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TeaThe covid-19 pandemic has exposed the realities and weaknesses of India’s healthcare system. There is no need to elaborate on the sufferings of the people during the pandemic. The need for reform in our medical care and medical education sectors is undeniable now. Better medical infrastructure and more highly trained medical professionals are the need of the hour if we want to ensure quality healthcare to our people.
Policy makers should now take all necessary steps to improve and strengthen our position with special emphasis on rural areas. Since much has already been written and said about the state of our physical infrastructure, I present a more long-term view, and some important areas of improvement with regard to medical education.
talent hunt
First and foremost, it is essential to realize that the medical profession is no longer the preferred destination for our brightest young minds. Being a doctor myself, it has been quite disappointing to see that in the last few years, there is a growing trend among bright young students to opt for the medical profession. As a society, we cannot accept this trend. The mediocre price, as someone wisely said, is a disappointment; And in matters of life and death we cannot tolerate despair. Long training periods, lack of commensurate remuneration and lack of adequate opportunities for professional development are some of the obvious reasons for the decline in popularity of the medical profession.
While some of these factors are unavoidable, given the nature of the profession, all efforts should be made to remove the systemic barriers and barriers that intimidate our youth. We must harness the best and brightest people, who are eager to serve and who yearn to achieve. The nobility of the profession, with the thrill of cracking the hidden mysteries and mysteries of science, has a magnetic attraction to intelligent minds and idealistic hearts, and should provide us with an ample platform for talent to flourish.
The quality of medical training is important. The race to increase quantity at the cost of quality will have serious negative consequences. Good teachers are role models for students, and the best teachers should be encouraged. Any compromise in the quality of medical teachers will not be tolerated. The criteria for appointment as faculty should be constantly revised and updated, and original research should be given the highest importance. New medical colleges should be encouraged to collaborate with established centers of excellence to mentor their junior faculty.
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improvement in neet
NEET exam was a revolutionary step towards bringing transparency and eligibility in the admission process in medical colleges. This has saved our system from the drawback of capitation fees. But its functioning has exposed more loopholes in our system which we must address. Recently a Tamil Nadu panel met The introduction of the entrance test in 2017-18 negatively affected students from economically weaker sections in favor of urban, English medium-educated and well-endowed students, prompting the state government to allow NEET for admission to MBBS programmes. Canceled as a criterion. .
Moreover, the proliferation of private coaching academies has greatly increased the cost of preparation for this exam. We run the risk of being out of reach of poor students and students from rural areas. This means we stand to lose many bright candidates. However, I fear that completely canceling the NEET exam would be unwise and regressive. It will only send us back to the pre-Neat era of tainted and questionable admissions processes. We should not throw the baby out with dirty bath water. We should envision measures to further strengthen the NEET system, or find better alternatives to ensure transparency and fairness in the admission process.
Governments at the state and central level can step in and implement special measures for poorer sections and students in rural areas so that they are in a position to compete with their counterparts who are in a better position. In this direction, ‘Corporate Social Responsibility’ (CSR) initiatives can also be encouraged and promoted, so as to bridge the gap between the rich and the underprivileged. Additionally, a more ‘hybrid’ model, which gives some weightage to performance in state/central board examinations in a transparent manner, in addition to NEET scores, may be considered. It is only by brainstorming to find the best option that we can meet the pressing demands of equality without compromising on competence and efficiency.
Improvements are also necessary in postgraduate NEET. One of the major drawbacks of PG NEET is its timing. The exam is conducted at the end of the internship period, which has seriously affected the effectiveness of the internship program. Students, instead of learning the practical skills required during this period of internship, devote their time to preparing for the entrance exams. We should consider a few options. A common exit test, whether at the end of MBBS course or at the end of each ‘professional’ examination (similar to ‘semester’ in MBBS course), which can be used for PG admission, is an option. Just as for the undergraduate NEET system, other ideas and possibilities should be explored and debated and the best alternatives implemented.
Read also: NEET is not about eligibility at all. It’s about the elimination of students
More PG seats
Another essential requirement is to increase the number of seats in postgraduate courses. In today’s world a graduate level medical degree (MBBS) does not provide any assurance of professional success. Every student wants to specialize in the field of their choice. Nevertheless, the number of postgraduate seats is much less than the number of undergraduate seats. Although efforts have been made over the years to correct this discrepancy, a significant gap still remains. There is an urgent need to bridge this gap so that every medical graduate can be assured of getting admission in the postgraduate course. It will also help in making the profession more attractive for the young candidates. Specialties like family medicine, which do not demand huge investment in infrastructure and help meet the urgent need for good general practitioners, should be encouraged to increase postgraduate seats rapidly. It is worth noting that in the United States, which has one of the most advanced healthcare facilities in the world, the number of PG seats is higher than undergraduate seats.
At present, there are two streams for postgraduate education and super-specialty, viz. MD/MS (NMC) and Diploma in Medicine/Surgery (NBE). The NBE was envisaged as a postgraduate level program to increase the number of clinical practitioners, especially in private hospitals, as opposed to the teaching faculty. However, at present, both the streams have become more or less equal. This leads to unnecessary confusion and duplication, especially in the eyes of foreign universities. I think it is necessary to streamline our system and have only one regulatory body to ensure uniformity of standards of training and evaluation.
Read also: Reactions to OBC medical quota re-exposing Indians’ flawed eligibility logic
Strengthening PHC
Finally, there is something to be said about potential policy incentives that will help us kill two birds with one stone. Primary Health Centers (PHCs) were established to meet the primary health needs of our rural and semi-urban population. However, the shortage of qualified doctors in PHCs has hampered the system. The need for strengthening PHCs cannot be overemphasized. One option we should seriously consider is to post fresh graduate doctors in these PHCs, and give them incentives as a preference for PG admissions. Alternatively, the Medical Council of India (MCI) recommended to the central government in 2012 that compulsory rural posting for one year should be made for joining PG courses.
The government agreed to the proposal but postponed its implementation in view of protests by students and doctors. The opposition was not wholly unreasonable given the lack of basic amenities and infrastructure in the PHCs and other facilities including reasonable remuneration and accommodation. However, it is not difficult to address these concerns, and the MCI had submitted its suggestions in this regard. Perhaps the present government may reconsider the matter, as this will not only give a boost to the PHC system, but will also give valuable experience to the budding medical professionals of India.
The time for complacency is long over, now is the time to act. We are indebted to the future generations to act with the right seriousness and to fully equip the country’s systems to meet all possible challenges.
The author is President, Cardiology, PSRI Hospital, New Delhi; Former Director, PGIMER Chandigarh; and former Chairman, Board of Governors, Medical Council of India. Thoughts are personal.
(edited by Prashant)
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