New Delhi: In his Independence Day speech Thursday, Prime Minister Narendra Modi announced that 75,000 medical seats would be created over the next five years for checking the flow of students abroad.
“Even today, children, mostly belonging to the middle class, are going abroad for medical education. They spend lakhs and crores on medical education abroad,” the PM said in his speech from the Red Fort.
“Every year, around 25,000 youths move to other nations for medical education. Some students move to such countries which makes me worry a lot. So we have decided that in the next five years, 75,000 new seats will be created in medical colleges in India.”
The announcement comes days after the Union health ministry presented statistics in Parliament showing that India’s doctor-population ratio now is 1:836 — better than the World Health Organisation (WHO) prescribed ratio of 1 doctor per 1000 population.
The total number of registered modern medicine doctors, according to the statistics, is 13,86,136, while the number of AYUSH, or traditional medicine doctors, stands at 5,65,000.
The data also showed that India now has 731 medical colleges offering 1,12,112 MBBS seats and 72,627 post graduate or post graduate equivalent seats in medicine.
The seats in institutions have largely seen a rise over the last decade following a number of relaxations — related to infrastructure, faculties, and teacher- student ratio — that the medical education regulator, the National Medical Commission (NMC), has offered in order to facilitate more seats in medicine.
This move was primarily aimed to help upgradation of district hospitals into medical colleges across states under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), apart from aiding private institutions.
However, last year, the NMC tried to tighten rules by making stricter norms for minimum standards for new medical colleges, or for those applying to raise seats after realising that most institutions — both government and private — do not comply even with relaxed norms.
These guidelines, however, were deferred following a nudge by the Union health ministry.
ThePrint reached NMC spokesperson Dr Yogendra Malik to understand how the regulator would work for increasing seats in medical colleges through calls. This report will be updated if and when a response is received.
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Concerns over oversupply of doctors
The fresh impetus by the PM on raising seats in medical colleges comes amid growing concern over oversupply of doctors, falling standards of medical education, lack of faculty in new and upgraded medical colleges, and lack of opportunities for doctors in public service.
“The continued emphasis on creating new seats in medicine reminds me the way engineering education had been promoted, largely Andhra Pradesh in early 2000s as the state government was trying to promote the IT industry. Over supply of poorly trained engineers due to want of good faculty making them ‘unemployable’ did result in the closure of hundreds of engineering colleges,” former Union health secretary Sujatha Rao told ThePrint.
Rao said that merely creating new seats in medical colleges without solving systemic issues — such as bringing quality faculty, ensuring good quality education in institutions and raising budget expenditure on health and medical education — may not be useful.
“Even AIIMS-like institutions are struggling to get their posts filled and have good faculty. So opening colleges or increasing seats without the accompanying infrastructure and budgets could be counter productive. What is urgently needed is a more clear and nuanced strategy for addressing the issue of shortages of HR in the medical system, no knee-jerk responses,” she added.
Regional divide, doctors unwilling to serve beyond big cities
Medical education experts point out that a large number of medical colleges are concentrated in southern states and Maharashtra, a fact acknowledged by the NMC, which in 2023 came up with guideline that application for new medical colleges or seats would be considered on the basis of 100 MBBS seats per 10 lakh population in the state.
This guideline, however, was deferred following strong protests from some states, mainly those from the south.
In such a scenario, experts argue, increasing the number of medical seats doesn’t address the issue of non-availability of doctors for primary and secondary care.
According to Rural Health Statistics released by the government in 2022, there were 26,464 doctors in rural primary health centres (PHCs) in 2015-16 which grew to 31,716 in 2020-21, marking a rise of 20 percent.
However, during the same period, the number of specialists at community health centres (CHCs) in rural areas went up from 4,192 to 4,405, an improvement of a mere 5 percent.
In fact, said public health specialist Dr. Antony K. R., many PHCs and CHCs are mainly run by AYUSH doctors for want of MBBS doctors.
“At many places, they are made to carry out deliveries, do minor surgeries and prescribe allopathy medicine of which they know little or trained to use. Just because it is a common practice in many North Indian states doesn’t make it less of a crime,” he told ThePrint.
Dr. T. Sundararaman, who previously headed the Union government’s National Health System Resource Centre and is now associated with Jan Swasthya Abhiyan, too, underlined that creating seats in medicine indiscriminately may actually “become part of the problem”.
“We are at a juncture where medical education even in government colleges is becoming prohibitively expensive and in private institutions the fees are at ridiculously high levels. Under the circumstances, we are creating business models where doctors only want to serve or start establishments where the customers can pay,” he told ThePrint.
Also, the large part of the private doctors’ earnings, he said, comes from incentives and commission from pharma companies and diagnostic labs while consultation fee is no longer the only source of income.
Additionally, he said, there are no large scale government jobs for doctors due to lack of budget for health in states and whatever hirings happens are mostly on contractual basis.
“Medical education policy in the country needs a complete overhaul. Creating more seats in the system at this stage will exacerbate the problem rather than solving it,” Sundararaman asserted.
This is an updated version of the report
(Edited by Tony Rai)