The Precarious State of Indian Medical Education
Part I: What was special about 2019?
“The more the merrier?”
Becoming a doctor was not my childhood dream, I stumbled upon it. Like most middle class first born kids, I did not have many options. So, I picked my poison and decided to prepare for the NEET-UG exam along with fifteen lakh other students. It was demanding and brutal but one thing led to another and I landed in one of the most prestigious medical colleges in the country. My family was euphoric. After all, I had achieved the middle class dream. After slogging for two years, quitting reading, limiting recreation to watching one episode of Friends a day, crying over stupid test results and living in constant fear for so long, being idle felt strange. It was like the kind of phantom head bobbing one experiences after a long train ride - a visceral memory. However, the people around me kept me busy. Phone calls wouldn’t stop rolling in; and before I knew it, I was reduced to the title of “Doctor Sahab”. That is all anyone could talk about then and that is all anyone can talk about now. I was honestly uncomfortable with the limelight and never understood what the fuss was all about. But eh! I was happy that at least the grind was over.
The year was 2019. The BJP was jubilant after its landslide victory, and so was I. We were ready for a new chapter. The National Testing Agency (NTA) had replaced the hitherto Central Board of Secondary Education (CBSE) as the body that conducts the two most horrid exams of the country: NEET-UG and JEE-Main. Every coaching institute was betting on how the question paper would be; everyone was shooting in the dark. As it turned out, we had been preparing for a missile attack and got hit by a firecracker. The question paper was so underwhelming that it boiled down to who was sloppier with the MCQs. It is not necessarily the worst way to eliminate competition but it does end up undermining merit. Naturally, the cut offs skyrocketed. It was the beginning of an era of massive “score inflation” (which means that the same score would fetch you a worse rank than it would have the year before). The NTA with its depreciating quality of question papers year after year, was a ticking bomb, which exploded into the NEET 2024 fiasco. After the results came out, I was sure that counting on a seat in Mumbai was a long shot. Alas, I’d have to move to a tier 2 city. But the EWS and SEBC quotas were introduced in the same year, and in order to accommodate the reserved seats, there was a 25-30% increment in the number of MBBS seats across the state. The pie got bigger, and as luck would have it, I could latch on to Mumbai for a little while longer. From a distance it looked like a silver lining, a win-win. But the problem with such “at the stroke of a pen” policies is that the ramifications are not well thought-out. They are meant to make headlines ahead of elections.
Our college was forced to admit 50 extra students overnight without adequate time to build capacity. There was a 33% hike in the batch strength. I remember huddling in a cramped space in the anatomy dissection hall and craning over my batchmates’ shoulders to get a look at what was being cut. The lecture halls, which were meant to accommodate 150 students, were now loading 200. Those at the back did not even pretend to listen to the professor. The amphitheatre and the basketball court, the only open spaces in the campus, were taken up for the construction of a new hostel building (which, 5 years later, is still under construction). Every lecture hall was taken up for renovation one by one and there was noise everywhere we went for the entire year. Hostel accommodation became a scarcity, the canteen was suddenly more crowded and life in college was chaotic for a while. Being situated in Mumbai, it hit us harder because of the existing space crunch but I’m sure every medical college must have faced an infrastructural crisis.
In terms of both, equity and infrastructure, Maharashtra lags behind its southern counterparts by a significant margin. To bridge the gap and make public healthcare infrastructure more robust, 8 new peripheral medical colleges have been opened since 2019. Why is this remarkable? Because, just 7 colleges were added in the state between 2000 and 2018; more colleges were introduced in the last 5 years than in the 18 years before it. Medical education had finally caught the government’s eye. In the coming years, bold and potentially transformative initiatives would be taken to renovate the Indian Medical Education.
The addition of seats to existing medical colleges and commencement of new ones was the first step in the right direction. But, history is replete with caveats when it comes to implementing impulsive quantitative changes while overlooking quality. In India, it’s always two steps forward, one step back.
A 2023 report by The Times of India revealed that about 42% posts in Maharashtra's medical education department lie vacant. The numbers hover around the same ballpark in most states across the country; it is a deep rooted problem. Introduction of new colleges amidst an existing staffing crisis overwhelmed an already crippled system. My friends at the newly inaugurated GMC Baramati would tell me that most of their faculty members are syphoned off from BJMC Pune. The TOI report also mentioned that as of 2023, 11 out of 25 dean positions were vacant. An article in the Hindustan Times revealed that the five medical colleges run by the Brihanmumbai Municipal Corporation (BMC), face a shortage of 439 doctors; 27% of the total sanctioned positions. A staggering 190 vacant posts are those of assistant professors, who play a crucial role in handling academics and patient care.
I concur that it is better to have understaffed hospitals than having no hospitals at all in the periphery but the supply-demand issue is so pressing that it needs to be addressed urgently. Despite the number of vacancies, landing a government job remains unattainable for a variety of reasons. Some say that the government is not advertising for the vacant positions; pulling political strings and leveraging internal connections play a pivotal role in the job market. Since some seats are reserved for respective categories, the unavailability of reserved category candidates can be a major roadblock. Medical teachers’ associations have also raised questions around increasing the age of retirement; everyone in the medical fraternity is familiar with the infinitesimal prospects of promotion in government institutes owing to long tenures of those at the the top. The discourse on this subject is not just confined to students’ and teachers’ associations; it is a national debate. In fact, the parliamentary standing committee report published in 2024, has acknowledged the faculty shortage and the Ministry of Health even recommends a teacher-student ratio of 1:2 to 1:3. Increasing the number of undergraduate medical students to produce more doctors while not having enough doctors to teach them in the first place, is an exceptionally counterintuitive idea.
While researching for this blogpost, I noticed that the political elite are not as ignorant of the problems as I had expected; there are well meaning and competent individuals inside the government who want to elevate Indian healthcare to global standards. But we’re so knee deep in the swamp that wriggling out of it is not going to be a cakewalk. The system is like a giant loopy waterpark ride, policies slide smoothly to begin with, only to get stuck somewhere along the curves. Ensuring cooperation at every level of governance is the biggest obstacle facing us head on. We need to use unprecedented lenses and tools to amend the system if we want to achieve India's aspiration of becoming a “Vishwaguru”.
In this three part series, “The Precarious State of Indian Medical Education”, I shall talk about the various changes introduced since 2019 and how they will affect the future of healthcare in India.