Wrong medicine, MCI

Playing with lives: Nothing can be more tragic for a nation which doesn't trust its own doctors

The Parliamentary Standing Committee on Health and Family Welfare has submitted a detailed and erudite report to the Rajya Sabha on the functioning of the Medical Council of India (MCI).

The report not only highlights the malfunctioning and corrupt practices of the council, but also the inadequacy and redundancy of the IMC Act in achieving the objectives of the council, in-terms of producing adequate number and quality healthcare professionals required to deliver appropriate healthcare in properly regulated healthcare system, reaching all its people. The question is, has the failure in the functioning of MCI and the prevalent corruption led to the poor quality of medical doctors?  

The MCI is the major regulator of medical education in India and it also prescribes a code of ethics for medical practitioners.  While there are a number of rules and regulations for establishment of medical colleges and maintenance of standards of medical education, it carries out very limited evaluation of the implementation of these standards and guidelines.

The MCI is not involved in any standardised summative evaluation of the final product – the medical graduate- emerging out of new or old medical colleges. This final evaluation, and therefore the final quality of every graduating medical student, is left entirely to the medical colleges and universities to assess and establish. The MCI’s code of ethics, too, is flouted everywhere by practitioners who do unnecessary treatments, prescribe inappropriate drugs under the influence of pharmaceutical companies and exchange all kinds of referrals for commissions.
The MCI has only a small Ethics Committee to deal with some complaints against medical practitioners that are mostly referred to it from State Medical Councils. Between 1963 and 2009, the committee has been able to take up cases against only 129 doctors (see website under the Indian Medical Register section) and many of these are still not disposed. Thus, there is no robust quality assurance system in place when a fresh graduate enters the system and starts practising. There are no further pressures on him or her to adhere to quality standards.

It is public knowledge now that with increasing number of medical seats being available for high prices in private medical colleges, the quality of students at the point of entry, too, is being compromised. A few years ago, as chairperson of an inspection committee of a private medical university, I had an opportunity to look at the school leaving marks of students admitted in the college.

The highest mark obtained by any student was around 65%. By comparison, in the same region, to get into a premier liberal arts college, the cut-off mark is well above the 90% or even 95%. This puts a strong case for a common entrance examination test for the country, but this needs to be conducted well, without any vested interests and without any scope for corruption.

With quality/merit being pushed aside for the sake of financial gains at the time of admission, no serious evaluation of the quality of teaching and imparting skills or of the graduate being produced by this system, and no quality assurance mechanisms in place for practising doctors, one can only conclude that quality has been hugely side-lined in the increasing commercialisation of medical education and medical practice.

Meanwhile, private medical colleges/universities have developed their own screening and admission procedure which is primarily monetary based. The majority of the seats are allotted for a capitation fee of up to Rs 50 lakh and more in some colleges and yes, this is for undergraduate education! This capitation fee is exclusive for the yearly tuition fee (as determined by legally constituted fee fixation committees) and other expenses that have to be paid through the five years’ duration of the course. We have heard parents’ accounts of identifying and contacting agents/brokers through newspaper advertisements who ensure a medical seat for a sum of money. Brokers for different states are spread out in the country, so brokers for Maharashtra and Karnataka can be found in Delhi. The medical colleges may themselves openly state the price of a seat.

Fall in standards

As private medical colleges currently outnumber government medical colleges, one clear implication of this trend of “sale” of medical seats is that there may be large numbers of students entering the system who may not be up to the required academic standards. Medical course is intellectually very demanding, and a student who is not capable of grasping the subject is often pushed up in his career by the private medical colleges and deemed universities for a price.

The MCI regulations provide very detailed guidelines on the curriculum, skills and competencies, and how these should be assessed by the institutions, but the MCI has no mechanism in place to conduct any evaluation of the final graduate or of the curriculum as it is being implemented or taught, especially the skills that is being imparted.

Thus, there is no meaningful evaluation of the actual implementation of the MCI’s detailed guidelines for UG/PG medical education. The yearly so called “surprise” inspections count the staff and look at their degrees and experience without any cross-checking of facts with their own data base. These “ghost faculty” are gone the moment the inspectors leave the town. Students are left with teachers who are inexperienced to cover the syllabus, which is antiquated. There are no faculty training programs organised either by the MCI or the medical institutions. Teachers are also moving from one college to the other looking for higher emoluments. This creates further instability to the teaching-learning process. There is an overall shortage of trained and professor-level teachers in the country which is known to our authorities but they turn a blind eye when approving new medical colleges.

Post graduate medical education is another Pandora’s box. Without a postgraduate qualification, a medical doctor cannot earn big money and hence the admissions cost crores of rupees. The training is dubious to say the least and lacks uniform standards.

A great disservice is being done to the country’s healthcare delivery system through a corrupt MCI. Apart from the poor quality of graduates, the distribution of medical colleges in India has led to disparity in quality and access to healthcare in different regions/states. For instance, Pondicherry, with a population of 2.4 million people, has 10 medical colleges, including a Central government and a state government medical college. In comparison, the eight states of the north-east have around five medical colleges.  

(The writer is a cardiothoracic surgeon and former vice-president of National Board of Examinations, New Delhi.)