Medical docs slog as students

Every family wishes to have a doctor in their family. The process starts once their children enter pre-university – from college to tuitions. The two years of near imprisonment with studies.

Immediately after pre-university exams is the preparation for entering the MBBS course. Most take up the common entrance test (CET), while others take the COMEDK, KLMPCA (both in Karnataka).

In addition to this, each of the eight deemed universities conduct their own entrance exam. For the determined few, it is AIIMS entrance, JIPMER, CMC Vellore, AIPMT too. Thus, there are 20 different entrance tests, with each having a separate entrance fees, clashing of dates and travel and accommodation for various centres. Imagine the young student preparing for all these tests!

For those who cannot make it, it is utter frustration and disappointment. Some have ended their lives.For those who finally make it, it is four and half years of studies with nine semesters. Often in medical college, it is self-studying – subjects are voluminous and 24 hours is not enough to study these subjects, yet, the students manage.

Then, they move on to one year of internship in clinical branches of medicine. The interns are really lost in their clinical postings, where theoretical knowledge is to be honed into clinical skills. Most often, they are not directly involved in decision making, a non entity in the hierarchy. Having been a teacher for decades — I feel these youngsters are still unsteady on their feet and hands.

Now, they have to move on to do rural postings for one year in a stage set up with no leader with skills yet to be learnt. The micro planning is not in sight as yet – regarding travel, accommodation and training. With no exposure to rural medicine- amidst the unfamiliar surroundings, with no one to guide and help them, the plight of these youngsters is pathetic.

With basic MBBS degree, the future of these doctors is uncertain. They now start preparing for the postgraduate entrance exams – again hefty fees to take up all 20 entrance exams. Currently, in Karnataka, there are 11.1 per cent of seats available for masters and 37.1 per cent for diploma. After three or two years of post-graduation, there is compulsory rural postings of three years — if they don’t do it, penalty is Rs 50 lakh.

Medical colleges

Thus, an average a doctor spends 12.5 years to become a postgraduate, provided he manages to get seat in first attempt. There are many who have made several attempts and their youth is thus spent behind books, exams and expenses.

An additional three years for those who want to do post doctoral degrees like MCh /DM. Those not qualifying for these degrees compete for fellowship programmes conducted by RGUHS, which currently runs 50 fellowship programmes. Unfortunately these are not recognised by the apex body – the Medical Council of India and the National board of examinations.

Karnataka, for example, has the maximum number of medical colleges – 45, out of which 22 are government medical colleges. Appointment of teaching staff in government medical colleges is often not on merit. Similarly, Promotions are not backed on publication (requisite by MCI). Stagnation and delayed promotion causes a lot of frustration – many leave to join private medical colleges.

The annual MCI visits expose the deficiencies and somehow are made up or ensured that they will be covered up before next MCI visit. During recent raids, the MCI detected ghost faculty, transit faculty and many posts held by one person. Medical education is three tier. The government sanctions medical colleges, MCI recognises and universities conduct exams. With many of our graduates doing their post MBBS, post MD courses and rural postings while some pursue post doctoral degrees, still other pursing fellowship programmes and National Board of examinations, others leave to foreign shores. So, who has to man the ever increasing medical colleges and newly opened corporate hospitals/ nursing homes?

Should not the annual student intake be a critical factor in assessing the requirement for teachers in various subjects? Many pursue clinical subjects, with hardly any taking up pre-clinical subjects like anatomy/biochemistry etc which are grossly vacant. Is starting new medical colleges the solution to plugging gaps? Should the entire medical profession be under “one head”. Where are the solutions? Is there a need for regulatory body to monitor the functioning of the products of health care industry?

(The writer is teacher in paediatrics for more than three decades)

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