Doctors slam Azad order, say not enough PG seats, job opportunities

India produces 40,525 medical graduates who vie for 16,088 post graduate seats every year. The medical education pyramid tapers drastically after that — only 1,555 seats in superspecialities like M.Ch. (Master of Chirurgiae) and DM (Doctor of Medicine). Research-based medical specialities like immunology, genetics and physiology are in their infancy in the country with little or no scope for one trained in them to do meaningful work here.

Given this reality, Health Minister Ghulam Nabi Azad’s whip on Monday against medicine students working in the US invited scathing criticism from the medical community, which said that the blanket decision to not process papers for a work visa in the US would only redirect brain drain. They held that in the absence of adequate medical training facilities in the country, the diktat may be high on populism but made little medical or administrative sense.

Azad had said that doctors going to the US for higher studies would have to now sign a bond that they would come back immediately after the course and not work in that country. There would be no option to make a payment to skip the condition.

“Expecting doctors to return to the country after finishing their studies is legitimate but this has to be supplemented by a well-developed framework for their guaranteed and gainful employment so that their knowledge and skills are adequately utilised either in AIIMS-like institutes or the district hospitals or in course of the extensive upgradation planned for medical institutes. It is important to couple regulation with an enabling environment and a positive pullback factor,” said Dr K S Reddy, former head of the department of cardiology, AIIMS (All India Institute of Medical Sciences), who headed a high-level expert group on universal healthcare.

Moreover medicine is one discipline where education is often half of the training, the other half being experience, said Dr P K Dash, consultant oncologist at Indraprastha Apollo and a former topper at AIIMS of research-based specialities. “There cannot be a blanket diktat on not to work abroad. If a doctor goes to train in disciplines like pharmacovigilance and immunology which are almost non-existent in India, they won’t even be able to apply those skills here because there are no facilities. There are so many departments in the US that do not exist here. What will such people do?”

A former AIIMS doctor who worked for 30 years in a US university said the assumption that brain drain is only of the best is only half true because the stiff competition in PG and superspeciality courses means that a lot of doctors leaving the country are actually from tier two cities and second or third rate medical colleges who are unable to get through to a course of their choice here. The solution to the problem cannot lie in forcing people to come back here, it would lie in investing in medical education, the doctor said.

Terming Azad’s announcement as a “political” one, a senior doctor in MAMC (Maulana Azad Medical College) said the government’s heart is in the right place, but the head isn’t. “It is logical that anybody — not just a doctor — who has had a subsidised education should serve the country. But it is equally logical that should they repay that money, they should be free to work anywhere. So the bond should be optional and the money raised from the payouts should be used exclusively for medical education.”

The key to the debate, agreed Dr Anoop Misra, director and head, department of diabetes and metabolic diseases, Fortis Hospital and former professor of medicine at AIIMS, is investment in medical education. “Issue of brain drain is of great importance to India, both from point of view of making Indian medical science robust and economically. A surer way of tackling this problem is building and maintaining academically oriented state-of-the-art medical centres, providing better working environment and increasing emoluments of doctors.”

Source: The Indian Express, April 25, 2012

Centre to partly fund medical colleges in states

For the first time since the 1990s when private players were allowed in the medical education sector, the Union Health Ministry is all set to partially fund medical colleges set up by the states in a bid to attract more doctors to the government sector and to bring down rising medical education costs. Through the scheme, the ministry hopes to be able to steer medical education to states other than known hubs like Karnataka, Gujarat, Tamil Nadu, Puducherry, Maharashtra.

Under the 12th Five-Year Plan, the ministry has set a target of 50 such medical colleges in the first phase. According to a report of the Planning Commission Working Group on tertiary care institutions for the 12th Five-Year Plan, of the 335 medical colleges recognised by the Medical Council of India, 154 are in the private sector where students pay Rs. 200,000-300,000 per year as fees and are often required to cough up Rs. 5 to 10 million as capitation fees.

“The model we are looking at is that the state provides us with land and we bear 75-85 per cent of the capital expenses. For special category states it would be about 90 per cent. Private medical colleges have made medical education so expensive that doctors have drifted away from government jobs in a bid to recover the costs they had incurred for their education. That did not help the cause of public health. That is why we have decided for the first time to start a scheme to support setting up of new medical colleges in states,” said a senior ministry official. The report also gave a glimpse of the shortage of doctors in the country.

Source: The Indian Express, February 21, 2012

AIIMS doctors overworked, no research

Hamstrung by an acute staff shortage and increasing overload of patients, at least one-third of the faculty members at the All India Institute of Medical Sciences (AIIMS) are compelled to work even on Sundays and other holidays. The first-of-its-kind study, which looked at how doctors on an average spend their time, has thrown up interesting findings.

With three in four faculty members feeling that the official working hours are inadequate for finishing their routine work, the study conducted by the institute’s department of hospital administration found that on an average, a member works for 55 hours and 47 minutes far in excess of official working hours of 42 hours and 30 minutes in a week. In absolute numbers, it works out to 13 hours 27 minutes or 31.2% excess time.

Surgery and allied speciality faculty members spend more than 50% excess time as compared to their peers in medicine, who spend almost 38% of extra time. Para-clinical and clinical departments’ faculty members spend 16% and 26% extra time, respectively. All of them have to report to work before time, stay beyond the working hours, work on off days like Sundays and other holidays.

The study, conducted by Dr Shakti Kumar Gupta (HOD, hospital administration) and Dr U S Garg, found that faculty members on an average spent most of their time seeing patients. Consequently, teaching or pursuing research took a beating. Around 26.2% of the time of an average faculty member was spent on teaching, research (25.2%), patient care (31.2%) and administrative work (17.1%). The faculty, on an average, availed just 32.5 days of vacation in a year against the authorized annual leave of 74 days.

More than 60% of the faculty members reported coming to work before the start of official working hours every day varying between one and two hours. Similarly, more than half of them stayed beyond the official working hours every day up to at least two hours. “Most of the departments in AIIMS are grossly understaffed. Though 629 faculty positions are authorized at AIIMS, only 434 are filled – a deficiency of more than 30%,” the study said.

Three-fourth of the faculty members interviewed felt that their department was understaffed. About 90% of the faculty disagrees that AIIMS has adequate strength. Faculty members told TOI that one of the main reasons for doctors finding no time for research or to socialize is due to tremendous patient load. Nearly 10,000 patients a day attend OPDs alone. Around 94.6% of the faculty said they have not undergone any formal induction training programme on joining AIIMS as a faculty member.

“Faculty in pre-clinical departments spent an average of 26.1% extra time over and above their official working hours in the institute. Faculty in para clinical departments spent an average of 16.7% extra time and spent just 26% time on research-related activities. Faculty in clinical departments spent an average of 38.2% extra time over and above their official working hours with 21.3% time on research related activities and 39.84% time on patient care related activity,” the study said.

Male faculty members spent an average of 38.6% extra time over and above their official working hours for the purpose of teaching, research, patient care and institute-related activities. Female faculty members, on the other hand, spent an average of 14.1% extra time.

An AIIMS faculty member said, “We sacrifice our personal time for the good of the nation. AIIMS is a tertiary care referral institute par excellence providing the best in terms of education, research and patient care in the country. The proportion of time the faculty spends plays a major role in determining the quality of research, education and patient care.”

Source: The Times of India, October 21, 2011

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

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

>MCI concerned over entry of foreign institutes

>The Union Ministry of Health and Medical Council of India (MCI) have expressed their concerns over opening up the higher education sector to foreign education institutions. Officials from the health sector, on Thursday, deposed before the Parliamentary Standing Committee on Human Resource Development. The parliamentary panel has been discussing the Foreign Educational Institutions (Regulation of Entry and Operation) Bill, 2010.

Sources said that both the senior health ministry official and head of the board of governors of the MCI S.K. Sarin expressed concern over the impact of opening up the sector to foreign education providers. Desposing before the panel, the ministry official said that the health ministry was working on a separate bill that would address the issues of education in the medical sector. Sources said that the ministry official told the panel that the bill, which would deal comprehensively with the health sector, was in advanced stages of preparation.

In elaborating their concerns about allowing foreign education providers in the health sector, the officials raised the issue of faculty shortage and standardisation of quality. The panel was told that there is at present a shortage of 3,000 to 4,000 faculty members in the existing institutions in the health sector. There also exists a shortage of 700,000 to 800,000 doctors. In what would be an echo of concerns raised by the BJP, Left and sections of the domestic higher education segment, the health officials raised the spectre of faculty moving out to the foreign education providers on the back of better remuneration and facilities. This would deepen the crisis that is already quite acute in the domestic medical institutions.

Ethical issues regarding quality was another concern. The MCI has maintained that any institution that offers medical degrees has to submit to its scrutiny. The Foreign Educational Institutions Bill does not provide for this scrutiny. The Medical Council had earlier written to the Ministry of HRD drawing attention to the fact that the bill in its current form does not allow for the MCI to undertake rigorous scrutiny prior to setting up a campus. The council has been designated as the statutory authority for health sector, but there appears to be no reference to scrutiny.

Sources said that the parliamentary standing will now be consulting foreign experts from institutions like the London School of Economics, Oxford and Stanford. It will also invite representatives of foreign universities which have footprints outside their home country. This would include French business school INSEAD, which has campuses in France, Abu Dhabi and Singapore, and the Wharton Business School which has a campus in Singapore.

Source: The Economic Times, March 18, 2011

>84 applications for new med colleges

>The Medical Council of India (MCI) has received 84 applications across India seeking permission to start medical colleges offering MBBS courses from the coming academic year.

In 2010, there were just 19 applications for starting new colleges. “The four-fold increase in the number of applications could be attributed to the rise in demand for MBBS and postgraduate courses in medicine,” said MCI board of governors head Dr. Shiv Kumar Sarin. Medical education, he said, was fast becoming a popular option.

The council received 3,000 applications for increasing postgraduate seats. “There is a huge shortage of doctors in the country. For this, existing colleges must also expand. We are in the process of reviewing all the applications that we have received,” he said.

Source: The Times of India, March 14, 2011