Foreign medical education and its problems

Ranjan Kumar Padmapati

(The writer can be reached at rkpadmapati@yahoo.co.in)

In the wake of the Ukraine war after the homecoming of Indian medical students, the situation has raised certain points to ponder over. It is known that roughly 20,000 students or so were studying medicine in Ukraine, and some are in other destinations such as Russia, the Philippines, Germany, Kazakhstan, Nepal, Bangladesh, etc. The chief reasons of going abroad are (1) inability to secure a seat in Indian medical colleges because of tough competition, (2) the high cost of medical education in private medical colleges in India, and (3) admission is possible with much relaxed standard. The WHO recommends one doctor per thousand of population, but in India the ratio is 0.8 per 1000. India needs 1.38 million of doctors against the present 1.2 million registered practitioners.

To have a quality check of the students going abroad, the Government of India set rules to bring them to a particular quality level in 2012. A student has to qualify in the NEET examination seeking admission in foreign countries. The other requirement is, the student must secure 50 PC marks in Physics, Chemistry and Biology in Class 12 standard final examination. In December, 2021, out of 16 lakh medical study aspirants, 7,72,500 students could qualify in the examination, against 88,120 MBBS seats and 27,498 BDS seats in India. The number of seats available in private colleges was 43,815 in 2021. Private colleges in India charge nearly Rs 10-15 lakh or even more per year, but it is Rs 5-6 lakh per year in foreign countries, including food and lodging. This naturally attracts the students. Now the NMC has given guidelines that half of the seats of private medical colleges and deemed universities be available at government rate from the next academic session.

On the quality requirements of doctors, the head of the JIPMER Z Zayapragassarazan said, "A hospital needs well-qualified doctors as they have to treat patients. There shall be a strict mechanism to check and filter the doctors before allowing them to enter the system." To ensure the quality of foreign qualified doctors, the MCI has made it compulsory to pass Foreign Medical Graduate Examination (FMGE) to make them eligible for practice in India. But it is seen that the qualifying rate is below the satisfactory level. Data from the National Board of Examination reveal that the performance of doctors as a whole of different countries between 2015 and 2018 ,the passing average is only 14.2.% and performance of Pakistan and Bangladesh topping the list with 29.6% and 27.11% respectively and that of Ukraine is 14.87% . Best of the performance was in June, 2021, 4,283 passed out of 18,048 aspirants showed slight improvement of 23.7%. The minimum qualifying mark is 150 out of 300. Medical graduates from the UK, USA, Australia, Canada and New Zealand are not required to clear FMGE. Similarly, Indian students have to pass the United States Medical Licensing Examination ( USMLE) to practice in the USA. It is also reported that there has been disparity in terms of salary packages as compared to Indian counterparts they get less. Those who could not clear FMGE, some are working in non-practicing fields and even in restaurants! Now government has taken a new decision that with effect from 2023 onwards all the medical graduates both of Indian medical colleges and foreign-returned doctors will be required to clear Medical Exit Test Examination before being allowed to practice. This is a good step forward to enhance the standard of medical education to an acceptable uniform level. The proposed National Exit Test will replace existing NEET PG test and FMGE .

Thus, it is evident that sending the children abroad attracts risk. One student reported that after clearing MBBS from abroad he could not pass FMGE even after 5 attempts , spent Rs 1,35,000 on coaching , his father even took loans. Now he is working in a farm house. Some parents even sold off cultivable land to meet the expenses. Retired Chief Secretary of Kerala, Dr V Mehta said, "I have been to Armenia, Georgia, and Russia ... students are not allowed to touch patients, so do not know how to put a catheter or an injection or even do a delivery." The clinical exposure of students is not up to expected standard of India. The course also does not match with that of India. There is also a language barrier, though they claim to teach in English the critical terms are referred to in local languages which Indians cannot follow.

The NMC has now allowed to complete the internship of those doctors in India for the left over period, provided they could pass the FMGE and will be entitled to a stipend at the rate applicable to Indian doctors. The seats must not exceed 7.5% of the limits in government medical colleges. But the problem remains unsolved for the students who are at different stages of learning. The Chief Ministers of different States have written to the Prime Minister requesting him to accommodate them in private medical colleges. To accommodate such a big number of students in limited facilities would pose a big question mark.

To cope with higher demand in seats, India must increase number of medical colleges on PP model or purely private or in State sectors. The main constrains in setting up private medical colleges are land availability of minimum 25 acres and construction of 430-bedded hospitals for a strength of 100 intakes. For, this, capital is needed to the tune of Rs 500-600 crore. One option is to allow good quality existing hospitals like Apollo, Fortis and Medanta groups of hospitals etc., with excellent quality teaching staff, to start medical education. It may be a viable one. The ratio of doctors in Assam is one doctor for every 1,453 people. Assam has 24,083 ( June, 2020 ) registered allopathic doctors. For a population of 3.5 crore the requirement is 35,000 doctors. The PM is proposing to set up one medical college in every district of India in the next 10 years. In Assam, 8 medical colleges are functioning at the moment with a few others at different stages of development. It is a very wise proposal to set up three more medical colleges in the ensuing Assam Budget. People need more number of medical colleges but no engineering college, as 48% engineers are unemployed on all-India basis. As performance in the FMGE is the only visible indicator of the quality of foreign medical education, a big question looms as to whether to send or not to send students abroad for medical education. This warrants rational thinking.