India’s medical education system has attracted a lot of adverse attention due to the crisis in Ukraine and the resultant need for evacuating medical students, delay in post-graduate counselling because of reservation-related litigation and Tamil Nadu legislating to opt out of NE ET. I take a look at what ails the system based on my close encounters with it, as a member of the faculty at a medical college and as a father whose daughters went through this process in the last decade.
There is a serious demand-supply mismatch as well as inadequate seats in terms of population norms. In private colleges, these seats are priced between Rs 15-30 lakh per year (not including hostel expenses and study material). This is way more than what most Indians can afford. It is difficult to comment on quality as nobody measures it. However, from personal experience, I can say that it is highly variable and poor in most medical colleges, irrespective of the private-public divide.
The MBBS degree continues to be an attractive option. However, unlike in the past, a substantial section of the middle class no longer feels that this is a good return of investment. Students opting for a medical career, with some exceptions, are of two types: Those who see this as a path to social and economic mobility. The second category is that of children of doctors, especially in the private sector, whose parents want them to continue their legacy. The first group is highly price-sensitive, while the second is not.
The government’s initiative to open new medical colleges has run into a serious faculty crunch. Except at the lowest level, where new entrants come, all that the new colleges have done is poach faculty from a current medical college. Academic quality continues to be a serious concern. The Medical Council of India (MCI) did try to address many of the earlier loopholes of ghost faculty and corruption. It introduced the requirement of publications for promotions to improve the academic rigor of faculty. But this has resulted in the mushrooming of journals of dubious quality. The point is that the faculty and medical colleges will learn to game the system. Faculty salaries in many state government-run and private colleges are low, and private practice is common. This ruins the academic atmosphere.
Another distinct feature of the medical education system in India is its complete disregard for students’ welfare. Only the top 0.25 per cent of the applicants get a seat in a decent government medical college. In times of scarcity, social justice takes a backseat. Most parents simply lack the wherewithal to weigh the pros and cons of individual medical colleges. The counselling process is very complicated to negotiate, even for a person like me. After my experience of reporting to a college at 9 am and leaving at 5 am the next day with scarcely any arrangement or hospitality in peak summer, I vowed not to send my daughter to an institution that has scant respect for its future students and their parents. The system is designed for non-resident and other wealthy Indians to capture the seats left unfilled due to their high prices. This is engineered by using a percentile system for defining eligibility — and not per cent — so that students with money and low scores can get through.
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