Jul 9, 2013

Questioning our medical education setup

Last year, Satyamev Jayate devoted an episode to the issue of generic drugs and doctors being motivated by commissions and profits to mislead their patients at times. Through acquaintances and Facebook etc., most of us would have heard tales of hospitals trying to rip people off by making patients undergo unnecessary tests and treatments. I've felt, for a while, that the root cause of these problems is something else.

Think about this. A typical engineer finishes college by the age of 22 and starts earning decently. S/he doesn't usually have a large loan to pay off. Adding on a masters degree is relatively easy and tends to add very significantly to their career prospects and earning potential. By age 30, most engineer-MBAs have a comfortable lifestyle and are able to afford a car and are on the verge of buying a house.

Doctors, on the other hand, generally don't finish their MBBS course before 23. Add a year of internship and preparation for MD entrance exams. 2 more years of MD, and then typically another year or two of further study or residency. Doctors are a few years older when they start their first jobs which typically pay peanuts. By the time they start earning a good amount, they're generally close to the age of 30. Unlike the engineer-MBAs, they don't already have big savings, instead they have huge loans to pay back.

Also, the medical education system in India is ridiculously corrupt. There are few 'merit' seats available. The majority of students have to make 'donations' to get in, and the amounts payable for more popular courses (specialties) are extortionate. This is true at every stage - bachelors, masters, fellowship, and sometimes even for getting passing grades, especially for final year courses.

By their early 30s, most doctors - who started with good intentions and a desire to do good and help others - give in to the temptation of dirty money. If you were earning less than your peers from school, and had already borne an additional cost of ~50 lakhs to reach this point - wouldn't you be tempted to compromise some of your values? Most people's conscience carries a price-tag, and it's usually lower.

What created this sorry situation in the first place? A simple mismatch between demand and supply. When I attended school in the 90s, the number of engineering and medical aspirants was roughly equal. I doubt if the scale has tilted too far since then. Last year, India produced 1.5 million engineers and 300,000 MBAs - that is more than USA and China combined in each case. Doctors? 33,000. That's about fifty engineers to each doctor. The number of seats available in medical colleges is several orders of magnitude lower than other streams, and with this kind of scarcity, corruption creeping into the system was quite inevitable.

There are also some other unfortunate consequences of this, which it isn't politically correct to mention, but I will do so here. Many failed MBBS aspirants now end up joining BDS, BHMS, BAMS or other such courses. I guess this helps them meet their own aspirations of becoming 'doctors', but judging by their employment trends, I'm not sure this serves a much bigger purpose for anyone.

Also, now that nearly half the medical college seats are reserved for 'quota' students, and many of the others are purchased by students with the most resourceful parents and not necessarily the most merit, the quality of the output is dubious. I, for one, avoid doctors with anything less than a solid reputation built over more than a decade. Most people don't have this luxury, and by lowering standards in medical education, their lives are being put at risk.

What makes this all the more appalling is that we need many more and better doctors, especially for primary care. We have the second (not for much longer) largest population in the world, and many national health indicators are among the worst in the world. The government's budgetary allocation for healthcare is also among the lowest in the world in percentage terms. They just don't seem to care. The situation desperately calls for more medical colleges to be set up and the whole system being cleansed and re-vitalized. I can't imagine voters being unhappy about the government setting up more teaching hospitals and/or medical colleges, so I don't understand why it isn't happening.

If the government can't handle this, they should encourage the private sector to do so. Why can't the kind of incentives that were offered to IT companies and BPOs be offered to private teaching hospitals now? Why can't PPP models be explored like they are for other kinds of infrastructure? Shouldn't this be a higher priority than messing around with the IIT JEE exam pattern every few years?

Caveats: This post makes several generalizations and no reader should take it personally. Also, I'm no policy expert and this is my opinion, based on common knowledge and common-sense rather than thorough research - please bear that in mind when you comment. If you agree that some of the issues and questions raised are valid, please share it forward because we need to push for things to change.

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