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More than 20,000 Indian students of medicine who have managed to reach the safety of home from war-hit Ukraine are confronted by concerns of an uncertain future. Yet, there has been no word of assurance from either the government or the Indian medical education regulator on how they can pursue their courses.
Officials in the National Medical Commission (NMC), however, do say that at the beginning of this year, before Russian forces invaded Ukraine on February 24, the wheels had been set in motion to usher in reforms to prevent the annual exodus overseas of thousands of students to study medicine.
Potential measures include removing the upper age limit for students taking the medical entrance test so that they can make multiple attempts to join courses at home and enforcing a cap on fees for a substantial number of seats in private colleges.
A huge gap between demand for and availability of MBBS seats in the country, coupled with the expensive fees charged by private medical colleges, has been blamed for nearly 20,000 students moving out of India every year to pursue their dream of becoming doctors.
Their favourite destinations include former Soviet republics like Ukraine, Russia, Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Uzbekistan, Turkmenistan, Tajikistan and Georgia, as well as China, Bangladesh, Nepal and the Philippines, depending on their budget.
This despite the fact that the quality of education in many colleges where Indian students land up remains questionable and very few manage to clear the Foreign Medical Graduate Examination (FMGE), a mandatory test they are required to pass before they can get a license to practise in India.
Ministry of education records show that as of 2021, nearly 120,000 students had been enrolled in MBBS programmes in various countries.
Demand-supply gap
India had 387 medical colleges in 2013-14, which increased to 596 in 2021-22, an increase of over 54 percent. During the same period, the number of MBBS seats increased from 51,348 to 88,120, a rise of over 71 percent.
Also read: Why Ukraine is a top draw for Indian MBBS students
A paper titled Seeking graduation in medical colleges outside India: Is it a ‘win–win situation’ or ‘lose–lose situation’ for the stakeholders and the nation? noted that of nearly 1.4 million aspirants taking the National Eligibility-cum-Entrance Test, which qualifies students for admission to medical colleges, only about 5.8 percent succeed every year.
The paper, published in the National Medical Journal of India last November, was authored by Dr Aruna V Vanikar, chairman of the NMC’s undergraduate medical education board, among others.
Although the distribution of MBBS seats in government and private colleges is nearly equal– there are nearly 45,000 seats in government institutions and about 43,000 in private ones – very few succeed in gaining admission to an affordable government college.
For the majority who take the NEET and qualify, the only choice available is to explore the other options — and that if they have deep pockets.
Fee structure
Parents who send their children overseas to study medicine spend Rs 15 lakh to Rs. 40 lakh when their annual income is only Rs. 12 lakh, the paper said.
Education consultants who help move thousands of students outside the country every year say that in contrast, a seat in a private medical college in India costs Rs 50 lakh to Rs. 1 crore, sometimes even more, for the duration of the 5.5-year course.
“Private medical colleges are not organised as far as fees are concerned,” said Dr Satendra Singh, a professor at the University College of Medical Sciences, Delhi University.
According to a consultant based in Noida, on the outskirts of New Delhi, those who go outside the country for medical studies do so out of a sense of desperation— they do not have enough money to pursue MBBS in a private college in India and yet they want to become doctors.
Also read: MBBS students from Ukraine can’t enrol in other institutions in India
“It’s true that apart from a requirement of having qualified NEET and seeking a no-objection certificate from the regulator, there is no major hindrance in seeking MBBS education outside India in select countries and therefore for those who are willing to pay the stipulated fee, this remains an attractive option,” the consultant said.
This trend needs to change, according to people in the government.
Had the right medical education policies been put in place in the past, “then you would not have to go abroad, ” Prime Minister Narendra Modi said on March 3 in an interaction with students who had returned from Ukraine.
The Indian government had to carry out an evacuation exercise called Operation Ganga to bring back Indian students trapped in Ukraine once they managed to reach its neighbouring countries.
The road ahead after overseas studies
Beginning in 2001, students returning from abroad with a degree in medicine have been required to pass the FMGE, conducted twice a year by the National Board of Examination under the health ministry.
The paper authored by Dr Vanikar said that of 38, 150 foreign medical graduates who took the examinations from 2015 to 2018, a mere 18.9 percent managed to clear it.
Many foreign medical graduates question the examination itself, calling it extremely tough, allege that it is conducted with little transparency and that often postgraduate level questions, too, are asked of them.
Some experts tend to agree. “I sometimes wonder if all medical students completing their course in India were to take up FMGE, how would they fare,” said Sridhar Rao who teaches in a government medical college in Chamba, Himachal Pradesh.
A senior official in the medical education division of the health ministry underlined that once the National Exit Test (NEXT)—a common examination for all final year MBBS students from India and abroad — is introduced in 2023, this complaint would not be valid.
“We do realize that there have been quality concerns over private medical colleges within India too and therefore the idea for a test like NEXT was mooted,” said the official.
Proposed reforms
The NMC recently announced that there will no age bar on students sitting for NEET, making anyone at any age eligible to take the test.
Beginning 2016, general category students aged beyond 25 years and reserved category students beyond 30 years were not allowed to appear in the highly competitive test although an exemption from the cap was offered over the past few years because of an ongoing case in the Supreme Court.
The regulator also said the tuition fee for 50 percent of seats in every private medical college will have to be in line with that in government colleges in the state where it is located.
Although concerns arose that the move may raise the fees for the remaining 50 percent seats, Dr Vanikar told Moneycontrol these changes were aimed at opening more opportunities for aspiring doctors within India so that they are not forced to study outside.
“We will also see what other measures may be taken to prevent students from pursuing MBBS course in other countries,” she said.
Another member of the board said another possibility was to open more medical colleges in India, serving the dual purpose of catering to a higher number of students and improving the doctor-patient ratio.
A look at the data on medical college distribution in India suggests that this needs a nuanced approach.
Skewed numbers
Dr Antony Kollanur, a public health expert based in Kerala, points out that private medical colleges are heavily concentrated in the southern and western states of Karnataka, Maharashtra, Andhra Pradesh, and Tamil Nadu and they charge exorbitant capitation fees for the seats.
“The family background and ethos of such students for whom parents purchase seats are not oriented to serve the marginalized communities in the periphery. No wonder even after graduation, they want to stick to the comfort zone of city life,” he said.
Also, high scores in the qualifying exams and entrance tests alone become the criteria for admission; aptitude for the medical profession is ignored in the student selection process.
No wonder then that 75 percent of doctors in India are working in urban areas whereas 65 percent of the population is scattered in the vast hinterland without doctors and hospitals.
“This would change if more attention is paid to the aptitude of aspiring doctors and there are more medical colleges in districts with none and states with the lowest number of medical colleges,” said Dr Kollanur.
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