Starting a new medical college or increasing the number of medical seats will now be a struggle in nine States and four Union Territories, owing to a new guideline by the National Medical Commission (NMC). A notification by this body, which regulates medical education, says that new medical colleges shall follow the ratio of 100 MBBS seats for every 10 lakh population in that State or Union Territory (UT). 

A businessline analysis shows that all five South Indian States, Manipur, Himachal Pradesh, Goa, Chandigarh, Puducherry, Andaman and Nicobar Islands and Dadra and Nagar Haveli will not be able to start a new medical college or increase the number of medical seats in their colleges. This is because, in these States and UTs, the number of medical seats per 10 lakh population is more than 100. In Puducherry, it is as high as 1329. It is 224 in Telangana, 173 in Karnataka and 151 in Tamil Nadu. Most of them are States with a healthy doctor-patient ratio. 

On the other side of the spectrum are States like Bihar, Jharkhand, Uttar Pradesh and West Bengal, where the ratio is way low and has a scope to have more medical seats. In Bihar, there are 2665 MBBS seats across colleges. However, owing to the State’s large population, for every 10-lakh people, there are just 21 medical seats. In Uttar Pradesh, the ratio is 41 seats per 10 lakh people. Most of these States have an unhealthy doctor-patient ratio.  

Uneven distribution of doctors? 

The NMC guideline seems to assume that there is an adequate number of doctors and medical seats in some States and UTs therefore it will be best to stop the addition of seats in these areas. But the primary question is, do we have enough doctors? 

The World Health Organization (WHO) prescribes a doctor-patient ratio of 1:1000, that is, one doctor for a population of 1,000 individuals. As of June 2022, 13.08 lakh doctors are registered with the NMC. Going by the UIDAI projection of India’s population, the country now has one doctor for roughly 1,060 people. This is not too far from the WHO norm.

However, the doctor population isn’t distributed evenly. Some States and UTs have more doctors while others don’t have enough. Within States too, doctors seem to be concentrated in urban areas with paucity of doctors in rural areas. 

Going by the number of doctors registered at respective medical councils, 11 States including Goa, Kerala, Tamil Nadu and Karnataka have a doctor-patient ratio, healthier than what is prescribed by the UN agency. Experts point out that soon there may be a situation where there could be a rise in unemployment among doctors in certain areas. 

There is a shortage of medical professionals in rural India too, data shows. According to the Ministry of Health and Family Welfare’s Rural Health Statistics, 21.83 per cent of the Public Health Centres in the country had no doctors. 

States with an unhealthy doctor-patient ratio are also unsurprisingly, the ones that do not have medical seats. In Jharkhand, there is one doctor for every 5352 people. The ratio is 1:2640 in Uttar Pradesh and 1:2630 in Bihar. 

Is the NMC notification fair? 

If we take the above data on the distribution of doctors into account, there are arguments both for and against the guideline. It seems unfair for the government to interfere with the addition of medical seats in a State, especially in private medical colleges. These seats are created based on the demand from students in those areas. If the demand for these seats reaches a saturation point, these colleges could reduce the seats. Also, the doctors in one area can migrate to other States with fewer doctors, if they fail to find employment. 

On the other hand, some States such as Uttar Pradesh and Bihar will benefit if new medical colleges are set up here instead of States like Tamil Nadu or Karnataka which already have adequate medical seats.

Oncologist Dr Subbiah Shanmugham, former president of the Akhil Bharatiya Vidyarthi Parishad, says that there isn’t anything strange about the new notification. “In the last nine years, the number of MBBS seats in the country has increased a lot,” he says.

The Ministry of Health and Family Welfare’s data show that the number of MBBS seats has grown from 51,348 in 2014 to 1.07 lakh in 2021. “It is now time to stabilise it and improve the quality of education and ensure that medical colleges are not concentrated in certain urban centres alone,” he says. 

Public health expert Dr T Sundararaman, former executive director of the National Health Systems Resource Centre questions the Centre’s stand to impose a restriction on the States. “It isn’t right of the Centre to impose a restriction on the states,” he says. At the same time, he says that “there is a good case for it to actually invest in developing more medical colleges in the Northern States.” 

Public Vs Private 

Currently, Tamil Nadu, Karnataka, Maharashtra and Uttar Pradesh have the highest number of medical seats in the country. However, a majority of medical seats in these States are in private medical colleges. Sundararaman stresses that the government’s focus here must be to increase the number of public-funded medical colleges.

“I think there’s a case for central investment in improving the number of medical seats available in states like Uttar Pradesh. But again, it has to be in public-funded colleges,” he says, adding, “If cutting back on seats will mean cutting back on the government expansion and letting the management quotas of the private sector expand, it’s no solution. I think we should start by abolishing the management quota and this fee structure that is so highly skewed in favour of the very rich.”