More than 18,000 Indians study medicine in Ukraine. Unable to secure a seat in India, these students were forced to move to countries like Ukraine to learn how to save lives. As Russia’s invasion goes on, some of them are still stuck in the country at the risk of their lives. Is this the cost they have to pay to learn to save lives? This is especially shocking for a country that needs 10 lakh extra doctors to meet global standards.
PM Narendra Modi has urged the private sector to open more medical colleges in India but it is important to ponder upon why it hasn’t happened already. The ivory tower that India’s medical establishment has become is more concerned about protecting its vested interests than responding to the growing healthcare needs of the country. India will significantly benefit from smashing this ivory tower down.
Medical education is an expensive affair around the world. But that doesn’t explain why an average Chinese student has to pay less than their Indian counterpart for the same education. While some of the costs are the same everywhere, most costs of running a college are determined by local inputs and regulations. The higher costs faced by Indian students are a result of the artificially constrained supply of medical seats by the establishment, which PM Modi wants the private sector to solve. But the question is, will he allow them to?
India’s missing doctors
Medicine is a popular field of study in India and is coveted by lakhs of students. Yet, somehow, India has lower doctors per 1,000 people than Pakistan and Syria and is well short of WHO standards. This means that the system fails to provide seats even to well-performing students. So, students who aren’t rich enough to afford the fees of Rs 1 crore or more asked by private colleges, and are outside the top 3 per cent of NEET rank holders studying in government colleges, are forced to move abroad, where the fees are lower.
Medical education in India is a walled garden. The cost of constructing a medical college runs into hundreds of crores of rupees. This is combined with a maze of complex and ambiguous regulations that benefit colleges with political connections. This ensures that even people who can start a college avoid doing so since they don’t have the will to fight a political death match.
The requirements set by the erstwhile Medical Council of India (MCI) for establishing a medical college are at the centre of this problem. These include a minimum of 20 acres of land and a full-fledged hospital. For bigger colleges, the requirements are even more stringent. These rules end up making seats scarce, favouring the political cronies who uphold the system. Medical universities in China, which have lesser requirements, are able to enroll tens of thousands of students while Indian colleges can only admit a few thousand.
Reducing the requirements for starting a college and encouraging them to leverage economies of scale will make medical education more accessible. Reducing or eliminating some of these requirements will ensure that more colleges can open and expand easily. As a consequence, more students will be admitted to colleges while simultaneously reducing costs.
Seemingly, none of this has disturbed the medical establishment enough to solve these problems. They forced foreign graduates to write an opaque screening test with a pass percentage of 10 per cent to practice medicine but then lobbied to have domestic graduates excluded from writing the proposed National Exit Test that could have been more transparent. They are also standing in the way of increased accessibility in backward areas by opposing Community Health Providers.
The MCI behaves more like a trade union trying to preserve their exclusivity rather than a body acting in public interest. The National Medical Commission was created to replace the MCI to free the medical industry from regulatory capture. But the new body seems to be more interested in capping the price of medical seats than in ensuring more seats are available. Price control might seem appealing but is akin to providing band-aids where an operation is needed. India needs more doctors.
We need a system that produces highly-skilled doctors in large numbers. However, the current system is designed to benefit cronies and forces a large number of students to go abroad to study. Can PM Modi do what it takes to change it?
The author is a student at Indian Institute of Technology, Madras. Views are personal