MBBS curriculum should be changed and government should give more salary and facilities to General Practitioners (GP).
A strict referral system will ensure that only those patients referred by the family doctor would be entertained by the specialists.
Another suggestion was to introduce health economics both at postgraduates and undergraduates so that the students understand the priorities and thereby avoid the wasting of resources.
