In critical condition

An RTI query has revealed that only 920 government medical college seats were added in the last five years, against an approval of 10,000 seats. To place this statistic in perspective, India today has just one government allopathic doctor for over 11,000 people, according to the findings of National Health Profile 2018; this is against the WHO norm of 1:1,000. When private practitioners are taken into account, the ratio looks more respectable at one doctor for about 1,600 people. But private care is both expensive (Ayushman Bharat is trying to fix this) and of uncertain quality, for which the state of medical education is substantially to blame. This mess is unlikely to be resolved in a hurry despite recent steps to clean up the regulatory side. Hence, a robust, regulated private health space needs to co-exist with a growing presence of government hospitals and colleges.

According to the Medical Council of India, which regulates both medical practice and education, there are about 500 private and government medical colleges offering nearly 62,000 seats, of which the latter accounts for about half the number. The paucity of government doctors is, therefore, also due to the large number of graduates opting for private practice. Medical education was thrown open to the private sector about three decades ago to address the sheer paucity of doctors. Today, a cocktail of unethical practices, sheer incompetence and lack of inclusiveness needs to be dealt with. It is an open secret that seats in medical colleges can be bought for a price that can go up to a few crore. Such colleges produce dubious ‘doctors’ who are focused on recovering their expenses. At the other end, even reputed institutions such as the new AIIMS facilities in small towns lack faculty and infrastructure. Doctors would rather work or teach for larger sums in private hospitals. To level the scales, working conditions in government hospitals need to improve. As for medical education, there can be no substitute for the varied hands-on clinical experience that a public hospital can alone provide.

The Centre has taken two noteworthy steps to reform this state of affairs. First, it drew up the National Medical Commission Bill in a move to overhaul the MCI model and replace it with a governance system less controlled by doctors themselves. Roles such as framing curricula, setting standards, monitoring ethics and conducting examinations will be fire-walled. In this connection, the working of the Indian Nursing Council, which has been rapped by the Patiala House district court in the Capital for wrongly according recognition to six colleges, needs to be revisited. Second, the National Eligibility-cum-Entrance Test for all medical colleges will hopefully raise the quality of medical students. However, medical education itself needs to move beyond rote learning to a focus on clinical practice, with smart technologies playing a bigger role in the classroom.

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