New Delhi: A notification by the National Medical Commission (NMC) restricting the setting up of new medical colleges across states and on increasing the number of Bachelor of Medicine, Bachelor of Surgery (MBBS) seats in existing institutions, has the medical fraternity divided, with voices being raised both in favour of and against the move.
The debate over the regulations — which is feared to impact the southern states the most — also was also taken up by leaders of the Opposition Congress this week, with former Union Finance Minister P. Chidambaram, who is from Tamil Nadu, talking to social media platform X (previously Twitter) Monday, to post, “If reports are true that the National Medical Commission has decreed that: (A) no more new medical colleges in Tamil Nadu and (B) no more additional seats in existing medical colleges in TN then it amounts to punishing good performance”.
He added: “This is another serious encroachment on the powers of the state government and the state legislature.”
Hitting out at the Narendra Modi government at the Centre over the NMC notification, Chidambaram further said, “Why should a state not start a new medical college out of its own funds and for its own students? The Centre and its agencies are undermining federalism… The assault on states’ rights continues under the (Narendra) Modi government.”
The post was shared by Congress general secretary-in-charge communications Jairam Ramesh.
Last month, the NMC — the medical education regulator of the country — issued the Guidelines on Minimum Standard Requirement For Establishment of New Medical College/Increase of Seats in MBBS Course, 2023. The provisions mention that starting the next academic year, approval for new medical colleges and rise in the number of MBBS seats will be based on the population of the state where the upgrade is being planned.
The guidelines pertain to both government and private medical colleges in the country.
According to the notification, “After 2023-24 [which means from the 2024-25 academic year], Letter of Permission for starting of new medical colleges shall be issued only for annual intake capacity of 50/100/150 seats [new medical colleges will only have 50-150 seats] provided that medical colleges shall follow the ratio of 100 MBBS seats per 10 lakh population in that state/Union Territory”.
This is likely based on a doctor-to-population ratio prescribed by the World Health Organisation (WHO), which requires every country to have a one doctor per 1,000 people ratio.
In response to a Parliament question last year, the health ministry had said that doctor to population norm in India was 1:834, better than the WHO-prescribed norm, but this calculation also factored in over 5 lakh Ayush (traditional medicine) practitioners, apart from about 13 lakh doctors of modern medicine.
ThePrint reached NMC spokesperson Yogender Malik over phone for comment on the new regulation, but did not receive a response till the time of publication of this report. The article will be updated once a response is received.
ThePrint explains what the notification means and why it has the medical fraternity divided.
The southern states’ problem of plenty?
According to data shared by the Union health ministry in response to a question in the Lok Sabha in August this year, there were 1,07,950 MBBS seats in the country during the 2023-24 academic session.
The maximum number of MBBS seats, 11,695, were in Karnataka, which has a population of 6.76 crore, according to the Unique Identification Authority of India (UIDAI) data.
Tamil Nadu which has a population of 7.68 crore, closely follows Karnataka with a total of 11,600 seats.
Now, if the new formula of 100 seats per 10,00,000 population is applied to these states, Karnataka should have 6,760 seats, while in Tamil Nadu the number of MBBS seats should be restricted at 7,680.
The rules would also debar Andhra Pradesh, with a population of 5.34 crore and a total of 6,435 MBBS seats, Kerala with a population of 3.57 crore and 4,655 MBBS seats and Telangana with a population of 3.8 crore and 8,540 MBBS seats, according to government data, from opening new medical colleges or increasing seats in existing ones.
According to ThePrint’s analysis of the current number of MBBS seats in each state vis-a-vis their population — based on data shared in Lok Sabha and UIDAI population figures — the problem of having too many MBBS seats is true only of the southern states, since the other states have not breached the ‘100 MBBS seats per 10 lakh population’ limit put in the guidelines.
The country’s most populous state, Uttar Pradesh, for example, has just 9,705 MBBS seats for a population of 24.14 crore. Going by the ‘100 seats per 10,000 population’ formula, UP should have 24,140 seats.
Commenting on the guidelines, the principal of a well-known government medical college in Chennai, who did not wish to be named, said, “It (the guidelines) clearly infringe upon the rights of a state to raise MBBS seats in order to produce more doctors who can then work in different parts of the country”.
Sudhir Kumar, a neurologist at Hyderabad’s Apollo Hospital also said it was “unfair to see states in isolation when India as a whole has a shortage of doctors”.
“Doctors trained in one state, if they are interested in opening more medical colleges, can go and serve in any part of the country,” he told ThePrint.
Kumar added: “If there were more MBBS seats than required why would Indian students be forced to go to countries like China and those in Eastern Europe, when the quality of medical education [there] is [allegedly] not up to mark?”
Citing that the government estimate of a doctor-to-population ratio of 1:834 for the country, also includes Ayush doctors. “So this way of presenting the figure masks the fact that there are fewer practitioners of modern medicines than required,” Kumar alleged.
He also said that medical colleges in India should actually target producing quality doctors for around the world.
“I truly think that the country should leverage the potential India has in quality medical education to enroll students from other countries and train them to be good doctors,” he said.
Not everyone from the fraternity, however, shares Kumar’s views on MBBS education.
‘Surplus production of doctors needs to be restricted’
Talking to ThePrint, some experts said the restriction on the opening of new medical colleges and increase of MBBA seats in existing colleges, in areas where there was a surplus, was a good thing.
“Otherwise it leads to deterioration of medical education as a profit-oriented commercial activity, with its unavoidable compromise on quality of education and ethical standards,” said Kerala-based public health expert Antony K. R.
Antony added: “Such commercial production of doctors only leads to export of Indian doctors to the Western countries. Need-based training of doctors and their rational deployment for service to communities in India is the need of the hour.”
The public health expert also underlined that the assured availability of trained doctors for posting in the vast rural areas of the country cannot be met by opening of new medical colleges.
“Attractive living quarters, enabling infrastructure and service facility in hospitals, mechanism for quality education of children, assured career progression are factors to ensure retention of young doctors in government health institutions in rural and tribal areas,” Antony said.
Another person from the medical fraternity in Kerala, an expert in medical education who has also served on WHO committees, Thomas Chacko, added what India needed was strengthening its primary health care system, rather than opening new medical colleges.
“A strong (less costly) primary health care system catches people with illness at early stages and so reduces the number of people with severe illness that need costly care in medical colleges,” he said.
Chacko added, “We also have a shortage of faculty to meet requirements of new medical colleges,” pointing out that most doctors prefer to stay and serve in their own states.
(Edited by Poulomi Banerjee)