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Updated: June 26, 2013 02:04 IST

Doctors by merit, not privilege

Sujatha Rao
Comment (77)   ·   print   ·   T  T  
The Hindu

Cleaning the mess in India’s medical education first needs a strengthening of the Medical Council of India through the appointment of members by an independent and rigorous selection process

India is the only country that authorises, as official policy, the sale of medical seats by private medical colleges, implicitly accepting the principle that the ability to pay, and not merit, is what counts. Further, in the absence of any system of third party certification by way of an entry or, more importantly, an exit exam — which could guarantee the qualities and competencies a doctor must possess before starting to practice — many medical colleges are producing quacks. The tragedy is that we all know about it.

The issue is not just about illegal capitation fees that range from Rs.50 lakh to Rs.1 crore for a MBBS seat. The process of admission is itself flawed with a walk-in system for those with money but for the others, it is a harrowing tale of expensive tuitions and writing 15 to 20 examinations across the country — a process that once again excludes and deters several.

Entrance test

In order to reduce the stress of multiple examinations, make it more equitable and ensure minimum levels of competence, having the National Eligibility-cum-Entrance Test (NEET) as a qualifying requirement for admission has been a long-standing recommendation of experts. It was reiterated in 2010 by the Medical Council of India (MCI), inspired by rapidly deteriorating standards of school education.

The delay in implementing NEET was because of a lack of political will and the growing clout of private medical colleges in a neo-liberal environment that has encouraged a deadly cocktail of money power and political muscle. It is creditable that despite pressures, the MCI conducted NEET in 2012, for 90,000 aspirants.

Defying the MCI mandate on regulating entry into medical colleges, about 90 private colleges held their own examination and, on specious grounds, successfully obtained a stay from the Supreme Court. On May 13, the Supreme Court issued an interim order, making NEET voluntary and permitting the private colleges to go ahead with admissions based on their own examinations. For the harried students, it was Black Monday.

As business

Archaic and outmoded rules, regulations and eligibility conditions requiring a capital base of more than Rs.150 crore have made the establishment of medical colleges a business proposition. Combined with no incentives for quality education, there has been a twofold impact: 1. commercialising the medical profession, where “recouping” the investment is the prime concern for the investor and graduating doctor alike; and 2. an aggravated shortage of doctors in three ways: 15 per cent of those in the Non-Resident Indian quota within the 50 per cent management quota do not practice in India; of the remaining 35 per cent, many do not practice, migrate abroad or establish themselves in cities for better incomes; and, poor training makes many “unemployable” as amplified in a provider survey by Jishnu Das in Madhya Pradesh which found a marginal difference in the practices of “qualified” doctors and quacks. Clearly, the commercialisation of medical education is one of independent India’s biggest mistakes.

Therefore, the solution of “flooding the market with doctors by opening more medical colleges” to contain the menace of capitation fees without in the first instance, overhauling the regulatory framework related to quality of instruction, faculty development, better salary structures and banning private practice, etc has little merit.

Issue of quality

There are no short cuts or easy solutions to what has become a highly political issue. If people’s health really matters for this government and if India is to stay competitive globally, it can no longer look the other way. It has to exercise its constitutional authority to bring in much needed institutional reform to clean up the mess, just as it did in 2010 by replacing a corruption-ridden MCI with a board of governors by way of an ordnance.

In the same year, the ministry also drafted a bill to establish a National Commission for Human Resources for Health (NCHRH) to address the issue of quality by balancing the three critical functions of the profession: a) curriculum — what is to be taught and for how long; b) accreditation — who is to teach and in what manner; and c) ethical practice — adhering to the best interests of patients.

While the first two aspects were placed within the domain of a nominated body of experts, ethical medical practice was to be ensured by an elected body of the MCI. A distinction between nomination and election was made keeping in view the professional expertise needed to address complex issues related to content, standards, quality, competencies and skills as required by the country. Such expertise has to be sought and is not thrown up through electoral processes. It is for this reason that in most countries such as the United Kingdom, regulators are selected by the Public Service Commission based on merit and suitability. In addition, the U.K. Medical Council also has patient groups, student representatives and civil society activists as members of the Medical Council. Such openness and transparency is the only effective antidote to an indiscriminate abuse of power.

Focus on the regulator

In October 2012, the Parliamentary Standing Committee returned the NCHRH Bill to the government to re-examine three major concerns: 1. States’ autonomy and potential violation of federal principles; 2. excessive bureaucratisation and centralisation, and 3. faulty selection procedure of regulators, providing scope for abuse. Rather than seizing the opportunity to come up with a better draft, the ministry has, for the third time, reconstituted the board of governors with a retired Directorate General of Health Services as chair.

It is believed that the main purpose of the reconstituted body is to oversee the elections to the Board of the MCI. If true, this is disheartening. The MCI is the regulator for medical education and practice just as the Reserve Bank of India is for financial institutions or the Election Commission of India for elections. Regulators cannot be elected on popular mandate — they have to be invited by the government for their professional eminence and moral authority. The MCI has to discipline and police the profession, more so on account of the extensive market failures that characterise it. Elected persons are compromised individuals and cannot do the task effectively. We have seen how disastrous our experience has been with an elected body; within the decade 2000-2010, it was set aside twice, once by the Supreme Court and the second time by the government by way of an ordnance. No other regulatory body has suffered such humiliation.

Since medical education is in the concurrent list of the Constitution, the Central government needs to leverage that power to bring in some discipline before permitting any more colleges to be established. The time has come to strengthen the regulator first by having the MCI Board freed from the clutches of doctors to include all stakeholders and have the members appointed through a rigorous selection process by an autonomous body like the Union Public Service Commission. This will end the nomination process of the ministry and the consequent conflict of interest. Once appointed, the regulator can be allowed to enforce its own rules and regulations.

The government needs to attend to a range of reforms from: appointing a tariff committee, indicating the right quantum of fees to be charged and legally enforcing the same; providing autonomy to medical colleges to stimulate excellence and innovation; constituting a committee of experts under the chairpersonship of a senior politician to examine some of the contentious issues, including the frequently made suggestion to nationalise private colleges, and appointing an advisory committee to undertake some of the critical functions of curriculum change and accreditation pending the establishment of a body like the NCHRH, which in today’s circumstances may take not less than three years. What is required is a non-negotiable, high priority concern for patient welfare and safety by focusing on the quality of doctors being produced, in sufficient quantity of the skill mix.

In conclusion, sorting out the mess in medical education requires a consensus across the political spectrum. Any shifts in the status quo will be bitterly opposed, so deeply entrenched are the vested interests. But the time has come for the government to act as the acute shortage in human resources is the main barrier to achieving universal health coverage. The more the delay in addressing the critical challenges facing human resources for health on grounds of political expediency, the greater the social, political and financial costs this country will have to bear in the years ahead. Prudence lies in stemming the rot by decisive action and before it is too late.

(Sujatha Rao is a former Secretary, Ministry of Health & Family Welfare. E-mail: ksujatharao@outlook.com)

More In: Lead | Opinion

When I was young our family doctor was Dr.Narayan Pai. His
qualification was his working as a compounder under a British Army
doctor. He used to commute in his bicycle to treat his patients who
were not in position to visit his clinic. He used to treat those
patients who could not afford to pay his fee without any
discrimination. When my mother suffered a deep wound on her head when
a stone hit her he sewed the wound under light from a hurricane
lantern and saved her all for a fee of Rs 10/ in 1967.In the present
time it would have costed us a fortune.The country needs such
doctors.It is possible by simplifying medical education and making it
affordable to the common man.They in turn will be sensitive to the
needs of common people.

from:  Baikadi Suryanarayana Rao
Posted on: Jun 28, 2013 at 10:41 IST

@smrita, there is a difference between partying free arms paying capitation money.

from:  Venkatesh
Posted on: Jun 28, 2013 at 10:05 IST

One is left wondering what did the author do as a secretary to Government to initiate reforms. In any event in India two critical problems are prevention of disease, which is neglected by political leaders and the bureaucracy as it not understood in all its complexity (food, agriculture, water, pollution etc) And the neglect of Ayurveda by Government(alternate system!}

from:  acharya
Posted on: Jun 27, 2013 at 22:20 IST

I comment on comment by Ms. Smrita. Someone has to pay! Patients are paying a heavy price ! With their health and wealth. The medical colleges know health is wealth! Poor author laments about merit in these days of business; a former secretary of health ministry. A new found courage.

from:  Swaminathan R
Posted on: Jun 27, 2013 at 15:24 IST

Without any "entrance" or "exit" tests but through rigorous
affirmative action for backward caste and scheduled caste students,
Tamil Nadu state has made relatively significant progress in public
health care and in the standard of Government Hospitals (compared to
other states) which has been lauded by no less an institution than
the reputed international medical journal "Lancet" (as reported in
"The Hindu" in the news report titled "The Lancet calls state's
healthcare programme a success story", The Hindu, May 21, 2013).
Scores of Tamil Nadu medical graduates are enjoying stellar careers
in western nations and Chennai has also become a “medical city”
mainly because of the reservation (affirmative action) in medical
college admissions to backward castes and scheduled castes which
widened access to medical education. This would not have been
possible if an urban upper caste elitist monopoly was allowed in
medical education through draconian, unnecessary and super-elitist
entrance tests

from:  Dr.Iniyan Elango
Posted on: Jun 27, 2013 at 14:55 IST

"Further, in the absence of any system of third party certification by
way of an entry or, more importantly, an exit exam — which could
guarantee the qualities and competencies a doctor must possess before
starting to practice — many medical colleges are producing quacks"
The author should know that there is a third party verification (by
external invigilators of MCI & not the colleges), & his comments that
medical graduates coming out after passing these exams are quacks is
extremely deplorable.

from:  Dr Sameer
Posted on: Jun 27, 2013 at 12:05 IST

The article has expressed the concerns very well.But,many complexities
are attached with this serious problem which is not alone as the web
of problems is not an easy one to decode.

The commercialisation of the medical education is witnessing an
exponential growth with every year.It is not so that well to do
families are only purchasing the seats and making the education a
mockery;the reservation system in the government colleges is also
promoting this lucrative business.The general category students,many
of them meritorious are kept at bay when taking admissions there
whereas the reserved category gets the admission easily.This injustice
is totally inexplicable and the next option exercised is purchasing a
seat in private colleges by the middle class families.

This whole plethora of issues are interlinked and they are all
responsible for dismal level of education in the country be it medical
or engineering.

from:  Mohit Kumar
Posted on: Jun 27, 2013 at 10:29 IST

Someone has to pay for the education . does this writer feel that medical education should be gifted to people like the MNREGA welfare scheme

from:  Smrita
Posted on: Jun 27, 2013 at 04:41 IST

It seems to be that many of the people are commenting about reservation in Govt. medical colleges.The cut off for Forward caste is 99% whereas it is 97% for S.C.candidates.I don't see that much of mark variation will make any difference. Moreover in India reservation for S.C. is 18%, but among the doctors practising in India almost 50% are S.C.It's also true that doctors from disadvantaged background mainly work in the rural community. So reservation especially in medical sector in one way has done the good for the nation.It is the forward caste person who gets 40% in pre-university exams and pass the M.B.B.S by bribing the examiner in each and every viva (It's widespread in private medical colleges in india) are more dangerous than a meritorious S.C. student. Having said that most of the medical students who acquire degree wihtout knowledge, either do a non clinical job or do an administrative job as a head of corporate hospitals owned by them.

from:  R.Manivarmane
Posted on: Jun 27, 2013 at 02:32 IST

The doctor as a profession requires high moral values. He is a saviour,
next only to GOD. No doubt, administrative set has to be just and
rigorously potent, equipped with all modern needs of the job. India
badly needs skilled professionals to fulfill ailing medical
requirements of its people. I hope that the MCI must pull up its socks,
and devise a mechanism , so that capable and responsive persons opt for
the job.

from:  Shobhit Namdeo
Posted on: Jun 27, 2013 at 01:17 IST

Dear Sujatha,

It's a foregone conclusion that medical and health benefits cannot
reach
the people of middle and lower income groups for long time. Ever
since
few London educated Indians wrote a Constitution for an non-existed
India prior to Freedom, the fate of India has been sealed. They wrote
Constitution for a nation that had never existed before. This subject
has become a debating point for intellectuals like you on English news
papers who domain is about less than 10% of India.

from:  Murthy
Posted on: Jun 27, 2013 at 00:07 IST

India's problem with medical education or education in general will not
go away until admission to the college is based 100% on merit. India is
politically not ready for this to happen. It will only happen when
reservation is eliminated.

from:  KGS
Posted on: Jun 27, 2013 at 00:04 IST

Well written article but whether any change will be brought by it remains to be seen.
India is the only country where the privileged rich can buy anything. Money rules. No
one is concerned about the quality of medical education and in time the so-called
self-financing colleges begin to achieve enough clout and power that they start to
achieve a certain amount of respectability. The whole system needs a complete
overhaul. But first the authorities should accept that there is a problem and stop any
further expansion in private medical colleges. It is a shame that many of my brethren
would not hesitate to buying a seat for their child if he/she do not manage to get a
medical seat by merit.

from:  Dr Karthik Maruthachalam
Posted on: Jun 27, 2013 at 00:02 IST

Why the medical education in India is meant only studying for MBBS and MD/MS, which is expensive and timetaking. Why not introduce courses like B.Sc. (Human Science) to produce bare foot doctors who can treat common diseases of poor. Further, why not train the so called quacks (RMPs-Rural Medical Practitioners) so as to bring the affordable healthcare to the masses. I strongly believe that vested interests are at work in restricting the doctors strength in India. Governments should introduce courses like B.Sc. (Human Science) to train poor rural 10+2 pass students to enable them to treat commonly occurring diseases at affordable cost.

from:  N. Sarat Babu
Posted on: Jun 26, 2013 at 22:53 IST

The headline should have been"Doctors by merit,not privilege of money and caste".When the under merit students are getting government seats through reservations the merit students of unreserved category have to approach private medical colleges for a seat for a price.But the management quota is very limited compared to majority government quota in private medical colleges.Then why bother the seats for money? This money is being utilised by the colleges to run the medical college and hospital as the fees paid by government quota students is not sufficient to run the college and hospital.It is true the capitation fees is very high and the managements must reduce it drastically and take the students from the entrance test results but not directly.

from:  Jayaprakash Reddy
Posted on: Jun 26, 2013 at 21:47 IST

Let there be a politician eligibility test based on a high qualification and merit basis to ensure a corruption-free india

from:  Chinmoy
Posted on: Jun 26, 2013 at 20:38 IST

But the biggest irony is the students getting MBBS degree from
Russia,China etc. Where there is no MCI to regulate these medical
colleges,in terms of manpower and infrastructure.Just one need to pass
one screeing exam to be eligible for registration with MCI.Why we have
discrimination between colleges situated in India and abroad?

from:  Dr Dharmesh Lal
Posted on: Jun 26, 2013 at 20:11 IST

Well written article...I don't want to comment on capitation/reservations etc. What would be better for Indian health care is to set standards in the competence of the medical students graduating. This could be done by have a computerised exam or evaluation of answers sheets by third person/s ( so that no malpractice happens) and finally evaluation of the student outside the college/state by independent assessors.
These measures will certainly improve the standards as pass rates will fall without hard work and fees doesn't pass you to get a degree things will correct themselves

from:  Anan
Posted on: Jun 26, 2013 at 20:03 IST

Even while presenting a rotting state of medical education in india, I
think neither the author nor the commentators have won in exposing the
real maladies in India’s medical scenario. First of all we all have to
understand and admit one important fact that allopathic medicine is not
the only medical practice in India. India is historically a land of
medical visionaries. The real malady in our medical sector is that in
the hues and cries for capitation fee, unfit doctors, quality of
training and all we are forgetting our traditions and millions of
people who are denied medical services. In the interiors of India, we
can still find traditional healers with immense treasure of local
knowledge about local medicines and practices. But MCI or any
authority are not trying for empowering them or recognizing their
talent, so that Half of India’s medical problems can be solved locally
without coercing the very demanding MBBS doctors to practice in rural
India .

from:  Bobitha
Posted on: Jun 26, 2013 at 19:56 IST

In the present stage of India’s growth trajectory where we hear
“demographic dividend” every other day, I don’t find any problem in
allowing private players to establish institutions of higher education.
In fact it’s the need of the hour. Let people who have enough to spend
also study. Also exams like NEET even if competitive is not inclusive
as the result is often heavily depended on how fortunate you were to
have a superior coaching beforehand which again most often depended on
your wealth status. But an independent regulator with real teeth is of
course needed to ensure whoever passing out of these institutes can be
approached without fear of loosing lives and getting indebted.

from:  Bobitha Stanly
Posted on: Jun 26, 2013 at 19:54 IST

The heart of the issue is politicians seek and obtain government as a means of self enrichment,so,naturally national issues like the present topic healthcare is only for enrichment of elected party not for national benefit!

from:  Dr N M SUDHIR
Posted on: Jun 26, 2013 at 19:50 IST

Why is it that all former secretaries write scathing articles and when
they are in a position to intervene they just sit and while away time.
The examination system , the establishment of medical colleges, the
formation of MCI and its working is all regulated by babus such as
secretaries and by their political masters who are keen to make money
till they are in power. So I would request the editor to not let such
people write such articles in a paper we all respect and tell us
things we all know in a better vocabulary. What our country needs is
something similar to the Arab uprising to weed out the rot that has
been present for the past 50 years in the bureaucracy and politics

from:  Dr Aniruddha
Posted on: Jun 26, 2013 at 19:44 IST

First step to ensure standardization in the Medical education is to get away from quota system. When a student is given admission based on quota to M.B.B.S course, he is no more a backward class. For the postgraduate studies quota should not be applied. This way a meritorious student is given all the opportunity to get into speciality fields. It is a shame that India is promoting mediocrity in medical education by following strict quota system. I come from Tamilnadu, where it is a curse to be born in forward community. Many dreams including mine was shattered by this quota system. Let us be civilized and take this quota system away.

from:  V.Raman
Posted on: Jun 26, 2013 at 19:24 IST

We have created enough quack Engineers and doctors through payment quota. It is hightime now to practice this. Elite education like law, Engineering, Medicine and like should be allotted on Merit basis and we should create well qualified professionals before we become a laughing staucks.

from:  S Thiruvengadam
Posted on: Jun 26, 2013 at 19:15 IST

Prevention is better than cure.

from:  Shyam
Posted on: Jun 26, 2013 at 18:24 IST

The capitation based admission is another nail in the coffin of
universal healthcare. How can someone who has paid 25 lakhs for MBBS
and a crore for PG be expected to work with the public health system?

from:  Gulrez Shah Azhar
Posted on: Jun 26, 2013 at 18:12 IST

By money only quantity can be achieved not talent.

from:  Ankur Bharadwaj
Posted on: Jun 26, 2013 at 18:11 IST

I congratulate your paper on publishing this very thoughtfully written article. It is appalling that India has the largest number of malnourished children, a very high maternal mortality ration etc and the production of a health workforce that is regulated well is one foundation stone for improvement. The comments of the author about the power of vested interests that block transparency and good governance in the sector of medical education are incisive and insightful.

from:  Panna Erasmus
Posted on: Jun 26, 2013 at 17:57 IST

The very fact,the determining factor of one's entry to a taxpayer paid Medical education is
by the final examination of the year itself is a contentious subject. There could be many
reasons one could not perform well on the day and if one looks into it closely it is a faulty
system to assess a pupil. Having said that, it does not matter if one pays one's private
money or the tax payers' money to study the Medical course. What matters is, if the
examinations conducted in the Medical colleges are in a proper and transparent manner and
if there are invited 'external' examiners who are part of the examiners who would give the
pass marks. More than marks, it is the attitude and service mentality of the individual who
takes to the Medical courses which are more important and many countries are now looking
into these areas before giving admission to the course.

from:  Saratchandran
Posted on: Jun 26, 2013 at 17:57 IST

The caption of the article deceived me. I thought the author is
batting for merit over reservations.
But after reading it for few lines I realized it is all tripe.
She hasn't mentioned how it is different from caste quota system
that is being followed? A person who has got 70,000 rank and gets
a good PG seat or a person who gets 5000 and buys a seat in some
private college?
If you(Author) is seriously concerned about merit in the system
she should oppose reservation system also, but she never did.

from:  Narasimha Rao
Posted on: Jun 26, 2013 at 17:54 IST

Everywhere in the capitalist world, there is a different standard for the haves and the have nots. Even in usa, people who can pay have lower score cutoffs for admission thatn people who cannot pay. So how is it different in India?

from:  Mohamed
Posted on: Jun 26, 2013 at 17:35 IST

Unfortunately there exist another evil namely the reservation. That
spoils the quality with Governments approval- whatever may be the reason
to justify it !

from:  C V Pillai
Posted on: Jun 26, 2013 at 17:17 IST

Among the questions that need answers are: a) Why does every MBBS student feel compelled to do a PG? b) What makes the MBBS degree so inadequate or perceived to be so? c) What are the avenues available to an MBBS Doctor? d) Why would anyone spend 50 lacs to 1 cr for a PG seat? Is there such a quick payback?

The alternatives that could address the above are a) extend the MBBS course by another 12/18 months, so that all have an opportunity of some kind of specialization b) increase avenues to pursue a PG through Hospitals outside of the current arrangement.

It is sad indeed to see an MBBS graduate completely lost with nothing at all in sight except trying for a PG seat.

from:  varadarajan raman
Posted on: Jun 26, 2013 at 17:17 IST

The Medical profession is now in a mess.Newer medical colleges are
sprouting like mushrooms in the private sector which lack qualified
teaching faculty with the option of private practise.The doctors
concentrate on private practise attending the college on specific
dates only.The research wing is totally running flop.Money power
decides admission leaving the deserving candidates desperate. This
results in producing poor quality medical professionals who are
interested in minting money only. To purify the system a powerful body
is needed at the helm of affairs selected not by elections but purely
on merit.God alone knows how this is achieved in the present
circumstances.

from:  Dr. Asok Sanker
Posted on: Jun 26, 2013 at 17:05 IST

This is the main cause for the high charges in our so called super
speciality hospitals .. Where the doctors who want retake their capital
from this . this country is going to be more expensive in coming years
where a normal man cannot live here ... A strong action and campaign
should be needed to stop this .. We Indians always take actions only
after a worst thing happens ..The mind set of the parents should be
changed.

from:  Narayanan
Posted on: Jun 26, 2013 at 15:39 IST

This profession deals with a life. Should not b adulterated. My neighbour has joined his daughter in one of the private institution for 60 lakhs. But she has managed to get only 65% in her 12th.. How can she cope up wit the curriculum. And how can she save a life after finishing her degree? Management quota should not be encouraged in medical profession. It might sound bitter, but has to be accepted!

from:  Jeykrishnan Janardhanan
Posted on: Jun 26, 2013 at 15:36 IST

Neither the author nor the commentators are concerned about the root cause of the malice. The ruling class who are responsible for the messy affairs should be removed first. Once this happens everything will change for the better.

from:  Cherian Mani
Posted on: Jun 26, 2013 at 14:09 IST

I do not want to enter into a discussion on the morality of obtaining a seat by capitation fee. I am not concerned about quality since all medical students have to take the same exam and one cannot pass the final exam by paying money (hopefully). If I am to know the details, I would rather trust a person who scored high on the final MBBS exams, than someone who entered on merit but scored less marks.

from:  Padmakumar Rao
Posted on: Jun 26, 2013 at 14:05 IST

Doctors by merit among the groups is the best, but doctors by money is certainly not acceptable. Democracy does not mean selling the seat to the highest bidder.

from:  G Simson
Posted on: Jun 26, 2013 at 14:04 IST

Why only Doctors by merit ? Why not elsewhere? In any case, our politicians, cutting
across the political spectrum, seek the best possible medical attention from
experienced and qualified expert doctors in the field from anywhere in the world and
not from those doctors "graduating" through the quota routes. Therefore, it doesn't
make any difference to them,whether the doctors qualifying through "quota" know
their job or not.

from:  KS Raghunathan
Posted on: Jun 26, 2013 at 13:48 IST

Let me be practical. In a country where everything is unethical, how can we expect medical education alone to be in line with principles.

from:  R.Manivarmane
Posted on: Jun 26, 2013 at 13:28 IST

Performing in school exams doesn't confirm the meritness of a student. The present system of coaching is converting students into mark-producing machines. Hence, Merit, on what field is imprortant.

from:  Siva
Posted on: Jun 26, 2013 at 13:26 IST

India is already haunted with the caste system, where lot of intellectuals are deprived from acheiving their dreams. This system of lucrative business in education is further culminating and is a major hindrance for India's glory in the near future. Goverment should therefore take stringent measures and thus create hiatus for this system.

from:  Saketh
Posted on: Jun 26, 2013 at 13:15 IST

The author fails to realise that general category students with ranks
of >4000 in the All India PG exam fail to get any seats in the Govt
medical colleges.
Whereas ST/SC and other category students can get the cream of the
medical seats in the best govt. institutes with ranks of even 70,000
in the All India PG exam.

Now, what other option does the general students have other than to
knock on the doors of the private medical colleges? First talk about
doing away the quota system especially in the post grad medical seats
then talk about the private system. Do you think a person is backward
even after he is already a MBBS doctor?

from:  Assam
Posted on: Jun 26, 2013 at 13:13 IST

A great article. Reflecting the culture of commercialisation of
medical education. Who will pay the final price for this sale cum
commercialisation of Medical Education in India???

from:  Dr. Mukund
Posted on: Jun 26, 2013 at 12:55 IST

Very relevant article. We need a uniform selction exam for the entire country. Only those who qualify should be admitted on merit. We should voice for incremental changes. Let us voice against the capitation method as a first step. Caste-based reservation is another topic which need not be a hinderance to this. There are genuinenly underprivilaged children from very challenging backgrounds who needs some sort of support to compete with the priviliaged children. Those who are in the medical profession should question why Indian medical degrees are not recognised and allowed to practice in certian countries? There is reason why politicians go over seas for medical treatment.

from:  Ayyappa
Posted on: Jun 26, 2013 at 12:43 IST

As a parent of a child who wants to pursue knowledge gain in the life sciences stream,I am appalled with the kind of inhuman, greedy grip of businessmen on medical institutions. Medical institutions demand nothing less than 60 lakhs for admission for MBBS which the common citizen of India can never afford. Deemed private universities (like JSS, Amrita to name a few) are the worst among these as they do not care for any regulations on this regard(if any). MBBS degrees are sold like roadside consumables except that these are sold in universities & colleges by greedy businessmen. Our elected representatives are the ones who facilitate these deterioration of medical education by acting like spineless, greedy policy makers. Most of the private medical colleges have been promoted by these elected representatives themselves. If this is the road to get into medical institutions in India, I feel bad about the future that's in store for our children and the citizens of INDIA

from:  Srivatsa
Posted on: Jun 26, 2013 at 12:37 IST

Selecting the best students for training may be one prerequisite to achieve standards. But it remains a small step in achieving quality training. Unfortunately for every other professional education in India the selection process for admission is made to appear as the sole determinant of quality. The infrastructure of the institution, the quality of teachers, the availability of clinical material, the methodology, research potential and uniformity of standards throughout the country does not attract attention and debate. This is unfortunate considering the huge difference in the standards of education in various parts of our country and between institutions within the states.

from:  R. Senthil
Posted on: Jun 26, 2013 at 12:24 IST

Madam good article ..but it should be applied but firstly who will obey the rule?

from:  Mahesh
Posted on: Jun 26, 2013 at 11:56 IST

There should be only one all india entrance for UG and PG and one exit exam for UG and PG. This will bring uniform standards in the country.

from:  Madhukar
Posted on: Jun 26, 2013 at 11:50 IST

World is run in the expectation/belief that the idealism shall be
established. May be today, it’s not so or difficult for such actions,
but some day when things work right, or when we make things work right,
the same shall be implemented. Hope so the day will appear soon...!!!

from:  Vedaprakash
Posted on: Jun 26, 2013 at 11:27 IST

The author might not be aware about the huge costs that these private
medical colleges have to bear, much of it to comply with the archaic
medical standards set by the MCI which dont have any relevance in
todays' time. Infact most of these institutes might not even break even
without the capitation fee that they charge. And if you are bringing in
the merit card, why dont you speak about the caste based reservation
that has been plaguing th entire country and not just the medical
education. Talk about double standards.

from:  Deepak
Posted on: Jun 26, 2013 at 11:17 IST

Yes. Admission can be based upon merit. But merit means not just marks. A doctor needs several other important qualities other than memorizing text books for exams. And if we expect higher research in medicine, mere exam base admission is not going to help. You may get a person who can become a decent doctor but not the best and brightest who can give be a leader in inventing new medical and surgical procedures(If just marks are considered.).

Moreover even if somebody pays money for admission, If he passes the same university criterion to acqiure the degree...that also should not be discontinued as we are not compromising in his training and competence.

from:  Narsing
Posted on: Jun 26, 2013 at 11:15 IST

The government is compromising on its quality to quantity of medical
seats across the country. It is sanctioning seats to private medical
colleges which are previously scrapped. During my M.B.B.S, I remember
my friends from private colleges complaining how their management buy
patients for conducting the university exam. The same is the case with
their internship now, where they wait for months to get a patient so
that they can catheterize.

from:  G D S Sarkar
Posted on: Jun 26, 2013 at 11:06 IST

I am one of the victims.Only people with wealthy background can study medicine in India.People like us don't get preference or value in this country.It has become a great business.Time for officials to implement regulations which will favour deserving people of all castes.Thanks to the author for such an informative article.

from:  Rahul Gee
Posted on: Jun 26, 2013 at 10:47 IST

1.India has triple burden of communicable infectious diseases, non communicable diabetes hypertension and cancer and the most ill equipped health system capable of handling the challenge of the sheer numbers.
2.Compounding the situation is liberalization's free flow of money eroding the quality of education and finally the care and dynamicity needed to meet the challenge.
3.50% of doctors produced are probably from those colleges which fake the numbers of patients treated and serviceability of the equipment and infrastructure needed for medical education.
4.Over and above regulating agencies for the recognition of courses including the local universities more under the political control than an independent body ensures perpetuation of the glaring defect shamelessly.
5.Every year great people in the field are called for the convocations of graduates and post graduates produced who give great sermons of being first a good human which is not ensured by the system of corruption in medical edu.

from:  Dr Haricharan
Posted on: Jun 26, 2013 at 10:44 IST

Oh look, the 'merit' buzz is here again!
No mention of caste-based reservation, how convenient!

from:  Sunil Lathwal
Posted on: Jun 26, 2013 at 10:17 IST

The medical education scenario in India is really rotten. It is no secret that many an institutions accept rich students after taking enormous amount of money as capitation. Students talk about it in terms of investment in returns which does augur well for future of medical preofession in India. All colleges must be merit-based. Only deserving candidates should be allowed to study medicine. We should take the money out of medical colleges and stop playing with people's lives.

from:  Aswin
Posted on: Jun 26, 2013 at 10:13 IST

Expecting the government to act...hmmm...is the writer aware that almost
everywhere, take for example Maharashtra, Tamil Nadu - most of the
private medical colleges are owned by politicians, directly or by proxy,
irrespective of party affiliations..perhaps it was convenient not to
mention that...and now we expect those same men to act in a manner which
hurts their interests....

from:  Preet
Posted on: Jun 26, 2013 at 10:07 IST

Good article.. But the author has avoided the issue of caste-based
reservation in medical education and it's possible impact of quality
of health care.

from:  Devi Prasad
Posted on: Jun 26, 2013 at 10:02 IST

Its great that the former secretary is highlighting the "payment" seat situation as hindrance to quality of doctors and merit.
How about the admission allowing quota's in medical seats based on Caste for student who barely pass the entrance exams is an hindrance. (God save the country as "Secular" politicians want reservations based on religion now).

Now talk about merit here!!

from:  aniket.sinkar
Posted on: Jun 26, 2013 at 09:42 IST

Your article only points out selling of seats by manangement quota and relates it with merit...your point is correct. But you conveniently removed the demerit system created by caste-based reservation...ie..a general student securing more marks than SC/ST, comes under management quota seat and other one securing less marks and getting regular seats in better college ..in your view which one is a bigger threat to people?

from:  Abhi
Posted on: Jun 26, 2013 at 09:03 IST

Sujatha Rao should be complemented on her clear analysis of the situation with regards to MBBS admissions . Apart from a common entrance test to assess academic excellence an aptitude test is mandatory to select candidates who are likely to stay committed to the practice of ethical medical practice. The qualities required in a medical professional are sincerity, honesty, commitment to professional excellence, a continuing eagerness to learn, perseverance and hard work.It is possible to devise aptitude tests to assess these qualities.
For selecting candidates to serve in rural India, the simplest thing to do is to identify school toppers from each village and give them an opportunity to become doctors with a clear written understanding that they will go back and serve in their respective villages.This is more likely to succeed than expecting a youngster urban or overseas background to go and serve in rural India.
In all this the mantra has to be transparency in all the processes

from:  Mandalam S Seshadri
Posted on: Jun 26, 2013 at 08:42 IST

Some of the reforms suggested are idealistic and the present political establishment will not even move towards it. But easier to implement will be "All India Level Exam" as is being conducted by other professional bodies like CA, ICWA, CS and others. This will bring down the pass percentage significantly and eliminate quacks from getting licence to practice. This body which conducts the examination should be independent comprising eminent doctors in various fields, should comprise multiple membership to avoid 'pre-fixing' for viva. This should be somewhat like the MLE conducted for post graduate admission in medical field in the US. If this is enforced strictly, then people will not pay Rs.1 crore for admission knowing that their son/daughter will not clear the exam - it will be a wasted investment. This is an immediate solution and this only the SC can enforce - politician will scuttle such a move.

from:  shyamraj n.g.
Posted on: Jun 26, 2013 at 08:21 IST

The author has critisised 'private' medical colleges for the dilution of standards, but is absolutely mum about admissions based on caste and religion based reservations and quotas!
When general categary kids' careers are drastically affected for want of a single mark, these 'privileged' students get admitted even with 8 and 10 PERCENT less marks. Does 'that' not affect quality?
I think, until India learns (albeit thehard way) the value of merit in Govt. sponsored/related issues, the least we can do is to issue varied coloured degree certificates for each category.

from:  Rajan Shete
Posted on: Jun 26, 2013 at 07:52 IST

Since when the politicians and bureaucrats interested in the health and
well being of the citizens? They are only interested in filling their
coffers as much as they can as soon as they can.

from:  bharatiya
Posted on: Jun 26, 2013 at 07:47 IST

There is a price tag for everything which increases with less on marks or requirements. This should stop. More over people are encouraged to depend on FREE stuff instead of hard and honest work to earn and not draw.Till this menace is removed, from our society, we will never improve on anything substantially.

from:  V.Sivasubramaniam
Posted on: Jun 26, 2013 at 07:40 IST

Commenting from a perspective of a doctor trained in India and now practicing away, these points mentioned are enshrined in any governance structure of most if not all responsible medical councils. Apart from the governance, independence and the power and the means to enforce the rules will determine how the system maintains itself. It also leads to a starting point in the discussion if the country is serious to grapple with the issue. Is it legislation that needs to enforce this?
Independence of the medical council and an assurance of non-intervention from the governments is the first step that will lead to a governance structure. There are multiple examples from countries with a robust system like the UK and New Zealand. Perhaps, an Egypt style mass gathering and protests will lead to this point, but do the people have the motives to do this?
Can the medical fraternity be the one to kick start this as their reputation is on the line?

from:  Thodur Vasudevan
Posted on: Jun 26, 2013 at 06:30 IST


The last sentence in the article is to be taken seriously as education in India has become a very lucrative business.

from:  pandharpurkar Tilak Sharma
Posted on: Jun 26, 2013 at 06:01 IST

This article is very insightful and the problems with medical education are laid out in a crystal clear manner. The Government could start out with standardization of education throughout the nation with common entrance and exit exams together with Board exams at every level of medical education. This should be followed up with recertification exams as is being done in the U.S.A.

from:  vinod vinjamuri
Posted on: Jun 26, 2013 at 05:29 IST

Very good article. I feel very good at least someone is concerned with our medical education system. Why should a graduate who doesn't even know even diclofenac injection to be given IM or IV should be allowed to practice.I say they are merely actors. By taking donations of plenty of lakhs and producing these medical actors private institutions are doing biggest crime against our country.Our government should wakeup and correct this .

from:  Surendra
Posted on: Jun 26, 2013 at 04:53 IST

If capitation fees are to be avoided, all medical education should be provided only in Govt Colleges. The social classes that enters medical colleges are skewed in favour of middle classes. There is no equity in school education. Private tuitions play a great role in getting high marks in eligibility exams

from:  S.S. Rajagopalan
Posted on: Jun 26, 2013 at 04:52 IST

What difference does it make? Our doctors are third-class anyway!

from:  Umesh Bhagwat
Posted on: Jun 26, 2013 at 04:26 IST

The corruption has entered in the DNA of our society. We have
become blind even for factors which are directly affecting us.
Do the authorizing officials can guarantee that the doctors
(Psuedo-Docs) produced by these moneyminded institutions won't
treat them or their family in future.
Or take the example of recent floods, someone engineer/bureaucrat
would have given the permissions for injudicious constructions.
Now think, have the river left them in this catastrophic
disaster?

from:  Gaurav
Posted on: Jun 26, 2013 at 02:43 IST

I belong to a family of doctors This is a discussion that
we take up at our home often. Medical education has become a highly
perverted market where medical seats are sold like items of luxury.
Only the rich and the mighty can afford them.
Medical Entrance ad Education should be purely on the basis of merit,
intelligence and aptitude. After all, doctors take care of precious
lives. Doctors are those who help us in being healthy. All this corrupt
game of asking huge sums of money in the name of capitation fees should
be immediately disbanded.
How could the Supreme Court not bring in the private medical colleges
under the purview of NEET? Why isn't the government increasing its
spending on Medical Education while it tends to spend on Commonwealth
Games and its ministers stack huge sums of wealth out of the weighty
scams that they do?
Please do not make a mockery of the hard work and effort of lakhs of
students who prepare sincerely to get into a medical college. Please!

from:  Manas
Posted on: Jun 26, 2013 at 02:36 IST

Despite the dull writing style, the author has drawn attention to the
ills inherent in the medical education system in India. One more thing
the author could have added -- after having screwed up the system, our
politicians choose to go the West for their medical treatment! They
should set an example by being treated by doctors who are the output of
the screwed-up system. Also,why doesn't the GOI study and adopt the
Cuban model of medical education? It is seen as very successful, as a
judicious blend of professionalism and social justice.

from:  Jay Ravi
Posted on: Jun 26, 2013 at 01:33 IST

A fantastic article reflecting the exact culture of comercialisation of medical education. Unfortunately this idea will not reach the decision making brains of the government or the supreme court. The corridors of power are unfortunately only open to financial clout and excellent imaginative and true ideas as that put up by the author unfortunately cannot enter the educational regulations set up to please private institutional lobbies.

from:  Dr Kamaraj Radhakrishnan
Posted on: Jun 26, 2013 at 00:58 IST
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