More than the lopsided demand-supply situation, it is indeed the failure of the regulatory structures which is reflected in the exodus of students to medical colleges abroad 

Russia-Ukraine crisis: Air India will fly two more planes to Ukraine on February 24 and February 26 to bring Indians home. (Image tweeted by @ANI)

Russia’s assault on Ukraine has several geopolitical ramifications, right from severe economic sanctions against the aggressor to the country getting suspended from the global footballing association to an ambitious gas pipeline project getting shelved.

It was generally felt that the Russian invasion will be over soon, as a result of pressure from the West or Kiev catapulting in a couple of days. But more than six days into the conflict, the West has not been able to stop Russia, and Ukraine has presented a belligerent face.

As the war prolongs, a humanitarian crisis is unfolding. While writing this piece, the news of the death of Indian student Naveen Shekharappa in Kharkiv is being flashed by news channels. He died when a Russian missile targeted a government building in Ukraine’s second largest city. Shekharappa was in the building waiting to collect food. He was a fourth year medical student in Ukraine.

With the news of thousands of Indian students, a majority of them studying medicine, stranded in Ukraine, India is slowly waking up to the gravity of the crisis. Ukraine has been a choice for thousands of Indian medical students every year, and it is estimated that around 20,000 of them were in Ukraine when the rumblings of the crisis started.

Why do Indian students go to Ukraine and several former Soviet republics to study medicine? A quick search in the website of the National Medical Commission, which replaced the beleaguered Medical Council of India as the top regulatory body for medical education in India, showed that there are 605 medical colleges with a total of 90,825 MBBS seats a year. While this number may seem huge, it pales when we compare it with the fact that around 1.6 million students wrote the National Eligibility cum Entrance Test (NEET) for MBBS admissions in 2021.

This situation in which only one out of ~16 aspirants will get selected for medical studies in India, throws up several interesting dynamics. The coaching industry for medical entrance exams thrive on this demand-supply mismatch, and many have made a fortune starting ‘coaching centres’.

At the same time, this also results in a situation where parents with deep pockets are willing to go to any length to finance their child’s dream. Their demand for medical seats are satisfied by some private medical colleges which find ingenious ways to tweak the system to admit non-meritorious students for a premium. The easy money in medical education made it a safe haven for crooks and shady characters, right from mining barons to former chief ministers. It was common knowledge that the Medical Council of India was hand-in-glove with these dubious medical college owners. If a student does not manage to secure a ‘merit’ seat in a government medical college, the parents will end up spending anywhere between Rs 50 lakh-1 crore on medical education in a private institution.

Foreign Degree

There comes the relevance of countries such as Ukraine, Belarus, Russian, Georgia, Armenia, China, the Philippines, and Trinidad & Tobago. It is estimated that around 20,000 students leave India every year to study medicine. These countries offered relatively good quality medical education at one-third the rates of private medical education in India.

There are hundreds of agents (‘educational counsellors’) across India who connect students to these medical institutions. The visa processing and all official paraphernalia will be completed in no time; and the students can find themselves on a plane to one of these countries. Though there are language barriers, most of these institutions offer a reasonable exposure to students on basic aspects of clinical practice.

Upon returning to India after their medical studies, they have to pass a Foreign Medical Graduate Examination, which is effectively a licensure test for practicing medicine in the country. Earlier the proportion of students who fail this examination was very high, but it has progressively come down over the years.

Usher In Reforms

More than the lopsided demand-supply situation, it is indeed the failure of the regulatory structures which is reflected in the exodus of students to medical colleges abroad. Medical education has been strangulated by unrealistic requirements, fee caps, and an ‘inspector raj’ put in place by the erstwhile Medical Council of India.

All of these conditions were promoted in the name of standardising medical education in India, but ended up being milch cows for the council’s functionaries, and most of the doctors who come for ‘inspections’ to medical colleges. It is open knowledge that there are hundreds of medical colleges without proper facilities, patients or qualified faculty to teach. But they continue to admit students and churn out doctors by the thousands.

It’s time that medical education in India is reformed. The National Medical Commission Act 2019, which replaced the Medical Council of India with a new body with four autonomous boards, is indeed a welcome step in this regard. But more needs to be done to release medical education from the shackles of perverse regulatory structures. Let the good institutions thrive and the bad ones perish.

Forcing all the private medical colleges into similar fee structures will only incentivise corruption and cutting corners, all affecting the quality of medical education. It is a matter of great shame that not a single medical college in India has featured in the list of top 100 medical institutions, as per QS World Ranking in 2021.

The Forex Outflow

The doctor-population ratio in India is 0.9 per thousand population, which is slightly less than the 1 per thousand recommended by the World Health Organization. Even though these numbers are not that bad, there is a huge disparity between rural and urban areas regarding access to quality assured medical care. Therefore, India needs more doctors, and they should be incentivised to serve in rural areas. This is only possible through capacity augmentation for medical education.

Besides, we can look at the kind of forex flow happening due to students going abroad for their medical education. Assuming that there are 20,000 students moving out of the country a year and close to 100,000 students are at various stages of their medical education, if a student spends Rs 5-6 lakh a year, the total forex outflow will be close to $1 billion a year. This shows that there is economic sense to reform and invest in India’s medical education.

While the military action and bombing are continuing, several news channels are showing visuals of Indian students huddled together in basements in the hope of a safe passage to Poland and Hungary. There are also reports to discrimination at the European Union borders, against students of Indian and African origin. Therefore, the priority should be on bringing our children back as soon as possible. But we should not forget to discuss the system that forced these students to go to an alien country.

Philip Mathew is a physician, public health consultant and a doctoral student at Karolinska Institutet, Stockholm. Twitter: @pilimat. Views are personal, and do not represent the stand of this publication