Young doctors across India have kicked off a “Save the Doctor’ campaign to demand for more post-graduate seats in medical colleges to make up for the acute shortage of specialists. Dr Devi Shetty, chairman of Narayana Health City, Bengaluru, tells HT how meeting the specialists’ shortfall can save lives and medical education India.
Has medical education changed much since you were a student? What are the changes you would like to see?
Unfortunately, the curriculum in India has not changed since I was a medical student 40 years ago. Today, medical students across developed world follow problem-based education where in they get hands-on training from the day they join a medical college. We are very far off from the innovation. As a result, the quality of doctors who are graduating today in India has not improved significantly compared to 40 years ago.
What is the biggest shortcoming in India?
The greatest short coming in medical education system here is the acute shortage of post-graduate seats. In the US, they have 19,000 undergraduate (UG) seats and 32,000 post-graduate (PG) seats. Even in the UK, the ratio of UG to PG seats is almost double. In India, we have 47,688 UG seats 14,500 PG seats in clinical subjects. This has resulted in nearly two lakh students spending two to five years in coaching classes to mug up multiple choice questions to get one of those rare PG seats. If the trend continues, bright student, especially from working class and poor families, will not join medical college.
Till the shortage of medical specialists is met, maternal mortality and infant mortality across the country cannot come down. Also, hospitals won’t come up in Tier-2 and Tier-3 cities since these hospitals will not have anaesthetists, gynaecologists, radiologists and paediatricians.
What is the way forward?
The government should equalise UG and PG seats. This does not require any regulatory changes. Medical Council of India (MCI) after assessing acute shortage of PG seats changed the norms for creating more PG seats. All that we now require is to implement those policies across the country in all medical colleges. Without spending even one rupee, government will straightaway get 40,000 PG seats. If this is accomplished, within two to three years we will have enough medical specialists to run secondary medical care facilities in Tier-2 and Tier-3 cities, which is required to reduce maternal mortality and infant mortality.
How can we meet the unmet demand of doctors in the rural areas?
Unless the cities get saturated with medical specialists, doctors will not go to Tier-2 and Tier-3 cities, leave alone rural india. Only when doctors do not have opportunity to practice in cities, they will decide to go to next level of Tier-2 or Tier-3 cities. No regulation can push the doctors away to rural areas unless there is surplus skilled manpower.
Why hasn’t Karnataka’s Yeshaswini health insurance scheme for poor, where they can choose the hospital for treatment, been replicated in other states?
Yeshaswini scheme in Karnataka is the only self funded micro health insurance scheme. All other schemes are doled out schemes from tax payer’s money. If the members do not contribute to the scheme, for whatever reason, if the tax collection goes down, these schemes are at a risk of failing. Understanding this, Karnataka government designed Yeshaswini as self funding scheme. Unfortunately this model has not been replicated in other parts of the country because policy makers have a mental block to collect money from the citizens. It is a wishful thinking, unfortunately not sustainable in the long term.
Will more seats in the absence of teachers and infrastructure in medical college impact the quality of medical education?
India can transform the medical education in no time. All it requires is innovation in training programmes. We have phenomenal infrastructure to train young doctors which is regrettably not adequately utilised. Instead of concentrating on better innovations in creating new syllabus for better medical education, current policies are emphasizing on acres of land, size of toilets in hospitals and size of professor's office room. Unless we make a major shift in the syllabus concentrating on physical infrastructure will not improve medical education.
Medical education series part I:
Docs seek more PG seats to meet dearth of specialists
Tomorrow: Why young doctors want change