Controversy over Medical Colleges and Hospitals – Dirty Blame Game Politics
Recently, Tamil Nadu Chief Minister M.K. Stalin has been indulging in “Dirty Blame Game Politics “over establishment of new medical colleges by writing to the Prime Minister Narendra Modi to direct the Union Ministry of Health and Family Welfare, to keep in abeyance, a notification issued by the National Medical Commission (NMC) to establish medical colleges.
Ipso facto, “Public Health and sanitation, hospitals and dispensaries” falls under the State List. And, medical colleges under the Concurrent List.
In August 2023, the Centre notified in the Gazette of India that after the 2023-24 academic year, a letter of permission for starting new medical colleges shall be issued only for an annual intake capacity of 50/100/150 seats, provided the college follows the ratio of 100 MBBS seats for 10 lakh population.
In 2022, Prime Minister Narendra Modi virtually inaugurated 11 new government medical colleges in the neglected-cum-backward districts of Tamil Nadu. The new colleges are in Tiruvallur, Namakkal, Ramanathapuram, Dindigul, Virudhunagar, Krishnagiri, Nagapattinam, Tiruppur, the Nilgiris, Ariyalur and Kallakurichi – with an intake of 1,450 M.B.B.S. Thus, nearly all districts have today a medical college in Tamil Nadu.
Be that as it may, Stalin objected to the NMC notification stating, “That it is a direct encroachment of the rights of state governments and penalization of states who have invested more in their public health infrastructure over the years.” More importantly, there is inadequate availability of doctors. Moreover, there are districts where the availability continued to be a key issue. In addition, there is huge demand for quality health services and new institutions are necessary to cater to it in the future. The notification will “completely eliminate any chance of Tamil Nadu getting new investments in the health sector by the Union government in future.” Therefore, Stalin wants the issue to keep it on hold and consult states prior to final decision on opening new medical colleges since it is creating a regressive situation.
Finally, the notification may be “legally untenable” he said, citing a recent judgment (Civil Appeal No. 6681 of 2002) of the Supreme Court that executive instructions could not impose reasonable restrictions on the fundamental right to establish educational institutions under Article 19(1)(g) of the Constitution.
In reality, extraordinary complex web has been spun around “Health Care and Medical Colleges”. “Corporatization” is real that includes Hospitals, Colleges to include Dental and Nursing, Diagnostics Equipment, medicines, medical insurance etc.
Quite a few political leaders and their followers have established Private Hospitals and Medical Colleges for making huge profits. For example, 30% intake of MBBS seats is reserved the Corporate Management. As per reports, they charge Rs.25 Lakhs per seat. If the Medical College has 100 seats intake, the income earned is nearly Rs.750 Lakhs. What about PG rates? Depends on the specialty with Rs.2-5 crores for a few selected ones!
“Basic Facts Tamil Nadu: Area - 130,058 km2 (11th largest state); Population – 76,860,000 (6th position); and 38 districts. Hospitals and College: 1373 Government and 2404 Private hospitals besides 1855 Primary Health Centers as of September 24, 2023; and highest number of medical colleges in the country with 73 (38 Govt and 35 Private) out total of 719 (393 Govt and 326 Private) at All India Level.
Whereas the data of territory and population of few states includes; in area Rajasthan is the largest state (342,239 km2), Madhya Pradesh (308,245 km2), Maharashtra (307,713 km2), Uttar Pradesh (240,928 km2); and population UP is the largest state (235687000), Maharashtra (126385000), Bihar (126756000), West Bengal (99084000), and Madhya Pradesh (86579000).
Similarly, the state of medical colleges in various states includes 72 (37 Govt and 35 Private) in UP, 69 (21 Govt and 48 Private) in Karnataka, 68 (34 Govt and 34 Private) in Maharashtra and 55 (27 Govt and 28 Private) in Telangana. Way behind them are Gujarat with 38 (23 Govt 15 and Private), Rajasthan with 37 (26 Govt and Private 11), Kerala with 35 (11 Govt and 24 Private), MP with 32 (16 Govt and 16 Private), West Bengal with 33 (25 Govt and 8 Private) and Bihar with 21 (13 Govt and 8 Private). Delhi NCR has 10 Medical Colleges (8 Govt and 2 Private).
The State of Nagaland does not have a single Medical College. Even the State of Arunachal Pradesh, Meghalaya and Mizoram have only one Government Medical College each.
The detailed review of the above data clearly reveals that Tamil Nadu (11th largest state in area 6th largest in population) is way ahead of other States. Stalin takes credit for the State to be hailed as the “Heath care Capital” of India just as the neighboring Karnataka and Telangana claim similar status to themselves.
With the highest number of medical colleges in Tamil Nadu, that is 73 in India, Stalin government’s record of planning of distribution of Medical Colleges in the State appears very poor. Ipso Facto, there are 18 medical colleges in Chennai: 12 private colleges and 6 government colleges.
Five years ago, the central government announced the district hospital to be authorized a medical college in the makeover plan. As the public health department manages district hospitals, such a transformation requires handing over to the medical education department, which oversees the running of medical schools attached to hospitals. In retrospect, at least 20 Medical Colleges need to be established to stop students going to foreign countries immediately.
Yet another controversy raked up by Stalin concerns the National Eligibility-cum-Entrance Test (NEET). The qualifying percentile 2023 varies. It is for General/EWS – 50; OBC, SC, ST – 40; General/EWS/PH – 45; OBC & PH – 40; SC & PH – 40; ST & PH – 40. Stalin has stated that rural and disadvantaged students face disadvantages due to language barriers and curriculum misalignment which is resulting in stress-related student suicides with political implications. Also NEET takes away the autonomy of states to make decisions regarding education. The Tamil Nadu government had passed the NEET Exemption Bill, 2021, which seeks to dispense with NEET for admission to undergraduate medical degree courses.
Quite glaringly, Stalin is playing politics with such a key human dimension as health care. “Quality Health Care” is the product of “Quality Medical Education” and “Quality Medical Infrastructure” particularly in government medical colleges and hospitals. In turn, “Quality Education” is dependent on “Quality Faculty Members particularly at senior levels”, “Quality Learning Climate” and “50% qualifying marks for graduation.
For example, senior faculty posts remain vacant in majority of medical colleges, particularly Government Hospitals. Add to it, as per Tamil Nadu Medical Services Corporation data, nearly 50 out of 95 Government Hospitals do not have the MRI facility. In the case of “Litho”, CT 64 and CT 128”, there only a very few hospitals with such facility. As per data in 2020, over the 3 years, MRI facilities provided in only in 11 of the 46 government headquarters hospitals.
What does it imply? Even the Government Hospitals with medical colleges do not have teaching staff and the state-of-the-art infrastructure to provide “High Quality” education.
Yet another input to consider is the intake of admissions into MMBS. As per latest information, at the time of 2023-24 counselling there will be more than 710 medical colleges with 110000 MBBS seats in India. If we compare with last year’s data, this year there will be 8500 more MBBS seats. Until now, 53 new medical colleges got approval for MBBS admission in the session 2023-24.
However, the demand for MBBS seats is very high. According to the Ministry of Health, there are 110000 MBBS undergraduate seats in medical colleges in India as of 2023-2024. 20.38 lakh candidates appeared in the NEET-UG (National Eligibility cum Entrance Test - Undergraduate) examination. 11.46 lakh candidates qualified for the exam. It implies that the number of undergraduate medical seats available (1.10 lakh) can only accommodate around 10% of the total qualifying candidates.
In Tamil Nadu, the intake of admissions into MBBS is estimated to be 11075 in 73 medical colleges - 38 government colleges with 5225 MBBS seats, 3 private colleges with 450 seats. In addition, there are 32 trust colleges with 5400 seats.
No wonder, as per estimates every year 20,000 to 25,000 Indian students go abroad to study medicine. The best destinations to study MBBS abroad for Indian students are UK, Australia, France, Canada, Germany, USA, Russia, Singapore, China, Nepal, Bangladesh, Ukraine, Georgia, Philippines, Malaysia, Caribbean New Zealand, Kyrgyzstan, Kazakhstan, etc. On an average, at present, there are over 10,000 Indian students in Russia, more than 7,000 in Bangladesh, and almost 100 in Guyana and Barbados.
The MCI recognizes degrees from countries like USA, UK, AUSTRALIA, CANADA, and New Zealand. Graduates qualifying from other countries have to undergo a course of theory, practical and clinical training equivalent to a Bachelor of Medicine and Bachelor of Surgery (MBBS) in India. The students should have completed an internship of 12 months in the same foreign institution. And, others are required to pass the Foreign Medical Graduate Examination (FMGE) conducted by the National Board of Examinations (NBE) on behalf of the MCI. Furthermore, the MCI does not recognize the Bachelor of Science (BS) issued by the Philippines.
Senior medical professionals are quite vivid in explaining shortcomings of real state of quality of medical education and health care. The quality of medical graduates is unsatisfactory. They apportion the blame to vacancies in senior faculty positions particularly in Government Medical Colleges, 40% cut-off marks, and state-of-the art infrastructure.
Recently there were 500+ candidates who appeared for just 20 junior resident doctor positions at Delhi’s Guru Teg Bahadur Hospital. The intensity of the competition and the scarcity of job opportunities for MBBS graduates is real. More importantly, while the scarcity of doctors is often discussed, the reality is that many doctors are unemployed.
Stalin must first address the demands of doctors in Tamil Nadu. In 2019, state government doctors held protests demanding the implementation of GO 354, which states that state government doctors will be paid on par with the Central government doctors. Then state Opposition leader MK Stalin supported the protests but did not implement it after coming to power.
Also, the Tamil Nadu Medical Students Association (TNMSA) and Tamil Nadu Resident Doctors Association (TNRDA) have termed the compulsory requirement of doctors post-graduating in medicine from Tamil Nadu government colleges and have not obtained service postings to serve at government facilities for two years “inherently exploitative” and “defective”.
The Associations have argued that PG doctors specializing in branches, like orthopedics, ophthalmology and surgery, are posted at primary healthcare centers (PHCs), where their specialization isn’t utilized. Since PHCs only function as referral centers, the skills of PG doctors are not fully utilized, the Associations have claimed and urged the government to post MBBS doctors permanently to PHCs.
Yet another demand of the PG qualified doctors that they do not get jobs at government hospitals nor private ones because their certificates are delayed by months. Without PG certificates, we are considered only as MBBS graduates and paid around Rs. 50,000 monthly. On the other hand, private medical colleges provide certificates soon after the completion of courses.
To sum up, Stalin, Chief Minister of Tamil Nadu is playing “Blame game politics” with “Health Care and Medical Colleges and Doctors”. Stalin must address the shortcomings in the teaching faculty and infrastructure in all hospitals, medical, dental and nursing colleges instead of politicizing and indulging in “Blame Games”.
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