'Getting teachers for new MBBS courses will be a major problem'

A trained cardiac surgeon, Prof M S Valiathan pioneered biomedical research in India. Being the first Vice Chancellor of the Manipal University and a former member of the University Grants Commission, he has a ringside view of the Indian medical education system.

Valiathan, currently a national research professor, spoke to Deccan Herald's Kalyan Ray on the government's plans on the expansion of medical education and its pros and cons. Excerpts:

In the last two weeks, the Union Cabinet approved 58 new government medical colleges in the districts and 10,000 additional MBBS seats in the government medical colleges. How do you think it will help improve the doctor-patient ratio?

We don't have enough doctors for India's population. Compared to developed countries we have too few qualified doctors. The deficiency is more acute in rural India. The government is trying to improve the situation and one of the ways is to increase the number of admissions in medical colleges. We produce close to 40,000 doctors a year, which is not enough for our growing population.

How do you think, the decision should be implemented?

Partly by increasing the number of new medical colleges and partly by increasing the cap in the existing medical colleges. But you need teachers. That’s a serious problem. Already there is a severe shortage in pre-clinical and para-clinical disciplines. If you are going to increase the number of seats by another 10,000, from where are you going to get the teachers? Secondly, the government has to create the laboratory, library and student facilities. Hospital facilities would have to be improved if so many students are to be taught.

Is opening of medical colleges along with district hospitals a good idea? What other steps need to be taken?

Opening up a greenfield hospital takes time, whereas a district hospital if expanded with competent teachers and better laboratory facility, is a good step. But the devil is in the detailed planning. It’s not easy, especially in getting teachers. Becoming a professor of anatomy is not attractive for students.

But somebody has to be there to teach anatomy. The non-medical teachers like an M Sc or Ph D in anatomy currently can not become the head of the department. May be we have to remove some of these restrictions. Medical Council of India's regulations have to be relaxed during this expansion so that somebody does not go to the court saying MCI guidelines were violated. Rapid expansion should not lead to confusion or collapse of the system.

How long it would take for faculty development for such large scale expansion?
If you take a poll among medical doctors passing out MBBS on how many would like to take up anatomy, physiology or forensic medicine, you would not find many takers even though these are subjects students need to learn to become doctors.

But no student wants to take them up because there is no possibility of medical practice. For government medical colleges, the problem is more because in the last 20 years, all expansion happened in the private sector that offered more attractive salary. The new government colleges would face competition from private colleges.

Don't you think the expansion in the private sector made medical education too expensive for a large section of students?

While more seats in the government colleges are welcome, it should not be at the cost of quality. That would be a disservice to the society. In the private sector, there is often a profit motive, which is not what India needs. If you want medical education at a price that the middle class can afford, then there has to be substantial subsidy. But often the cost of medical education is under-estimated. When I started in Manipal, the student fee was Rs 1.75 lakh per year whereas in government hospitals it was Rs 20,000. If you take into account every expense in a medical college scientifically, costing of medical education would be high. It has to be recovered from students. But there should not be any profiteering. Every state has a cost fixation committee, but there are so many ways of circumventing these regulations in India.

Will there be enough post graduate seats to accommodate these additional MBBS students?

That will come. But one problem with everybody going for MD or MS is that those who have done MD or MS or other super-speciality courses will inevitably come to the cities. Because of poor quality of MBBS, even students now feel MBBS is no good whereas ideally MBBS doctors should be like old family physicians so that you don’t need to see these specialists every now and then.

There is a speciality called family medicine in the USA. It’s a residency programme and difficult to get into. UK's National Health Services too is based on these family physicians. MCI has approved family medicine, but hardly any university offers an MD in family medicine. The All India Institute of Medical Sciences, Delhi, which does not come under MCI, can use its emergency room to train students on family medicines. People who cannot afford a doctor, come to the emergency room. Students trained in family medicine can go to a smaller city and practice.

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