Remove caps on age, attempt for MBBS students: National Medical Commission

Is a medical degree from abroad a winwin situation for the stakeholders and the nation Should Indian middleclass and lowincome families be stretching their resources for this The National Medical Commission the apex body that regulates medical education and medical professionals in the country is trying to solve this challenge by recommending the removal of the age bar for entry to MBBS and lowering of fees for seats under government quotaThe NMCrsquos recommendations have been sent to the Government of India after an extensive study by its experts The Centre may soon come out with directives to this effect A paper on the study has been published in the National Medical Journal Medicine and SocietyDr Aruna Vanikar President Under Graduate Medical Education Board along with three of her colleaguesmdashDr Vijayendra Kumar Member Full Time Dr M Mintz and Dr D Chakraborty both Members part timemdashhave worked together on the study which has been published in the National Medical Journal Medicine and Society of the All India Institute of Medical Studies AIIMSDr Aruna Vanikar President Under Graduate Medical Board NMCldquoWe have recently published our findings in the National Medical Journal and have even made our submissions and recommendations to Union Ministry of Health Government of India who is in the process of finalising the same before making the same publicrdquo said Dr Aruna Vanikar President Under Graduate Medical Board NMCldquoWe have also proposed that the minimum age criteria of 25 years for entering into MBBS entrance should be done away with Instead we have suggested that there should be no age limits for appearing for MBBS entrance and that anyone keen to do medicine should be able to do it at whatever age they are comfortable For this we have already increased the medicine seats in governmentrun medical colleges across the country so that parents from middle class and lower middle class would think twice before sending their children to go abroad for doing medical education and it is not the best solution Also the NMC has appointed a different committee to look into the revised fees for medical coursesrdquo explained Dr ArunaWhen asked if the recommendations would be implemented soon Dr Aruna clarified ldquoIt is a process the Union Ministry of Health will put forward the proposal before the parliament and once the same get approved the directives would come into forcerdquoThe doctor dreamldquoThe Bachelor of Medicine and Bachelor of Surgery MBBS course is one of the most sought after by students of science streams in India and their parents The main reason behind this choice appears to be the respect and for some monetary gains in the medical profession Even if it appears that the profession is losing respect in society medical professionals are still able to eke out a comfortable life so as to be counted among the elite With rising inflation globally and locally expenses incurred when healthcare and lifesaving situations arise are hugeAbout 519 per cent of MBBS seats in India belong to the government quotaThe expense is lsquoout of boundsrsquo for most average and economically underprivileged families in India The COVID19 pandemic has exposed this daunting issue Unfortunately the Indian allopathic system has not fulfilled the need of equitable healthcare for its citizens With such contrasting problems gnawing at society children from average middleincome group families fail to realize their dream of becoming a lsquodoctorrsquo For the privileged classes there is often a need to have a successor to the family business of medicinehospitalrdquo the report statesToo many people too few doctorsAs per the data provided by the then Union Minister of State for Health as of March 2019 there was 1 doctor for every 1445 Indians for an estimated population of about 135 crore This is lower than the prescribed norm of 1 doctor for 1000 people by the WHO The government said that besides these allopathy practitioners there are 788 lakh Ayurveda Unani and homoeopathy practitioners in the country Assuming 80 per cent availability it was estimated that around 63 lakh doctors practising these systems of medicine were available for service Considered together with allopathic doctors it gives a ratio of 1 doctor to 860 people This exceeds the recommended WHO norms Unfortunately there is an inequitable distribution of qualified doctors in the country The doctorndashpopulation ratios are widely different between states Bihar and northeastern states such as Nagaland have very few doctors Even when a state has a decent doctorndashpopulation ratio the urban areas have much better ratios than the rural areas According to the Rural Health Statistics of 2016 the number of doctors at primary health centres was 26464 against sanctioned posts of 34068 The shortfall at that time was 3244The cost factorAs per the Ministry of Health and Family Welfare the number of MBBS seats available in India in 2020 was 80312 While three government medical colleges in the state of Punjab charge Rs 44 lakh as a fullcourse tuition fee in some private medical colleges it is up to Rs 70 lakh The NMC has been asked to design a new fee structure The average annual per capita income of households is R44901 This was revealed from the results of the Longitudinal Ageing Study in India LASI survey conducted in 2017ndash18 This accounts for about 39 per cent of the per capita income in the same year according to the National Account Statistics This crosssectional study was based on a relatively small sample 42249 households and its reference frame is confined to households that had at least one person aged 45 years or higher Thus educating a child in the field of medicine is a challenge for a middlelowincome group family Education in a private college in India is beyond the reach of these children with big dreams For families looking for a successor to the family business of a hospital or running a medical education programme economic constraints may not exist the study revealedThe NEET scenarioNEET conducted by the National Testing Agency is a mandatory entrance examination for students seeking admission to medical colleges in India As per the information available on their website about 14 lakh students appeared for the NEET examination in 2019 and 2020 And a mere 58 per cent cleared and got admission to medical colleges A number of MBBS seats were not taken up in 2021 one of the reasons is likely to be the high fees As per the study the students securing admission to MBBS courses in India are highly meritorious compared to their peers The students who are keen to pursue medical education have some options that is either to take up admission in some other branch of biological sciences and attempt the NEET again or take up alternative healthcare education such as Ayurveda or go abroad to CIS countries like the Philippines Bangladesh Nepal or China The CIS countries include Ukraine Russia Armenia Azerbaijan Kazakhstan Kyrgyzstan Uzbekistan Turkmenistan Tajikistan and Georgia The last choice of going abroad is often out of desperation and with a hope of getting qualified as an MBBS and then returning to India the study revealsUncertain future The future of Indian students who return as lsquoforeign medical graduatesrsquo FMG after training in certain countries is often uncertain ldquoWe analysed the current status of medical education in India the Commonwealth of Independent States CIS and some neighbouring countries Of approximately 14 million 14 lakh students taking the National Eligibility cum Entrance Test NEET about 58 per cent get admission in medical colleges There are about 554 medical colleges in India with 82550 MBBS seats 519 per cent seats belong to the government quota Parents who send their children to a foreign country to do medicine spend R15 million 15 lakh to R4 million 40 lakh against an estimated annual income of R12 million 12 lakh and the child spends 4ndash6 years in a foreign country Of 38150 FMGs who took the examinations conducted by the National Board of Examinations from 2015 to 2018 189 per cent passed the FMG examination mandatory for registration to practise medicine in India says the studyldquoThe National Medical Commission is trying to solve this issue by removing the age bar for entry to MBBS and recommending lowering of fees for MBBS in government quota Seeking graduation in medical colleges outside India may not be advisable for those from the middle lowincome group of Indiardquo said Dr ArunaAnother issue according to Dr Aruna is that ldquoEducation in most foreign countries is conducted in the local language which is different from the languages spoken in India Even if a student is extremely good at picking up languages learning medical terminology in a foreign language other than English is itself an uphill task for an Indian student and understanding the patientrsquos history and symptoms narrated in their local language and interpret them for assimilation of the problem concerned and tackle the same is itself an exercise that may not turn out to be costeffective in terms of energy mental stamina and finances spent to obtain a medical graduation degree in these countries If the language of communication is English these students are taught in separate schools than their local peers A majority of these students get nominiscule clinical exposure which is the mandatory foundation for becoming a good doctorrdquoWhat is the way outThe efflux of students to CIS Commonwealth of Independent State countries China Nepal or Bangladesh is leading to exorbitant spending by the studentrsquos family with questionable monetarymaterial benefits to them apart from the unnecessary drain of foreign currency of the nation to these countries The experience of the past few decades and the changing scenario in India this efflux can be reversed to an influx of students to India Considering the drain on families that are sending their children to CIS nations to study medicines the study suggests ways to turn the situation on its headSuggestions by NMC includei to build a robust system to improve upon the quality of medical education imparted across the nation ii to try to minimize the gap between the level of education imparted in different institutions and iii some other possible measures discussed below The UGMEBNMC is planning to address these issues It is also planning to remove the upper age bar for aspirants seeking admission to medical graduate courses Thus students can try to make as many attempts as they desire if they are keen to pursue medical graduation This option can be taken by aspirants instead of going to these countries explained Dr ArunaTable 1 Highlights of the National Eligibility cum Entrance Test NEETParameter20192020Number of candidates registered15193751597435Number of candidates present14107551366945Number of candidates absent108620230490Indian nationals15160661593907Nonresident Indians18841869Persons of Indian origin6349Foreigners687878Open category534072475534Schedule Castes211303221253Schedule Tribes96456100519Other backward class677544706214Economically Weaker section93915Table 2 Countrywise performance of Indian students in the Foreign Medical Graduate Examination FMGE during 2015ndash18CountryAppearedPassedPass percentageChina2001923631180Russia1172415121290Ukraine 813012241505Nepal 589410421768Kyrgyzstan 53355891104Georgia 16823482069Philippines 14213652569Kazakhstan 13931431027Bangladesh 12653432711Armenia 10972372160Source National Medical JournalAlso ReadWork from home culture taking a toll on the young Health experts