UKRAINE CONFLICT EXPOSES INDIA’S FLAWED MEDICAL EDUCATION SYSTEM
by Prabhjot Singh
An unexpected outcome of Russia’s invasion of Ukraine is the brutal exposure of the inequities of India’s medical education system.
Still far short of achieving the universal standard of providing a doctor for every 1,000 people, the government and the private sector — led by globally massive private Indian companies — continue to shy away from accepting the challenge of pulling the country out of a grave crisis it faces today, the acute shortage of trained doctors, nurses and paramedics.
Leaving aside Karnataka, Maharashtra and Telangana states, where politicians-turned-entrepreneurs dominate the providing of medical education at exorbitant rates at almost five to six times that of government medical colleges – other states and union territories lag far behind in matching even these dismal statistics.
In India, the ratio of Bachelor of Medicine, Bachelor of Surgery (MBBS) seats and aspirants is shockingly skewed.
Indian students going overseas for MBBS degrees are in fact helping the nation to bridge this gap at their own cost, security and wellbeing. The Ukraine woes have the disparities in the Indian system, which has provided doctors in large numbers to the developed world such as the UK.
India is not alone in grappling with Ukraine’s humanitarian crisis, as it tries to bring back its students. Several developing nations, including those from Africa, are equally affected. Nearly a quarter of the 76,000 foreign students who were in Ukraine before the Russians invasion were from countries like Nigeria, Morocco and Egypt. This is the result of a tradition that was set during the Soviet era when there was an effort by the government to extend its influence over the developing world by attracting students from African countries newly freed from Western colonisation.
Over time, Ukraine emerged as a gateway to Europe and the facilitator for entry into the European job market for foreign students, both African and Indian.
Ukrainian degrees are widely recognised in Europe. Ukrainian universities have tailor made their courses to the foreign students needs, providing them not only food and faculty members who spoke their language, but also an affordable fee structure. An MBBS degree in any of these countries will cost anything between 2.5 million and 3.5 million Indian rupees (USD $32,000 – USD $45,000), while a similar degree in a private medical college in India costs in tuition fees and ancillary expenses more than a 10 million Indian rupees (USD $130,000), rising up to 12.5 million Indian rupees (USD $160,000).
Furthermore, in countries such as China, some medical colleges have experienced doctors of Indian origin. This is why China is one of the most popular destinations for Indian medical students. It is the same case with the lower costs of medical education in other European or Asian countries. For instance, if you know the German language and get admission in a medical school in Germany, your education is free.
Recently, India’s Ministry of Education published statistics which revealed that a total of 84,649 medical graduation (MBBS) seats were available nationally in institutions in India in 2021, with 1,614,777 candidates appearing for the undergraduate National Eligibility cum Entrance Test (NEET) examination, a mandatory entrance test for medical colleges, both government and private. Almost 99 percent of the candidates – 870,074 in all – cleared the test. But due to the limited number of seats available, only a little less than 10 percent finally got admission into medical colleges in the country. That left only one option available for aspiring doctors who did not get into Indian medical college despite getting through the test. Most of them, especially, sought overseas alternatives.
UK-based Kulwant Dhaliwal, who has been spearheading a cancer awareness campaign in South Asia, put out some startling figures. Quoting Government of India officials, he says nearly 120,000 Indians are studying medicine abroad. Of these, nearly 23,000 are in China; 18,000 in Ukraine; 16,500 in Russia; 15,000 in Philippines; 10,000 in Kyrgyzstan; 7,500 in Georgia; 5,200 in Bangladesh; 5,200 in Kazakhstan; 4,000 in Poland and 3,000 in Armenia. He did not mention Nepal and other countries where again a sizable number of Indian students are doing medical studies.
Of the 562 medical colleges in India, 286 are government-run, and the rest private. While education in government colleges is comparatively subsidised, the fee for an MBBS course in private colleges varies.
SAME EDUCATION, DIFFERENT QUOTAS
There is a huge difference in the fee structure for students admitted under the NEET, government quota, the owners or management quota and the quota for expatriate Indians. In September 2021, the Punjab government finally notified the fee structure for different categories of medical students in the state medical colleges, both government and private. The Punjab Government fixed the tuition fee for first year in government colleges at Indian rupees 158,000 (USD $2,100), to be subsequently increased by 10 percent annually for five years. Therefore, a student completes an MBBS course in the stipulated period at around one million Indian rupees (USD $13,115). This excludes all supporting expenses, including hostel, food and, at times, even buying of material for practical classes. Many government medical colleges force their students to share the cost of laboratory materials. This cost comes to another 300,000 to 500,000 Indian rupees.
Elsewhere in India, tuition fees for students admitted under NEET are between Indian rupees 67,000 (USD $870) and 160,000 (USD $ 2,098) annually. For government-sponsored seats, the fees are between 300,000 (USD $4,000) and 400,000 rupees (USD $ 5,200) per year. For those qualifying under the expatriate Non Resident Indian (NRI) quota, the fees are between USD $110,000 and USD $115,000.
On the other hand, fees for the first year of a private college under the government quota is rupees 368,000 (USD $4,900) and for students under the management quota is rupees 945,000 rupees (USD $12,460). By the end of the fifth year in a private college, a student would have paid nearly 1.5 million rupees (USD $19,670) and nearly rupees 5 million (USD $65,000) under the management or owners quota in private colleges. The fee for those within the NRI quota is USD $110,000. These fee structures do not include boarding, lodging and laboratory costs.
RISKS IN GOING OVERSEAS
Those going abroad for medical degrees also risk their degrees not being immediately recognised back home. They are put in a 10-year window during which they must meet all the mandatory requirements before they get a licence to practice in India. Despite this, they continue to do so, indicating the desperation in families where their offspring wish to secure a medical degree at an affordable cost.
Indian medical students seeking degrees abroad mostly wish to return to India after graduation and consequently need to take the foreign medical graduate examination. The numbers taking this test have gone up by more than three times since 2014-15. As against this, over the same period, the number of medical colleges has gone up only 1.5 times, and the number of seats have risen by just 1.6 times.
INDIA’S REGULATIONS ON FOREIGN DEGREES
For medical students with foreign degrees, the National Medical Commission’s (NMC) has a set of regulations. The Foreign Medicine Graduates (FMGs) regulations promulgated in 2021, prohibits transfer from a foreign university to an Indian one in the middle of an MBBS programme. The reason given is that the entrance guidelines and selection criteria differed. The FMG regulations provide a 10-year window for students to obtain their degrees, complete their internships (one year in both Ukraine and India) and apply for the Foreign Medicine Graduates Examination to get their licenses. Since an MBBS degree in Ukraine takes an average of six years to complete and taking into consideration the additional two years required for internships, it therefore leaves the candidates only two years more to secure a license in the 10-year window.
Given the current crisis, there is no way of knowing when these students will return to Ukraine to finish their studies. Thus the 10-year window poses a big challenge for them, as they may not be able to apply for a license to practice medicine in India if they do not complete the formalities in the stipulated time frame.
With the violence in the Ukraine showing no signs of abating, India may have to take a decision to safeguard the interests of these displaced students.
During 2021-22, only a quarter of the students who appeared for this test (it is held twice a year), cleared it, to acquire the right to practice in India. Those who eventually do not clear the test despite reappearing stood to lose the investment made in a foreign degree.
The numbers taking this test have gone up by more than three times since 2014-15. Against this, over the same period, the number of medical colleges has gone up by only 1.5 times and the number of seats by 1.6 times.
PRIVATE VERSUS PUBLIC
One reason why there are fewer private medical seats than for other disciplines is that private players have kept away from medical education due its longer duration. An MBBS course, including internship, needs five-and-a-half years to deliver, whereas a bachelor’s course in management takes three. Thus, private investment in medical education is best done by those entities which can live with a longer gestation period. The other side of this reality is that it is impossible for a middle-class family to afford private medical education, while seats in government medical colleges are relatively scarce. Besides this, the promoters of private medical colleges, like engineering colleges, are often without scant exposure to education and often of questionable integrity.
About the author: Prabhjot Singh is a veteran journalist with over three decades of experience covering a wide spectrum of subjects and stories.