The ongoing Russia- Ukraine conflict has generated a discussion about a sub-plot, which links to India’s medical education. There have been reports that there are 18000 Indian medical students in Ukraine. People are wondering why Medical Students from India need to go to Ukraine for studying medicine. Answer is quite simple and does not need an Einstein Brain. It is the steep fee that private medical colleges charge from students which is unjustified and beyond any logic. It just needs a sincere ‘Government Will’ to implement the justified fee for MBBS seats in private medical colleges in India. Medical colleges in Ukraine, Georgia, Kyrgyzstan, Bangladesh, Philippines and China have been benefitted because of the severe exploitation of medical students in India.
It needs a sincere and honest assessment of the fee and expenditure of medical college and education rather than a permission for heavy profiteering. If honest calculations are carried out, the fee should not be more than one fifth of present rates, taking into account the hospital services expenditure.
Why do Indian students go to Ukraine to pursue courses, especially MBBS? Because of affordability, says Manjula Naidu, proprietor of a firm that helps send students to Ukraine’s Bukovinian State Medical University. Usha Rani, an Anekal resident whose son is in first-year MBBS at Zaporizhzhia State Medical University, said she wouldn’t have sent him to Ukraine had she been able to pay nearly Rs 80 lakh for an MBBS course in Karnataka. Though Karnataka has more than 9,000 MBBS seats, government quota seats account for not even 40%, forcing many aspirants to opt for countries like Ukraine, Georgia and Kyrgyzstan. What students and their parents find attractive is the Rs 25-30 lakh package for the entire course. Besides there are consulting agencies to help them with loans and the medium of instruction is English. On the other hand, the first fee slab for an MBBS seat in a government college is Rs 59,000 per year, followed by the second slab of government quota seats in private colleges (Rs 1.4 lakh per annum). The next fee slab is of private seats (management quota) in private colleges that varies from Rs 10 lakh to Rs 25 lakh a year. Even more expensive are the NRI quota seats and those in deemed universities.
Non-uniformity of medical education is treating medical students as slaves and killing enthusiasm of young doctors.
Medical profession is an extremely strenuous and highly specialised field that requires individuals to dedicate their lives in the service of others. As part of medical professionals’ education and training, they are necessitated to undertake training across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government. In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman for proper pay and working conditions.
Great disparity in stipend at Govt. Private Colleges
Medical education is one field where one can notice the extreme variations of the unimaginable magnitude that are beyond comfort.
Falling standards of medical education is the most important side effect which should be an important issue, but sadly it is the last priority on the list of administrators. Each and every medical college can be different and student passing out of many colleges receive below average medical education.
Another important variation is in the stipend and remuneration of young trainee doctors receive. It varies from college to college, city to city, state to state as well as North to South and East to West. Besides being a cause for heartburn. it is a cause for extreme dissatisfaction among medical students.
Needless to say the arbitrariness exercised by various authorities to pay them at their will is a reflection of grave injustice imposed by administrators.
Another arbitrariness reflecting injustice is variation in fee of medical colleges. The steep fee charged by private medical colleges and restrictive bonds of Government medical colleges in name of expensive medical seats need a sincere and honest introspection by authorities. The basis for calculations of the cost of medical education should be transparent and shown in public domain.
Needless to say that medical students have been sufferers of poor and arbitrariness of inept administrative policies. Just because they decided to be doctors, they have to endure poor, unjust and arbitrary policies.
Ironically as a child decides to be a doctor, he is exploited in name of such policies of unreasonable high fee, poor education and low pay. That too while working in extremely inhuman conditions, long and hard working hours. Strangely these medical students suffer grave injustice inflicted by the society since start of their medical education, but when they become doctors, everyone expects sympathy, empathy and honesty.
In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman.
Still the sufferers of grave injustice themselves are expected to impart justice to everyone along with burden of mistrust.
Ensure uniform stipend to Interns: Great disparity in stipend at Govt. Private Colleges
Binoy Viswam, Rajya Sabha MP, has urged Union Health Minister Mansukh Mandaviya to ensure equity in payment of internship to medical students in private and government medical colleges across the country.In a letter to the Minister, Mr. Viswam said that the National Medical Commission’s Draft Regulations on Compulsory Rotating Internship, 2021, issued on April 21 and gazetted on November 18, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”
“The phrasing of this provision allowed for great ambiguity and arbitrariness. It may also result in management of private colleges denying stipend to the interns as they have complete discretion without any safeguarding mechanism. The ramifications of the same are already being seen in colleges across the country as great variance exists in stipend amounts being paid in government colleges as opposed to private colleges,” he pointed out.
A right, not charity
Mr. Viswam said that medical profession was an extremely strenuous and highly specialised field that required individuals to dedicate their lives in the service of others. “As part of medical professionals’ education and training, they are necessitated to undertake internships across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government,” he said.
The MP requested the Minister to consult with all stakeholders, including State governments, medical college managements, medical professionals, and students to formulate a policy that ensures equity among medical students. A uniform stipend to all interns would ensure that, he added.
The erstwhile Medical Council of India had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering a provision that said “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State government medical institution/Central government medical institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.
At a time when medical students and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat of MBBS.
A famous axiom “as you sow so shall you reap” has an application to health system. One is convinced that industry selling medical college seats has been quite powerful and practically, every technique to sell seats is prevalent to bypass the merit and deny seat to deserving candidates. These meritorious children, who are denied seats could have been good doctors and real custodian for the health of people. But if for some reason, business prevails and government fails to prevent this cruel and corrupt selling of medical seats, an Einstein brain is not required to guess the whole malaise prevalent in health system
Truth cannot remain hidden for long. It has to be realized that getting into medical college is a minuscule component of the process of becoming a good doctor. Once they opt for this profession, the real tough and prolonged battle begins. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it, especially those who may have invested in heavy fees and in debt.
Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario,considering the difficult times and vulnerability of medical profession
Paying the irrational fee of medical colleges may be an unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward or fail to get residency.
The government should regulate these fees and also ensure that if a heavy fee is charged, then it should be spent on medical education of students only. It should not take a form of just any another money minting industry to be used for other purposes.
Going by selection criteria of candidates as doctors, if given a choice, by whom a patient will like to get treated? A candidate who scored 20% – 30 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and candidates getting around 30 % of marks may be able to secure a degree to treat patients. What will be the deciding factor? So in the end, seats remain unfilled and may be a kind of auction, whosoever can pay millions, takes the seat.
Ironically, that strange equation is acceptable in lieu of money paid!
It is ironical that the medical profession is regulated, but medical business or medical education is not. Such business of producing doctors based on their paying capacity should be clearly trounced for the benefit of public. Foundations of healthcare should be on touchstone of merit, ethics and character and not based on business deals.
Therefore meritorious students, especially from average backgrounds, who opt to become doctors feel cheated when they pay massive fee to buy a seat. It is an insult to the very virtue of merit which should have been the sole criteria for these admissions.
It is the people and society, who will be the realsufferers in future. Therefore resentment to such system should come from the society. If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors.
The value of putting a money on something is judged by the return it gives, or a status, it confers to the candidate. The fee of medical colleges is exorbitant in many medical colleges and may not be worth buying a seat, because it may take, whole years of life working to even recover the fee or repaying the loans, amidst the present era of complex working scenario for doctors.
Private medical colleges may charge fee of 5 million to 10 million rupees or may be more. There are glaring financial complexities arising out of the huge amount.
1. The aspiring doctor will not add that much to his worth, because in case he loses his life in Covid (for example), the family will not receive that much compensation. Compensations for doctor’s death are lower than the fee charged by medical colleges. Not to talk about hard work and years spent and the sufferings of years to become a doctor. So a doctor’s life still remains cheaper than money spent on purchasing a medical degree.
2. Fee paid for education purposes may be worth, if the person is able to earn it back in one or may be two years. In present scenario, some lucky doctors will be able to earn that much amount in 5 to 10 years, by honest means. Rest, not so lucky, just try to repay loans, all over their life span. Any business done by use of that money will pay more than what a doctor will earn.
3. Doctor spends his life, treating hundreds and thousands of patients and saving uncountable lives, but one patient may sue the doctor for millions of rupees, mistake or even a unsatisfied patient. These compensations sought and given by courts are much beyond the money given as compensation in case of doctor death. Just proves that doctor’s as a person and with the degrees earned is not worth spending that huge amount.
4. So money demanded from doctors, be it for medical education or malpractice lawsuit, is multi-fold of what is given to them. There can be various pretexts to exploit doctors. They pay thousands of times of the amount they charge from patient, to lawyers, in medical malpractice lawsuit and insurance companies, just to save themselves.
5. After paying millions to medical institutes, putting themselves to hardship of years, provides them degrees. But simultaneously they become target for medical lawsuits, verbal abuse, administrative pressure and sometimes physical assaults. Getting a degree and having a healing ability does not enhance their respect in present era.
The lack of sense of gratitude towards doctors takes away the last inspiration to spend millions for the expensive medical college seat.
Paying huge fee to medical college will make a person poorer, especially honest people. One has to apply wisdom, how buying an expensive medical college seat is going to be beneficial.