Medical waste | Shattered dreams of becoming doctors

The government is resetting medical education standards, giving colleges leeway with infrastructure, among other measures at the MBBS level. The Hindu finds that through these policy changes, students are adversely impacted, doctors fear the lowering of standards, and some States protest ‘penalisation’

November 10, 2023 02:12 am | Updated November 11, 2023 11:56 am IST

(From left) Devanath V.S., Ajmal T., and Giridhar K. Sajeev in Jalandhar, Punjab, where they are pursuing a BSc degree after losing their MBBS seats.

(From left) Devanath V.S., Ajmal T., and Giridhar K. Sajeev in Jalandhar, Punjab, where they are pursuing a BSc degree after losing their MBBS seats. | Photo Credit: R.V. Moorthy

In 2015, Giridhar K. Sajeev secured a near perfect score in Class 12. The next year, he cracked the National Eligibility-cum-Entrance Test (NEET), the qualifying exam to pursue an MBBS degree. While his NEET score didn’t get him a government college seat, where the fee is less than ₹1 lakh a year, Giridhar did manage one in Glocal Medical, a privately-funded college established in 2015 in Mirzapur Pole village, Saharanpur district, Uttar Pradesh.

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His mother, a retired head nurse, and his father, a clerk, both government employees from Kollam, Kerala, paid ₹25 lakh across the two and a half years he was there. “They took a loan and invested their retirement money. The fee was ₹10 lakh a year,” says Giridhar, of the university run by the Abdul Waheed Educational and Charitable Trust, which was set up in 2009.

In 2019, when Giridhar had settled into the U.P. village with a view of the Himalayas, and just about got used to an alien language, away from his hometown of coconut trees and backwaters, Glocal lost recognition to run its MBBS course. The university, offering many other courses, had allegedly admitted 90 undergraduate MBBS students despite the then medical education regulatory body, the Medical Council of India (MCI), issuing a warning not to do so. The institute was allegedly unable to meet the minimum infrastructure, student-teacher ratio, and patient requirement to run the course, details that came out during the hearing in the case in the Allahabad High Court, which the students lost.

Glocal is an example of the danger that MBBS students are often exposed to when taking admission in a private establishment: the fee can range from ₹50 lakh to ₹1 crore, and the uncertainty of whether the college has met all the norms is a concern. On its part, the government is bringing in measures to increase the number of medical seats across the country, giving private players incentives in terms of a leeway with infrastructure, staffing, and other aspects, to set up colleges. However, doctors and teachers in medicine worry that this lowering of norms will impact the quality of education, and consequently the standard of patient care in India.

Giridhar and 66 other students, out of the 90 in his batch, lost their MBBS seats. “Our lives changed overnight. But we believed we would be transferred to other private medical colleges to continue our course,” he says. But despite many appeals to the college, local authorities, and finally the court, the students were refused seats in other colleges. Another year and a half went by in the process, and by 2020, Giridhar decided to give up on the hope of becoming a doctor.

Students suffer

“Becoming a doctor was my only dream,” says Giridhar, who spoke about how he grew up watching and being inspired by his mother’s profession. “I have always believed her work was very noble,” he says, of his desire to serve.

He is now pursuing a bachelor’s degree in Agriculture at another privately-funded college in Punjab, where the fee is ₹60,000 per semester for the four-year course.

Besides his dreams shattering, there is guilt. “I feel that I pushed my retired parents into a financial mess,” he says, adding that the family is now again seeking the help of the court to at least recover the fee deposited with the college.

The owners of Glocal Medical are now reportedly on the run from the law, according to various media reports and students. The university did not respond to phone calls, and email messages bounced back.

“In 2016, Glocal used a relaxed-norms clause, which was a multi-crore bank guarantee that it would have to forfeit if the university failed to meet the basic infrastructure requirements, including that of teacher and patient strength during inspections,” says Giridhar’s father, Sajeev K.

He adds that out of the 90 students admitted in 2016 for the 2016-17 academic year, 23 were allotted this college through State counselling, a process that involves seat allotment through submission of documents.

The rest were admitted under the management quota and slated to be subsequently added as regular students by sending their names to the Central medical authority, at the time the MCI. “These students who lost their seats are the ones caught in the crossfire of the debarred college and government rules,” says Sajeev. The 23 other students secured transfers to other colleges.

The management quota is only applicable in private institutions that can draft their own criteria for students who pass NEET and are willing to pay a fee 10 times or more compared with government colleges. Once the students who get top ranks are allotted Central and State government colleges, the rest can opt for private colleges. Within this system, quotas and sub-quotas play out, including those based on caste reservation, domicile, and several others.

“There has to be some justice,” says Giridhar, whose mother is now fighting a relapse of cancer.

The number game

In 2023, over 20 lakh students appeared for the NEET exam, competing for less than 2 lakh MBBS and BDS seats across India.

As per government records, 11,45,976 students cleared the exam in 2023. In 2016, the year Giridhar took the exam, 7,31,223 candidates appeared for it, out of which 19,325 students qualified in the top 15%, and 4,09,477 qualified as per MCI’s regulations, government data show.

In 2020, the MCI was dissolved following charges of corruption and red-tapism, and the National Medical Commission (NMC) was established. The commission, which has 33 members drawn from State Medical Councils, regulates medical education and professionals.

Data from the Ministry of Health and Family Welfare indicate that in the past nine years, India has seen an 82% rise in medical colleges (384 to 704 in 2023), and a 110% increase in MBBS seats (51,348 in 2014 to 1,07,948 in 2023).

The same data also show that in June this year, over 2,000 undergraduate medical students in 38 medical colleges across India were faced with the danger of being pushed into the same situation as the 67 students from Glocal.

Several colleges in Tamil Nadu, Karnataka, Maharashtra, Uttar Pradesh, Rajasthan, Gujarat, Assam, Punjab, Andhra Pradesh, Puducherry, and West Bengal either lost recognition or were served notices to correct deficiencies. All quickly made a course correction.

“Corruption breeds in these institutions, and the ultimate price is borne by students,” says Sanjay Nath, a retired military man, whose son also gained admission in Glocal and lost his seat after it was derecognised. “For those in these colleges, it seems that these institutes are only collecting money and playing with the careers of several young people,” he says.

A senior NMC official, who did not want to be named, says, “Transparency and quality control are our primary goals when it comes to medical education in India. We can’t allow colleges to run if they don’t meet our basic criteria.”

Among the criteria are adequate infrastructure, a set teacher-student ratio, proper attendance keeping, and an internship programme.

In an attempt to keep a strict check on medical colleges, the NMC, at their head office in Delhi, has set up a control room. On monitors here, they tap into CCTV cameras across colleges to make sure everything from infrastructure to student-teacher ratio is maintained. “Our long-term goal is to do away with physical inspection and bring in technology-based assessment,” the NMC official says, not giving clear answers on the way ahead with this system or on concerns of privacy.

The class of 2016 at Glocal Medical, a privately-funded college in Mirzapur Pole village, Saharanpur district, Uttar Pradesh. 

The class of 2016 at Glocal Medical, a privately-funded college in Mirzapur Pole village, Saharanpur district, Uttar Pradesh.  | Photo Credit: Special Arrangement

Quality concerns

Senior doctors say the expansion spree in the past few years has been coupled with the falling standard of medical education and is a cause for concern. The Health Ministry and the NMC though claim that they are working towards making quality medical education accessible, and to bring more doctors into the workforce.

In December 2022, the Ministry informed Parliament that India’s doctor-patient ratio currently stands at 1:834, better than the World Health Organization’s prescribed norm of 1 doctor per 1,000 people. Yet, this year, the NMC decided that the doctor-population requirement is in the ratio of 100 MBBS seats for a 10-lakh population.

State governments feel this is an interference, as health is a State subject. Tamil Nadu Chief Minister M.K. Stalin, in his letter to Prime Minister Narendra Modi in the first week of October, requested that the Health Ministry be instructed to keep in abeyance the NMC notification that has imposed certain restrictions on the opening of new medical colleges. He said this was a way to penalise States that have invested more in their public health infrastructure over the years.

Karnataka, Kerala, Tamil Nadu, and Telangana have already crossed the 100 seat to 10 lakh population norm, and this would imply that they can’t open and offer more seats locally.

“They are more than welcome to open colleges in Bihar, U.P., and even Delhi,” says a senior NMC official, explaining that the rule was brought in to offer services where there is a deficit.

In its August notification, the NMC excluded physical medicine and rehabilitation, respiratory medicine, and emergency medicine from its list of required departments (now revised to 10 from the earlier 14) to run a medical college and hospital. The commission also withdrew its notification on bringing in a single exit exam for MBBS students across the country, much like the Class 12 board exam. Exit exams were to be considered as the entrance exam for the postgraduate degree. The implication was that medical colleges would be forced to ramp up quality.

Vacant seats

Despite the push by the Central government to increase medical seats, the paradox is that India’s private medical colleges often reflect vacant status. There were 273 vacant seats in 2019-20, this number increased to 326 in 2021-22, stood at 261 in 2022-23, and crossed 200 this year.

“This surprises no one,” says Dr. Ganesh Kumar, the dean of Shaheed Nirmal Mahto Medical College, Dhanbad, Jharkhand.

He says while the Central government’s initiative to increase the number of seats and medical colleges is welcome, colleges that do not meet the basic requirements should not be allowed to come up at all. “Even my own government-run medical college is faced with a faculty shortage, which it has been trying to rectify for nearly a decade now,” he says.

Dr. Kumar elaborates that the major problems facing private medical colleges include the exorbitant fee (despite the NMC’s directives to make it affordable), uncertainty of them being able to maintain their registration, the lack of Centre-State coordination during counselling, and students not wanting to go to remote areas. “This is why private colleges continue to be a gamble for many,” he says.

Meanwhile, Giridhar and his friends — Ajmal T. and Devanath V.S. — former students of Glocal Medical, still cannot get over the shock of losing their MBBS seats. “Even today our struggle and search for justice continues,” says Giridhar.

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