Time critical for reform

Medical Education

By Dr Oishee Mukherjee

All eyes will be on the ensuing Budget session to see whether the National Medical Commission Bill, sent to a standing committee will find final approval by Parliament. Overhauling of the rot in medical education has been long overdue, as was even identified in an earlier report of the Parliamentary Standing Committee of March 2016. As is well known, the rampant corruption, the failure to maintain uniform standards of medical education, failure to put in place a robust quality assurance mechanism and the high rates charged by private medical colleges and dubious admission procedures have reinforced the need for such transformation.
The report rightly called for institutional changes in the regulatory framework of the medical profession of the country and accordingly the Government had tabled the National Medical Commission Bill 2017 in Parliament this past session. Four autonomous medical boards are to be created to oversee education, assessment and rating of medical institutions, ethics and regulation, replacing the infamous Medical Council of India (MCI).
This is, no doubt, a very positive step taken by the government, but it met hurdles, with the Opposition questioning some of the provisions. However, the draft of the Bill was guided by the excellent Report of the Group of Experts, headed by late Ranjit Roy Choudhury the Parliamentary Standing Committee had also endorsed earlier. But unlike the Choudhury report, the Bill proposes 25 members, selected by a search committee headed by the Cabinet Secretary, with a majority of them medical doctors and only five of these to be elected from amongst medical practitioners.
At the very outset, one may mention the suggestion in the Bill that the Commission will fix fees for 40 per cent of seats in private medical colleges has come in for severe criticism from certain sections. They have questioned the use of a national entrance exam if candidates who are high on merit cannot afford seats in private colleges. As is well known, these colleges have been charging exorbitant fees, thereby making these institutions beyond the reach of the common man.
The bridge course, proposed in the Bill, has raised controversy with the Indian Medical Association (IMA), which made known its protest by observing a nation-wide strike last month. Keeping in view the necessity for more doctors, specially in rural and semi urban areas of the country, to ease the burden of diseases. It well known that there are large parts of the country where no medical practitioner is present and none are willing to go.
Being a doctor, it is indeed difficult to out rightly oppose the government proposal. There is thus a mention in the proposed Bill where homeopaths willing to practice allopathy may do so in rural and semi urban areas, say for a minimum period of five years. Thus, the contention that modern treatment may be retarded if homeopaths are allowed to practice and prescribe allopathic medicines are prescribed is unfounded.
Some feel that homeopathy is a “complete science and is in no way limited to prescribe allopathic medicines”. However, it may be admitted that most homeopaths are not well versed in allopathic medicines but there may be some stipulation regarding the types of diseases in which the homeopaths would be allowed to practice. The bridge course would also equip them to some extent in this area. All said and done, while it cannot be denied that it may be difficult for homeopaths to venture into complicated diseases, the final Bill could look into the issue and perhaps make amendments to satisfy those opposing.
Concerns have also been expressed that homeopaths may not be able to interpret modern investigations and diagnostic tests but these are not quite valid. In fact, modern practice of homeopathy has changed over time and most homeopaths are using modern diagnostic techniques to assess outcomes of their treatment.
Though the initiative of the government in this regard should be welcomed by the people by and large, there are other aspects that need urgent attention. The foremost is the need of opening more medical colleges so that more seats are available. But equally important is the need to at least double Post Graduate seats – MD and MS – immediately as this is an age of specialisation. The number of such seats is minimal and even doubling the seats, say within two to three years may not be sufficient.
Most experts believe that requirement of doctors have to be increased as comparable statistics reveal that most Third World countries or the emerging economies have much large number of doctors per 1000 population. The obvious need is to spread medical education in a big way in the public sector by setting up more hospitals in every district – at least two or even more – to cater to the needs of the every growing population. Specialised hospitals need to be opened not just in metros and big cities but also in the major districts.
Obviously, for this Post Graduate doctors would be needed and thus more seats have to be made available for this purpose. Thus after three years, there would be at least the minimum amount of specialists, hopefully. As pointed out earlier, more resources have to be for the health sector for setting up the required infrastructure.
It is indeed painful that in spite of being an emerging economy, the state of medical education as also the state of the health sector is so deplorable in the country that has resulted in the growing burden of diseases. Successive governments have, in fact, turned a blind eye to this sector without evolving a rational and judicious approach to the need for spread of medical education in the country.
Being in the profession for just a little over a year, I have been appalled at the state of poor people who suffer from various types of diseases and cannot offer proper treatment, even in cities. The case with women and children is better not said and the situation is extremely distressing in the backward districts of the northern and eastern parts of the country. How long should this be allowed to continue? Why should the armchair doctors have any objection if homeopaths can mitigate the sufferings of the poor and the impoverished in the rural and semi-urban areas of the country?—INFA