India’s doctor population is quite large - 9,49,617 registered as of March 2015 and medical graduates with 63985 seats in 462 medical colleges. However, as compared to a world average of 1.5: 1000, the current estimated doctor-population ratio in India is 1:1700.2.

 

           

 

So what does it take for a person in India to become a “doctor”?

 

Appearances Can Be Deceptive

 

Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates, become ‘doctors’ and practice medicine after registering with Medical Council of India (MCI) or a state medical council. In contrast, other countries such as the US require that medical college graduates clear the USMLE exam before practising medicine plus undergo regular CME (continuing medical education) and Maintenance of Certification (MOC) reviews to maintain their licenses. The Union Health Ministry, in 2016, introduced the Indian Medical Council (Amendment) Bill that will change the professional roadmap for MBBS graduates:

 

• MBBS graduates must clear the National Exit Test (NEXT) to be eligible for practising medicine as well as for admission to postgraduate (PG) medical courses.
• Allocation of 50% quota in government college PG courses for Medical Officers who will serve in rural areas at least three years before and three years after acquiring the PG degree.

 

Students from various parts of the country have opposed the proposal. Medical organisations such as the Kerala Medical Post Graduates Association as well as state units of the Indian Medical Association (IMA) in Kerala, Telangana, and Maharashtra have been vocal in their resistance to NEXT.

 

Organised protests include proposed shutdown of medical colleges, on February 1st, 2017, accompanied by dharnas and rallies. News reports from across the country have recorded mixed responses from students — some students find merit in NEXT as a means of standardisation in medical education that may improve the quality of doctors; others opine that it will further lengthen the process and increase stress. Many students are against the 50% PG quota.

 

In solidarity with the students, doctors groups such as the Telangana junior doctors' association (TJUDA) have also voiced their opposition to NEXT.

 

The medical community also thinks that the central government is not addressing issues of inadequate infrastructure, academic facilities, and faculty that severely impact the quality of medical graduates. The medical fraternity of Tirunelveli Government Medical College protested NEXT by forming a human chain on hospital premises. There are concerns about a further shortage of qualified doctors since all medical graduates may not clear NEXT.

 

In a nutshell

 

Pros 

 

1. Countrywide uniform exit examination will improve medical education standards.
2. Prohibits incompetent doctors and bolsters confidence in medical education quality.
3. A college is rated by inspectors based on its infrastructure and faculty. Results of NEXT will be made public and highlight the performance of individual colleges as an indicator of its education quality.
4. Increases the probability of meritorious students getting admission to the PG medical courses.
5. Mandatory three years rural service for the post-PG degree through the quota will address the shortfall of specialists in the countryside.

 

Cons

 

1. A single test cannot adequately evaluate the practical knowledge and skills acquired.
2. Under the PG quota, a doctor would be almost 30 years old by the time he/she becomes a certified specialist. This could place a burden on the already skewed doctor-patient ratio.
3. May lower the morale when “qualified” doctors who don’t clear the exam are filtered out but six months specially trained AYUSH doctors are eligible to practice allopathic medicine under exceptional circumstances.
4. No clarity on what happens to the MBBS graduates who do not clear NEXT.
5. The exit exams may not make any difference to identifying truly qualified doctors.

 

MCI has proposed a standard syllabus for all the medical examinations (MBBS entrance, NEXT, and super-specialties entrance) to counteract disparities in existing inter- and intra-states syllabus. The Health Ministry plans to save resources and lessen the burden on students by making NEXT a three-in-one test: Exit test, PG entrance test, and Foreign Graduates Medical Exam. According to Health Ministry 2014-15 data, the shortfall of allopathic doctors in primary health centres (PHCs) was 12.8%, and that of the specialists at the community health centres (CHCs) was 81.0% of the total requirement. The criteria for claiming PG quota aims to fix this shortage.

 

Food for Thought

 

Students go through many pre-clinical and clinical exams and mandatory one-year internship to obtain their MBBS degree. Is an additional review required?  Consistent standard of education can be achieved by one main central governing body which ensures uniformity in facilities, curriculum, and syllabi for MBBS.