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Updated: January 2, 2011 21:54 IST

Shortage of doctors,hurdles to access

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S. Viswanathan
The Hindu S. Viswanathan

A splendid response from readers to last week's column (‘Universal health care: media push needed,' December 27, 2010) denotes not only their deep concern for one of the major issues that confront them, but also their eagerness to share with others their understanding of the problem. The long letters from some readers testify to this. They register their displeasure over the failure of successive governments to evolve comprehensive, effective, and practicable healthcare policies — particularly during the last about three decades, which saw a gradual withdrawal of the state from health-related commitments.

Some noted that relevant issues such as the shortage of medical and paramedical personnel, the status of medical education, and health insurance schemes in many States could have been discussed in greater detail. Following up, this column addresses issues relating to medical education and also health insurance, which have seen some developments recently.

The content, quality, and status of medical education have a direct bearing on the quality of health care delivered in society. In contrast to engineering colleges, which have mushroomed everywhere, the number of medical colleges has grown very slowly. There are 273 medical colleges recognised by the Medical Council of India; they have a capacity to educate and train fewer than 32,000 students. The acute shortage of medical seats leads to an acute shortage of doctors, which continues to be felt especially in rural India. This hamstrings the functioning of rural public health centres and hospitals. Equally important is the question of quality. With talented doctors leaving government hospitals in large numbers to join corporate hospitals, government hospitals in urban India have also started feeling the pinch. The prohibitive cost of medical education, the capitation fee system that has managed to stay in many places defying adverse court verdicts, frequent changes in admission procedures, and hidebound professional opposition to major increases in the number of medical seats work against quantitative expansion as well as qualitative upgrading.

Dr. G.R. Ravindranath (Chennai) contends, in his e-mail response to last week's column, that privatisation of medical education has fuelled commercialisation of medical care. Rural hospitals suffer an acute shortage of doctors. His view is that if the efforts of the Medical Council of India (MCI) to hold a common entrance test succeed, it would do more harm than good for the less-privileged students. It might also affect certain special features of the reservation system in operation in Tamil Nadu. Further, students from non-Hindi States might find themselves disadvantaged, because they might have to write tests only in either English or Hindi.

The kind of situation Dr. Ravindranath discusses is not new. It is not difficult to understand the problems of aspiring young men and women seeking higher education in a multi-lingual, multi-cultured country. They will have to write the qualifying general academic examination in the next two months and sit for the entrance test (which was abolished in certain States, including Tamil Nadu some years ago). If a candidate is kept in the dark about the details of the admission procedure and the nature of the test, the mental stress can be imagined. Leaving such vital matters unaddressed, in uncertainty, is indefensible.

Misreading and confusion

The Medical Council of India (MCI) is yet to come with the needed notification and regulations for the common entrance test. To add to this, incorrect reporting of a brief Supreme Court order by a section of the news media, print as well as broadcast, caused some confusion in Tamil Nadu. Political leaders were critical of the entrance examination on the premise it would affect the implementation of the reservation system.

A report in The Hindu (December 14, 2010) said: “The Supreme Court on Monday [December 13, 2010] made it clear to the Medical Council of India that it could not grant approval for the proposal to introduce a common nationwide eligibility-cum-entrance test for MBBS and postgraduate medical courses from 2011-2012 even before the regulations were notified.” The Bench comprising Justices R.V. Raveendran and A.K. Patnaik said in a brief order: “We make it clear that the pendency of the application shall not come in the way of MCI notifying any regulations framed by it, in accordance with law, if it had been approved by the Centre. Nor would the pendency stand in the way of anyone challenging the validity of the regulation after it was notified.” For all this, the uncertainty over the entrance test continues for students.

One of the strategies adopted in various parts of the world to shield vulnerable sections of society from ill health is health insurance, the other one being government-run hospitals. Insurance schemes work well, particularly in respect of groups of people working in the organised sector. In such cases, either governments or employers pay the premia. But what is badly needed in India is a universal health insurance scheme to ensure decent medical coverage for all sections of the people. The Rashtriya Swasthya Bima Yojana (RSBY), the health care scheme meant for the Below Poverty Line (BPL) people, excludes a substantial number of middle income group people who do not have any insurance coverage. Those classified as BPL and covered by the insurance scheme are entitled to a maximum of Rs. 30,000 per family to cover hospitalisation charges. Several States, including Tamil Nadu, Kerala, Andhra Pradesh, Karnataka, and Rajasthan, have evolved their own distinctive health insurance schemes.

A reader from Nalkonda, Dr. J.P. Reddy, in his e-mail praises the successful working in Andhra Pradesh of the government-run insurance scheme, “Arogyasri.” Introduced boldly and imaginatively by the government of Y.S. Rajasekhara Reddy, the scheme treats the poor and the needy suffering from even major and complicated diseases absolutely free of charge.

S.V. Venugopalan (Chennai) has a quite different perspective on health insurance. Citing Michael Moore's “Sicko” (2007), he says the movie powerfully exposes the collapse of the health care system in the United States and the disastrous failure of insurance companies to honour their commitments to the insured. Dr. Lord W. Reza, in his communication, makes another point. Insurance charges, he contends, invariably inflate health care cost beyond reach. Governments have long been focusing on tertiary hospital care, deviating from the earlier emphasis on primary health care. “Encouraging the private sector in health care,” Dr. Reza asserts, “is not and will never be a solution.”

The debate on the most appropriate healthcare model for India will and must continue and newspapers must play a more active role in informing the reading public on the choices available to the country under challenging circumstances.

readerseditor@thehindu.co.in

I am doctor by profession and I did my MBBS from Kilpauk medical college and after finishing M.B.B.S came to US of A for Internal medicine training. Now I am trained Endocrinologist and diabetologist and I want to come back to India for my practice. I want to be in an academic institution doing clinical research and teaching what I have learnt but it is so difficult to find a position in an academic institution. I have emailed people, telephoned them and yet no response. I am very frustrated by the lack of response.

from:  Sruti Chandrasekaran
Posted on: Nov 16, 2011 at 20:19 IST

SHORTAGE OF DOCTORS a big cry why,I remember reading a article some
time back "INDIAN Dr Are capable of handling multiple cases at the
same time" it is very true.some times we need to attend to more then 3
to 4 cases at the same time yes we can deliver more and yet do Justice,
European Dr need lots of time to get to the root of a problem and
treat the case ,it takes time for him to come out of the case and go
to the next .
So we need to be taken care of first of all ."YOU PAY PEANUTS You
GET MONKEYS" let the govt Produce more Doctors and absorb every one at
least for first 5y rs pay them well,give them a job security ,try to
allow them to pursue PG in the line of interest instead pushing them
into what you have,allow every one to enter POST GRADUATION,you get
the best doctors How ever bad some one is TRAINING FROM efficient
hands will make them perfect HANDS we have enough and more ,but goes
unidentified bcos of bureaucracy.YEARS TO COME GOVT NORMS WILL NOT
BRING GOOD TO PEOPLE And Dr.

from:  Dr.Ramesh
Posted on: Oct 10, 2011 at 08:22 IST

The shortage of doctors is really a critical issue in the world most populated country like India. Author juxtaposes the thriving of Engineering and Medical colleges, which indeed could not be lucidly compared as of now .As sudden growth of former is directly attached to the demand in global economy (job opportunities created by US) , where as later didn't have much to offer, even in crisis. Furthermore, the cost of the education could be one of the vital problem, Medical colleges demand more finance than the Engineering colleges, As a result many candidates find it difficult to bare it(except few government colleges ). In addition to this opening a medical college could be more costly affair than an Engineering/MBA college. Author also states the Migration of the doctors from village to city is very genuine problem; the very primal reason is "the demand for better life style" is attracting many doctors into cities. However government should come up with some strict policies to check this flow.

from:  Anupam Nandan
Posted on: Jan 23, 2011 at 15:43 IST

I fail to understand what is the problem with non-Hindi speaking states in holding common entrance test? Since there will be no change in their state quota of seats 85% of seats in common CET for UG and 50% PG seats may be reserved for the states as it is done today. The CET will not only save students from appearing in many ent. exams and but also do away with corrupt admission practices in colleges specially the private ones.

from:  Dr. Kamal Parwal
Posted on: Jan 21, 2011 at 18:07 IST

Some very interesting and valuable comments. What I have understood that standards for setting up a medical college need to be relooked at. What was set in 1956 is not very relevant today. Basic requirement of 25 acres avilaibility and 300 beds(no of patients occupying these beds is important) and requirement of qualified, experienced teachers and investment & fees to be charged and many other factors are contradictory. one prevents the fulfilling of other criteria. medical colleges can not be compared with engineering colleges.

from:  Bhagat Dr
Posted on: Jan 20, 2011 at 21:15 IST

Why cannot entrance tests be offered in other languages other than Hindi? Why is Tamil Nadu government not taking up this issue for allowing exam questions and written answer in Tamil ?

from:  Selvaraj K
Posted on: Jan 11, 2011 at 13:17 IST

As has been rightly pointed out, with the mushrooming of private hospitals there is a real shortage of doctors in rural india. Amidst all the hype surrounding medical tourism, the government has neglected the plight of healthcare in rural India. One must note that most of the Medical Colleges in India are run by the Government. The government should introduce a compulsory service of at the least 4-5 years by doctors in government hospitals.

from:  Prakruthi Gowda
Posted on: Jan 5, 2011 at 14:22 IST

In western countries, doctors prefer to be in the villages and big cities have doctors from India, Pakistan and Bangladesh.Reasons: Villages have schools for their children of same standards as cities, Villages have electricity, water, food etc of same standards as cities,Villages have hospitals with full infrastructural support. If my father as a doctor had stayed in villages, I would not have had the education to become a doctor today!

from:  Dr Arun Prasad
Posted on: Jan 4, 2011 at 18:06 IST

India should focus on preventive and primary health care.Let the Govt.ensure safe drinking water,better sanitation, nutrition to children and and pregnant women. 80% of diseases will be wiped off from India.Thinking of insurances is nothing but 'safety net' policy of World Bank which will its agencies.

from:  Ponniah Rajamanickam
Posted on: Jan 4, 2011 at 08:29 IST

In last five years I remember, inaugural of barely three-four colleges(one by Smt. Sonia Gandhi in Meghalaya) could make in news. While the Ministry of HRD announced dozens of IITs, IIMs & NITs. In a country where 50million people are diabetic(diabetic capital of the world),doctor-people ratio is 1:1700 against world average 1.5:1000, less than quarter population is insured; policy of setting professional institutes should be reversed (i.e more new medical colleges then technical colleges). Moreover, Govt. is planning to have 'half-doctors' (3 yr. trained rural doctors), showing apathy towards setting up full fledged medical colleges. As per 'Jan Nayak' Karpoori Thakur the country will be prosperous when the doctors will be unemployed. Recently I read, the Center relaxed norm of land requirement(from 3.5 acres to 2.5 acres) to setup technical institutes. It will further fuel mushrooming of 'technical education industry' with enhanced quantity of products but with cheap quality. I wonder, when many leading industrialists like N.Murthy endorsed repeatedly that more than three-quarter engineering freshers are not employable. Then how Ministry of HRD is only focussed on quantity instead of far important quality. One can find hundreds of 'ten-roomed engineering colleges' in Noida, Pune, Bangalore. The 57% contribution of service sector in GDP may be driving force for such higher educational policy. The India's booming service sector includes software, finance & business consultancy, BPOs, KPOs etc. For all these one need not to be an engineer(except computer science graduates for programming only, not coding. Today there is no relation between the education they got and what they are doing. So, it is baseless to be biased towards technical education. Further in real sense, service sector growth helps in prosperity of urban areas(30% population) only as it has low backward linkages. While, more medicine graduates will bring prosperity to entire country by employment generation(private medical consultants) besides health.

from:  Nikhil Jaiswal
Posted on: Jan 3, 2011 at 15:39 IST
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