Docs now take a shot at Consulting, Go for MBAs

Dr Ashvini Jakhar plunged into civil life from the services last year, with dreams of navigating the world of entrepreneurship. The surgeon lieutenant commander in the Indian Navy enrolled for an MBA from the Indian School of Business (ISB), and will join McKinsey and Company in a consulting role next month. Dr Jakhar represents a growing number of clinical doctors who are heading to business schools to bag lucrative opportunities in streams like healthcare consulting, hoping to turn entrepreneurs some day. The number of doctors in ISB’s flagship one-year MBA programme has gone up to 11 this year from six last year. The alternative career path is precipitated by the absence of an organised placement process at medical institutes, poor starting salaries and a booming healthcare sector.

The opportunities for medical professionals are huge: the Indian healthcare sector is estimated to reach $100 billion by 2015, growing in double digits year on year, according to ratings agency Fitch. Private equity and venture capital investments have been increasing in the sector too, and all this means more work for consultants.

Having medical professionals on board is a win-win situation for consulting firms too. “Well-trained doctors have rich professional and life experience as medical professionals, as well as sharp analytical abilities,” says Nikhil Prasad Ojha, head of the India strategy practice who also looks after human resources for Bain & Company.

At IIM-Calcutta, two to three doctors have been consistently clearing the interview stage to pursue their MBA over the past three years. This trend is expected to sustain or increase, an institute spokesperson said in an email. IIM-Lucknow has also witnessed a steady stream of doctors at the two-year, post-graduate MBA programme. The recently-graduated batch of 2013 had eight doctors out of a batch size of around 420. The batch of 2014 too has nine doctors out of a batch of nearly 450 students.

Dr Rohan Desai, who completed his MBBS in 2008 was very clear about his career path. In January this year, he co-founded management consulting firm Arete Advisors with a focus on healthcare, three years after completing his MBA from the premier IIM-Ahmedabad. In the interim, Desai worked in a consulting role with Gurgaon-based Feedback Infra. “A career in consulting helps you understand the business of healthcare besides sharpening your analytical skills and domain knowledge acquired through clinical practice,” he says. In an operations role, he adds, growth does not come easy.

Dr Tushar Gupta, a second-year student at IIM-Calcutta, too interned with a consulting firm this year and hopes to bag a consulting role with the same or another marquee consulting firm next year. Gupta completed his MBBS in 2010. “I was always interested in the business aspect of healthcare, and as a consultant, I can address the various lacunae that exist in businesses,” he says. He hopes to turn an entrepreneur with his own chain of hospitals some day. Consulting firms like Bain and KPMG attest to recruiting more doctors for their healthcare practice.

“We are looking for talented doctors to reinforce our consulting expertise — just like the strong base we have in MBAs and engineers,” says Bain & Company’s Ojha. Ojha says highly skilled doctors support their expanding healthcare practice, which spans delivery, pharmaceuticals and bio-technology, and also provide support for other sectors. “Doctors work well across teams, which is a crucial skill we look for in our consultants,” he adds.

The number of doctors in the pharma and life sciences practice at KPMG has grown by 12% over last year. “Some of our medical professionals have held very senior positions in hospitals and health systems across the world. Doctors with a management degree bring a combination of domain, clinical and functional skills to the table,” says Utkarsh Palnitkar, national head of the life sciences practice .

Institutes and doctors also point to low salaries, and absence of placements at medical institutes as reasons for doctors looking at B-schools and a career in consulting. “Unless medical schools do something about this, graduates will choose more lucrative opportunities offered by management education,” says professor Rajiv Misra, chairperson, placements at XLRI Jamshedpur. Misra feels doctors are hard working and the ability to diagnose ailments and diseases sharpens their analytical abilities, which can be put to good use in streams like consulting. XLRI’s executive MBA programme has four doctors this year, up from two last year.

Though his summer internship was with Marico this month, consulting figures high in the list of prized streams for Dhaval Shah, a second-year student at XLRI, who decided to pursue an MBA after doing his MBBS from Rajiv Gandhi Medical College in Thane. Shah dreamt of being a cardiologist, but decided to give it a pass as he realised it meant working in hospitals for seven years before he could think of starting his practice. “The healthcare sector is booming in India, and that explains why doctors like me are opting for an MBA to cash in,” he says.

Source: The Economic Times, June 21, 2013

India hopes to achieve WHO’s doctor-people ratio by 2028

India will take at least 17 more years before it can reach the World Health Organization’s (WHO) recommended norm of one doctor per 1,000 people. The Planning Commission’s high-level expert group (HLEG) on universal health coverage (UHC) – headed by Dr. K. Srinath Reddy – has predicted the availability of one allopathic doctor per 1,000 people by 2028. It has suggested setting up 187 medical colleges in 17 high focus states during the 12th and 13th Five-Year Plans to achieve the target.

HLEG estimates that the number of allopathic doctors registered with the Medical Council of India (MCI) has increased since 1974 to 612,000 in 2011 – a ratio of one doctor for 1,953 people or a density of 0.5 doctors per 1,000 people. The nation has a density of one medical college per 3.84 million. There are 315 medical colleges that are located in 188 of 642 districts.

There is only one medical college for a population of 11.5 million in Bihar, Uttar Pradesh (9.5 million), Madhya Pradesh (7.3 lmillion) and Rajasthan (6.8 million). Kerala, Karnataka and Tamil Nadu each have one medical college for a population of 1.5 million, 1.6 million and 1.9 million, respectively.

The HLEG has proposed a phased addition of 187 colleges. It expects that by 2015 under phase A, 59 new medical colleges will admit students in 15 states like Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jammu and Kashmir, Jharkhand, Madhya Pradesh, Maharashtra, Meghalaya, Orissa, Punjab, Rajasthan, Uttar Pradesh and West Bengal. By 2017, 13 of these states will have an additional 70 medical colleges, and by 2022, another 58 institutes will be built in two additional phases (2017-2020 and 2020-2022).

By 2022, India will have one medical college per 2.5 million population in all states except Bihar, Uttar Pradesh and West Bengal. The implementation of HLEG’s recommendations will enable the additional availability of 102,000 doctors by 2017, and another 190,000 doctors between 2017 and 2022. “With this rate of growth, it is expected that the HLEG target of one doctor per 1,000 will be achieved by 2028,” the report says.

It recommends that along with establishment of new medical colleges, the admission capacities of existing colleges in the public sector should also be increased. Partnerships with the private sector should be encouraged, with conditional reservation of 50% of seats for local candidates, fixed admission fees and government reimbursement of fees for local candidates. The revised MBBS curriculum proposed by the MCI (Medical Council of India) should be refined to put greater focus on preventive, promotive and rehabilitative healthcare.

“Measures such as a compulsory posting of one year for all MBBS graduates immediately after internship, with 10% extra marks weightage for one year of rural service and 20% extra marks for two years of rural service in the post-graduate entrance examination should be included,” the report suggests.

The World Health Statistics Report (2011) says, the density of doctors in India is six for a population of 10,000. India is ranked 52 among 57 countries facing human resource crunch in healthcare. Between 2001 and 2005, India had a doctor: population ratio of 0.5 per 1,000 population in comparison to 0.3 in Thailand, Sri Lanka (0.4), China (1.6), the UK (5.4), the US (5.5) and Cuba (5.9).

The nation has the largest number of medical colleges in the world, with an annual churning rate of over 30,000 doctors and 18,000 specialists. However, the average annual output is 100 graduates per medical college in comparison to 110 in North America, Central Europe (125), Western Europe (149) and Eastern Europe (220). China, which has 188 colleges, produces 1,75, 000 doctors annually, with an average of 930 graduates per institute.

Source: The Times of India, September 27, 2011

Concern over doctors migrating abroad

Expressing concern over doctors migrating to foreign countries, union Health Minister Ghulam Nabi Azad Sunday said the ‘poaching’ needs to be stopped. Speaking after laying the foundation stone of a new block in Delhi’s All India Institute of Medical Sciences (AIIMS), Azad said in the last three years over 3,500 doctors have gone out of India.

“In the last three years, around 3,500 doctors have joined other countries as medical professionals. This poaching needs to be stopped as it is India that is spending money and resources on their training and skill development,” Azad said.

Speaking about increasing the health infrastructure, the health minister said six new AIIMS like institutions will be ready by 2013 in the states of Chhattisgarh, Bihar, Madhya Pradesh, Rajasthan, Orissa and Uttarakhand.

The minister said special incentives were being given to agencies constructing the projects to ensure timely completion. “We have introduced incentive-based projects where the agencies given the task of building projects are awarded with incentives. So this should speed up the infra development in health sector,” Azad said.

The minister laid the foundation stone of a new convergence centre in AIIMS which will have the department of anatomy, electron microscopy, knowledge centre, pathology, bio-chemistry pharmacology and micro biology. Being built at a cost of Rs.50.85 crore (Rs. 508.5 million), it is likely to be completed in 18 months.

Source: The Economic Times (Online Edition), August 14, 2011

Entrance test for PG medical courses from next year

The Medical Council of India (MCI) will hold an all-India level examination for admission in postgraduate (PG) medical courses across the country early next year. This will be the first common entrance test for postgraduate medical courses.

According to the MCI, the syllabus for the National Eligibility and Entrance Test (NEET-PG) will be that of the MBBS, and further information in this regard would soon be put on its website. “The Common Entrance Test (CET) for admission to Medical Post-graduate Courses across the country (NEET-PG) shall be held in Jan-Feb 2012 for admissions in the academic year 2012-2013,” a notice issued by the MCI said.

“The Multiple Choice Questions (MCQs) would be based on the MBBS syllabus as well as the knowledge that needs to be acquired during internship. The distribution of questions, model questions, and method of tie breaking for ranking would be placed on the website in the due course,” the MCI said.

The MCI’s decision to hold a national level examination for admission in undergraduate and post-graduate courses was opposed by various stake holders. A student has to take over a dozen examinations for one medical seat, despite facing problems like the clash of dates and multiple fees. Various students’ bodies have demanded single examination for PG medical entrance on the lines of All India Engineering Entrance Examination (AIEEE).

Every year about 40,000 students are admitted to undergraduate programmes and some 19,000 for postgraduate courses. There are close to 300 private and government controlled medical colleges in the country.

Source: The Hindu, August 10, 2011

Doctor, anyone?

Anshuman Verma, 36, belongs to a family of healers. His great grandfather and grandfather were reputed doctors in Rawalpindi. His parents are doctors. As many as 16 of his extended family is a medical doctor. Anshuman is not. He chose engineering and then an MBA. He works as a banker. Anshuman explains his choices very simply: “Medicine involves too much rigorous training. I saw my parents working hard but getting little gratitude in return.” He may be 36, but Anshuman seems right on trend.

A.K. Agarwal, Dean of Maulana Azad Medical College (MAMC) says the number of aspirants for medical courses has dropped 30% in recent years. “Everyone wants to make quick money. Medicine doesn’t allow that,” he laments. Agarwal pinpoints a trend away from medicine that schools pick up on in Class XI. They report a substantial drop in students opting for biology. Abha Sehgal, Principal of Delhi’s Sanskriti School says “her students prefer physics and chemistry with either economics or computer science. Engineering and MBA are more attractive options as the incubation period is short. Only those dedicated to medicine take up biology now.”

India is feeling the pinch. Its ratio is one doctor for every 1,700 people. That is way below the global average and way below whats required. Is the big turnoff simply the fact that a medical degree takes lots of time and trouble to acquire?

All those years: There was a time when an MBBS degree was enough to establish oneself as a doctor. Today, it takes years longer. There’s MBBS, then MD, then DM… it seems to go on and on. Unsurprising then that Utkash Chaturvedi, 15, who studies at Mother’s International School in Delhi, chose computer science rather than biology. “Biology involves mugging, whereas in physics and chemistry, the concepts are interesting. There’s no sure shot route to success in medicine. How many can get into good private hospitals or set up their own practice?” Chaturvedi asks with a wisdom beyond his years.

But Anshuman’s father, a consultant physician, seems to understand our changing times the best. R.N. Verma says “doctors were daredevils” back in the days when his Pathankot-based father, who had just an MBBS degree, would do major surgery and treat colds. “My father used to make IV fluids himself, sometimes using coconut water. Once a patient was brought to him with a broken spine. With few options, he got a galvanized metal sheet cut in the shape of his body, padded it with cotton and immobilized the patient in it. Primitive, but it worked,” he says.

The pressure on doctors today is to become a superspecialist with all that this entails in years of study. But S.K.S. Marya, Chairman, Max Institute of Orthopaedic and Joint Replacement, says this may be useless “if a doctor doesn’t have good diagnostic skills. The more you know, the less you know. Today, you have a knee specialist, a neck specialist,a hip specialist … but is that what our country needs India should have 80% doctors as general practitioners as in the UK. That will take the load off senior consultants.”

Delayed gratification: Anshuman agrees that long years of study mean that by the time a highly qualified doctor starts to earn a proper living, he’s past 30. “As an engineer with an MBA, I started earning at 23. I have already changed four jobs,” he says. Marya agrees that it now seems to take too long to get just a little and that may be too little for a consumer-centric age.

“Today, there are many material attractions designer clothes, watches, LCDs… So why wouldn’t a bright young doctor earning Rs. 80,000 as a junior consultant feel cheated when his classmates in other professions start at Rs. 2.5 million a year?”

More Trouble: Doctors are often a harried lot and other professions mean more leisure, say medical students. Marya, who studied at the prestigious All India Institute of Medical Sciences (AIIMS), recalls slogging as a junior resident. “I would do 36 hours of duty at times.”

Source: The Times of India, May 15, 2011

Lure of bureaucracy: Engineers outnumber humanities list

In the present times of job uncertainties and layoffs, the lure of bureaucracy is clear. The trend of engineers and doctors joining Civil Services has gone up significantly in the UPSC (Union Public Service Commission) results announced today. Those tracking the development said salary revision for government officials following the 6th Pay Commission recommendation has made Civil Services an enticing option once again for many, especially in the backdrop of the economic slowdown and job cuts. However, the biggest attraction is the prestige and status attached to the job of a bureaucrat, an IAS (Indian Administrative Services) officer pointed out, requesting anonymity.

Although the accurate number crunching of the Civil Services results would take time, estimates indicate that around 40 to 42 per cent of the candidates who have cleared the exam are engineers. Doctors make around 10 to 12 per cent of the total numbers. Humanities graduates or post-graduates, who used to be the main contenders for IAS and IFS several years ago, are just about 19 to 20 per cent of the 920 candidates.

In comparison, the Civil Services examination conducted in 2008-09, for which results were announced in 2009-10, only 25 per cent of those who cleared the exam were engineers and just a little over six per cent were doctors. The number of humanities grads and post-grads who cleared the exam in 2008-09 was quite high — at well over 40 per cent, according to the UPSC annual report published last year. According to Prof. Pulin Nayak of the Delhi School of Economics, Civil Services is definitely an attractive option. It’s a secure service for a long period, salary is good and perks (house, medical and conveyance) are attractive too, he said.

The number of vacancies for Civil Services, the top ranks going to IAS and IFS and the rest to IPS and central services, varies from year to year. Way back in 1999, the number was just 411, the following years clocked 427, 417, 310, 457, 453, 457, 533, 734 and 881 in 2008-09. Out of the 881, 791 were recommended for selection.

In the results announced today, there were five women in the top 25 list and 12 in the first 100. The topper is a woman — S. Divyadharshini, a student of Ambedkar Law University in Chennai who appeared for the Civil Services exams for the second time, said a statement issued by UPSC. Sweta Mohanty, a B.Tech. from Hyderabad, was ranked second and this was her third attempt. R.V. Varun Kumar was third and is a BDS from Ragas Dental College, Chennai. This was his third attempt.

Among the top 25, 15 are engineering grads, five were medical students and the remaining from the humanities, commerce and management.

Source: Business Standard, May 12, 2011

>New initiative to impart teaching skills to doctors

>The historical lack of formal teacher training for doctors may yet be reversed by recent trends offering degree and diploma courses for medical educators across the globe, Eamonn MM Quigley, past president, World Gastroenterology Organisation, said.

Very few doctors have had formal training as teachers, Prof. Quigley, who is with the University College, Cork, Ireland, explained. Teaching is a skill, and recent teacher training programmes that have emerged try to bring modern techniques into education, with a special focus on the intricacies that medicine demands. More and more countries are adopting such methods in order to teach their doctors to teach medicine, he added.

This is precisely what the WGO attempts to do with its ‘Train the Trainers’ programme — correct the deficit of a formal training as educators. The first session of the WGO’s TTT was held for the first time in Chennai, between April 10 and 14, for about 50 gastroenterologists. Some of the aspects that were dealt with during the session, conducted in association with the Indian Society of Gastroenterology, included modules on adult education, teaching techniques, how to conduct high quality research, and evidence-based medicine.

Prof. Quigley’s colleague at the WGO, its current treasurer David Bjorkman said the programme was a huge success and the discussions that took place were of the highest quality. The WGO was an organisation of national societies of gastroenterologists with the goal of improving digestive health across the world.

Twenty-five of the 50 participants were from India, according to conference chairman K.R. Palaniswamy. Though the response from professionals was overwhelming, the number of participants was deliberately kept to a low 50 in order to provide the kind of interactions and discussions that is an essential part of a WGO TTT.

The TTT will also be followed by a two-day continuing medical education (CME) programme to be held on Saturday and Sunday, conference organising secretary V. Balasubramanian, said. The lessons of the TTT programme would be encapsulated in a single session during the CME, he said.

Other issues that will be discussed are emergencies in gastroenterology, abdominal injuries, obscure gastrointestinal bleeds, chronic pancreatitis, dysphagia, and liver tranplants. A live workshop on endosonography and endobronchial ultrasonography will be held parallelly at the Apollo Hospital, he added.

Source: The Hindu, April 16, 2011

>New MCI rule bars 6,000 docs from teaching

>A Union Ministry of Health notification has deprived India of the services of around 6,000 doctors as teaching faculty in medical colleges hamstrung as it is by an acute shortage of doctors and teaching professionals. The ministry-approved Medical Council of India’s (MCI) recommendation bars Diplomate of the National Board (DNB) degree-holders from teaching if they do not have the one-year additional teaching experience to make them on a par with MD/MS candidates.

The directive bars around 3,000 DNB degree-holders who have taught for several years as faculty members. It also disqualifies another 3,000-odd doctors who are pursuing senior residency from teaching, said an official. According to the new rule, DNB degree-holders who have passed out from private or non-MCI recognized medical colleges are required to undergo an additional year of senior residency in a teaching medical institution.

National Board of Examination (NBE) has dubbed the move discriminatory. Pointing out that the directive is in direct conflict with various judgments of high courts and the Supreme Court, the Board claimed that amendments are irrational and a breach of statutory powers.

Surprisingly, the ministry revoked its own notifications of July, 2006; and February, 2009, that had done away with the need for an additional years teaching experience on unilateral recommendation of MCI without consultation with stakeholders like NBE. These notifications, which had suggested that the teaching experience gained during DNB courses should be treated as experience for teaching in medical institutions, were based on reports of expert committees and in adherence with statutory process as prescribed by the Indian Medical Council Act.

Many within the ministry and NBE were taken aback by the move seen as a U-turn. “There is neither a cause nor any justification at this stage to backtrack on the 2009 notification and approve these amendments,” Dr. K. Srinath Reddy, President, NBE, wrote in a letter to the Union health secretary. “The amended qualification reveals that uniformity of the prestigious DNB qualifications has been breached unilaterally,” the letter stated.

The ministry, in turn, has asked MCI to address NBE’s demand of a rollback of the discriminatory notification. An official said MCI is dragging its feet because the Council has been asked to reconsider its recommendation. Indian Medical Council Act does not empower MCI to consider or adjudicate the issue, he added. MCI can’t regulate post-graduate courses.

Source: The Times of India, April 10, 2011

>New ‘quality’ test for medical students

>India will soon have two new examinations for medical students – one each for undergraduate and postgraduate students. From 2013, Medical Council of India (MCI) has proposed the introduction of Indian Medical Graduate (IMG) degree – a national examination to enhance credibility quotient, “similar to an ISI mark, guaranteeing quality”.

This test will take place two months after an UG student appears for the MBBS examination. MCI governing body chief Dr. S.K. Sarin on Tuesday said that this examination would be voluntary and any UG student can appear for it between 2013 and 2016. Plans are afoot to make it mandatory for all UG students from 2017.

MCI also recommended the introduction of a Master of Medicine (MMed) examination – a two-year course after MBBS – for PG students. As per the proposal, doctors, who obtain the MMed degree, will become a specialist in any field they want. These PG students will be trained mainly to enhance clinical skills rather than basic research. Those opting for MMed can also choose to do a six-month rural stint within that two-year timeframe. MMed degree-holders will get an additional 5% marks when they apply for a doctor of medicine (MD) or master of surgery (MS) degree. “Now, students, at times, miss a PG seat for MS or MD for only one mark. This additional 5% marks will give them an added advantage,” Dr. Sarin said.

MCI is also giving utmost importance to the one-year compulsory internship that students do after they appear for the MBBS examination. For the first time, students will be graded on how they perform during their internship. Almost 50% of their MBBS marks will be on the internship, which will be added to their IMG theory score.

At present, there is no evaluation to figure out if MBBS students take their year-long internship programme seriously. Most students utilize the time to prepare for their PG examination.

Source: The Times of India, March 30, 2011

>MCI to grade medical colleges

>For medical aspirants across India, the options during admission broadly boil down to two. Their first preference is almost any public college which offers the MBBS degree at throw-away rates, followed by the private colleges where education is a lot dearer. But, which is the second best college among the government institutes in Maharashtra or Tamil Nadu or Karnataka? Making that choice will get a lot more hardboiled as the Medical Council of India (MCI) has decided to assess and grade their colleges. A student will now be able to make a tough call on whether to sign up at JIPMER, Puducherry; or Christian Medical College, Vellore; or at the All India Institute of Medical Sciences, Delhi.

The Council, which has so far been a college-recognizing and doctor-licencing body, is now looking at expanding its mandate. “We want to see how we can improve the quality in medical education. To date, we just checked the faculty strength, infrastructure and looked at other parameters. Now, we need to see how to up the quality of the country’s medical colleges,” said Dr. Devi Shetty, a member of the MCI board of governors.

Stemming the rot that has set in will not be easy. But improving quality of medical institutes is in sync with the larger framework that the MCI’s vision document 2015 spells out: “Raising the bar for Indian healthcare to match the global standards”. The Vision-2015 document prescribes sweeping reforms for the under-graduate and post-graduate medical education programmes. The document aims at evolving strategies for the road ahead in an ever-expanding medical education sector that has not been able to focus on quality.

So, from the quality of the curriculum to the patient inflow, from adopting new technology in teaching-learning to the quality of research carried out, the assessment process will consider all that before a college is graded. While the National Assessment and Accreditation Council (NAAC), has graded some medical colleges of the country, not all the institutes are graded. It is unclear if the MCI will make assessment mandatory or not, but Dr. Shetty added, “We are in the process of taking inputs from the NAAC and the National Accreditation Board for Hospitals & Healthcare Providers on the quality processes we need to develop.”

With the MCI rethinking the direction medical education should take, colleges will have to put the quality factor on steroids.

Source: The Times of India, March 18, 2011