If the shortage of doctors in India hasn’t proved to be a good enough reason for drastically increasing medical education intake in the country, Russia’s war against Ukraine should. The fact that medical students form a sizeable chunk of Indian evacuees underscores how medical education in the country is simply out of reach for tens of thousands. The rush for affordable medical education aboard has only gotten worse over the years—between 2015 and 2020, the number of candidates taking the Foreign Medical Graduates Examination (FMGE) to practise in India has risen from 12,116 to 35,774.
For perspective, the National Medical Commission which regulates medical education in the country lists 605 colleges in the country that offer 90,825 undergraduate seats in modern medicine. This, when the country added 30,000 new seats over 2015-2020. In 2021,16 lakh aspirants appeared for the National Entrance cum Eligibility Test for MBBS seats, of which 8.7 lakh cleared the examination. But the seats available, as per ministry of health data from December 2021, numbered just over 88,000—barely a tenth of the eligible cohort. Even if one considers the average FMGE pass percentage —a rough proxy for MBBS eligiblity in India, assuming all such MBBS-holders obtain a license to practice—that’s almost 5,725 seats that weren’t available to eligibles in 2020.
The problem of choked access is compounded by deep inequity of opportunity, with affordability of courses and prior coaching becoming key determinants not just of admissions but also of clearing the qualifying exam. Students who received coaching support make up an overwhelming number of those finally securing education, as a Tamil Nadu-government appointed panel reported last year. This is to be read against the fact that top coaching institutes charge upwards of Rs 1.2 lakh annually for NEET-UG coaching. While the average annual cost of a MBBS education in a government college is around `2 lakh, in private colleges, it is as high as Rs 10-15 lakh.
The large capitation fees charged by many private colleges—perceived as a golden ticket for people who have the wherewithal to ‘buy a seat’, eligibility notwithstanding—worsens the problem. Contrariwise, it costs Rs 15-20 lakh for a 6-year undergraduate course in Ukraine; no wonder, in 2020, a fourth of overseas medical students there were from India. There is also considerable regional inequity when it comes to medical education infrastructure. The All India Survey of Higher Education 2019-20, the latest edition available, shows that just seven states in the country accounted for 65% of the country’s medical colleges in that year.
Reforms for regulating costs of courses from private colleges have now started to trickle in. The NMC guidelines say the cost of 50% of seats in private medical colleges and deemed universities must be on a par with government medical colleges from the coming academic year. The government has to step up its act, too, and develop some of the required infrastructure and talent pool—in 2019, a parliamentary standing committee highlighted that 48% of the sanctioned teaching posts and 60% of non-teaching posts remained vacant in six “second-generation” AIIMSs.
The need, as experts such as Dr Devi Shetty and Dr K Srinath Reddy have repeatedly called for, is to ease the regulatory framework to facilitate addition of capacity; the government should take a cue from Cuba and other jurisdictions that allow medical and paramedical education institutes to come up in much smaller spaces than what the Indian regulations on medical-college approvals call for. Last week, Prime Minister Narendra Modi called for encouragement to the private sector for creating medical institutes as “lakhs of rupees are going out” of India to smaller countries. His government should walk the talk now.