Millennium Post

Corrupting medicine

Commercialisation has been antagonistic to universal healthcare; the government must now step in to become a provider to its citizens.

Corrupting medicine

India produces nearly 50,000 MBBS doctors across its 479 medical colleges every year. There are about 9.3 lakh doctors registered with the Medical Council of India. Out of this, doctors engaged in active professional work are presumed to be numbering at about eight lakh only. With this number, we are unable to meet the requisite of doctor to patient ratio, which is much less than what is required, as per the WHO guidelines. WHO recommends one doctor per 1,000 persons, whereas we have one doctor for 1,650 persons. Considering the population distribution in the country, we find that there is a huge urban-rural gap in this ratio, as the number of doctors serving in rural areas is proportionately much less. We thus need more doctors. It is in this context that we must review the scenario of medical education in our country.

Medical education is not only tough but also versatile as the students are prepared to treat the sick while also preventing disease. The subject of preventive and social medicine is taught for the longest period in the medical curriculum. In fact, students are ingrained with the idea that their primary duty is to prevent a disease from occurring and cure only if needed. Students are also trained to express sympathy and empathy towards the sick, irrespective of their economic status, caste, creed, religion, beliefs or gender. Medical students are thus trained to fully integrate themselves into the society. This in itself requires an environment and system that harnesses the attitude of young doctors so that they can uphold the society, which has high expectations from them. But ironically, the situation has deteriorated continuously and we find a lack of such an atmosphere in our educational institutions today. The medical colleges, which should have been only the centre of knowledge, have now become centres of business.
Before Independence, there were only 20 medical colleges in India, 19 in the government sector and only one in the private sector. After Independence, the scenario began altering and seven more colleges were opened in the state sector by the end of 1950. For the nearly three decades to come, more colleges opened in the government sector only. By the end of 1980, our country had only 13 medical colleges in the non-government sector, while there were 99 colleges in the government sector. After 1980, we witnessed a shift in the situation: more colleges started coming up in the private sector. In the last two decades, from 2000 till now, 96 colleges have opened in the government sector, while the number in private sector is 182; that is almost double of the state sector. In the last three years of the present government, 58 colleges have come up in the non-government sector with only 36 in the government sector.
These private colleges charge exorbitant tuition fees. Till two years ago, there has been open trading of seats in these colleges, with underhand money transactions putting seats on sale. This prevented meritorious students from entering medical colleges. After NEET, since it became difficult to exchange underhand money, these colleges further increased their tuition fees. Thus, opening a medical college now has become a lucrative business. That is why many corporates have joined powerful politicians and are openly flouting the rules for running these colleges.
A large number of these colleges do not fulfil the norms laid down by the Medical Council of India. It is a common practice in these colleges to hire dummy patients at the time of inspection by the MCI. Though sometimes the MCI conducts surprise inspections, these colleges have their own resources from where they receive prior information, even about the secret inspections. They also manage to set up dummy faculty – ghost faculty – who receive salaries but hardly come for teaching. Concerned about the low standards of education in many medical colleges, the government, instead of improving them, has opted to hold exit exams for the students thus placing more burden on them, which provides no solution to the problem. Ironically, when the Punjab Medical Council took certain decisions to check the practice of ghost faculty, it was met with strong resistance from none other than the Medical Education Minister of the state, to scuttle the process.
This paradigm shift began since the 1980s and the process gained pace after changes in economic policies, where the government decided to be the facilitator and not only the provider of education and health. This trend needs to be reversed and the government must become a provider if there has to be inclusive healthcare for all citizens.
(The author is senior vice-president of Indian Doctors for Peace and Development. The views expressed are strictly personal.)

Next Story
Share it