Opinion
NMC ban on southern states adding medical colleges defies logic
Summary
- Medical education in India has a number of issues, but where colleges come up isn’t one of them
The National Medical Commission’s decision to allocate medical colleges to states based on their population is quixotic to say the least. It also has the potential to further strain the already fraught relations between the union government and southern states – none of which are governed by the BJP at present.
The new guidelines, published via an extraordinary gazette notification (and apparently without any sort of public consultation), do two things, both of which are unlikely to sit well with many states. First, they introduce a ratio of 100 MBBS seats for every 10 lakh people. Second, they cap the current number of medical colleges – both government-run and private – in states that have exceeded this ratio.
The southern states – comprising Tamil Nadu, Andhra Pradesh, Telangana, Karnataka, Kerala and Puducherry – all are above this new cut-off. Manipur, Sikkim and Himachal Pradesh also exceed the NMC’s ratio.
There also appears to be a clear attempt to ensure that the ability to open new medical colleges rests firmly with the union government. The NMC has said that after the current academic year, 2023-24, “letter of permission for starting new medical colleges shall be issued only for annual intake capacity of 50/100/150 seats, provided that medical college shall follow the ratio of 100 MBBS seats for 10 lakh population in the states/Union Territory (sic)." The guidelines also clearly state that no medical or dental college can be established or their capacity increased without the prior approval of the union government.
The regulations are baffling, considering India already has a severe paucity of doctors. The aim instead should be to add as many qualified healthcare professionals as possible, not restrict the supply further.
Just how poor is the availability of doctors in India? According to Index Mundi, which uses WHO and country data for its rankings, India is currently ranked 116th out of 194 countries on the ratio of doctors per 1,000 people. India’s official position is that its doctor-population ratio, at 1 for 854 persons, comfortably exceeds the WHO’s recommended minimum of 1:1,000.
However, that is not how the world may see it, because India also counts practitioners of ‘traditional medicine’ – ayurveda, yoga, unani, siddha and homoeopathy – as doctors. According to a written response to a question in the Rajya Sabha by the minister of state for health and family welfare, there were a total of 10 lakh 78,732 qualified doctors registered with the 27 State Medical Councils and the Medical Council of India. By the minister’s own admission, it is estimated that only 80% of these are actually practicing. The rest have either stopped working as medical practitioners, retired, emigrated or passed away.
Even this 80% figure might be an overestimate. A 2021 study called ‘Size, composition and distribution of health workforce in India: why, and where to invest?’ by Anup Karan, Himanshu Negandhi, Suhaib Hussain, Tomas Zapata, Dilip Mairembam, Hilde De Graeve, James Buchan and Sanjay Zodpey found that while the National Health Workforce Account counted 11.6 lakh allopathic doctors (2018 data), the NSSO 2017-18 estimate of active workforce put the number of active allopathic doctors at just eight lakh.
The study found that a large number of these active doctors were not adequately qualified. Adjusting for the mandated qualification (at minimum an MBBS from a recognised institute for an allopathic doctor, for instance) the number fell further to around five lakh.
Clearly India needs more doctors, not less. The availability of doctors is also highly skewed. The pandemic cruelly exposed the acute shortage of doctors in the country, especially in rural areas and remote states. While there is an oversupply of doctors in the metros, the situation in rural areas is alarming. According to the government’s own rural health statistics, over 21% of primary health centres and sub-centres in rural areas – the last mile delivery point for health services for the poor – don’t have any doctors! A whopping 68% of community health centres also did not have a qualified specialist in 2021.
But the answer to the shortage of doctors in rural areas – particularly in the northern states – is not to stop those states that are performing better in medical education from growing, and waiting for the laggards to catch up. The NMC’s justification for introducing the population-linked rationing of seats – that there should be a uniform distribution of doctors across the states – defies logic, as where doctors end up practicing their trade has little to do with where they got their degree.
That the current demand for medical seats far exceeds their supply is shown up by the staggering costs of a private medical seat, and by the fact that tens of thousands of Indian students travel abroad to study medicine. Thousands of these students had to be evacuated from Ukraine when the war broke out. And despite tensions between India and China, as many as 25,000 Indians are pursuing medical studies in that country.
Medical education in India has a number of issues, but where colleges come up isn’t one of them. The NMC would serve the cause of medical education better by focussing on improving the quality of education, particularly by ensuring the availability of adequate infrastructure and qualified faculty in medical colleges, and reducing the exorbitant cost of private education and increasing competition for students by making more seats available.
