The issue of medical education in India is back in the limelight thanks to the Russia-Ukraine crisis. Thousands of Indian students pursuing medical education in Ukraine are being evacuated by the government. While the number of medical colleges & seats has increased in the country, thousands still go abroad for cheaper medical education. Their pass percentage in the mandatory FMGE is still hovering around 20%.
Medical education forms a crucial segment of the health infrastructure of a nation. India is one of the nations with a large health infrastructure in the world. India ranks 10th in the Medical Tourism Index (MTI), 2020-21, out of the 46 destinations studied. It stands at 6th in the quality of facilities and the services in the MTI index.
The medical college system in India is also the largest in the world. The number of medical colleges catering to the demand requirements of medical education has also been growing. However, this expansion in medical education has proven to be inadequate, giving rise to wide inequities in accessing medical education. In addition to this, the growth of private medical colleges coupled with a lack of fee regulation had made medical education more expensive, making it unaffordable. Because of this, many students opt to pursue medical education in foreign universities, where the overall costs are low compared to India. In a July 2019 answer to the parliament, the Minister of State in the Ministry of External Affairs stated that the low admission costs and less demanding admission requirements are reasons behind students opting out for foreign nations like Ukraine, Russia, China, etc.
In this story, we look at the growth story of medical education in India and the changing patterns of migration towards foreign universities. Data is collated from the Annual Reports of the Ministry of Health & Family Welfare, Annual Reports of the National Board of Examinations, and questions raised in the parliament.
68% growth of medical colleges in India during the last decade
There is a significant growth in the number of medical colleges across India over the last decade. In 2010-11, the number of medical colleges, including private and government, was 334, which increased to 404 by 2014-15 and stands at 562 in 2020-21. This amounts to a 68% growth in the number of colleges in these 10 years. Accordingly, the number of medical seats at the ‘Under Graduate’ (UG) level increased from 41,500 in 2010-11 to 86,649 in 2020-21. Similarly, the number of seats at the ‘Post Graduate’ (PG) level increased from 21,100 in 2010-11 to 42,015 in 2020-21. This translates to an expansion in capacity up to 110% in UG seats and 100% in the PG seats.
Similarly, the ratio of seats per college has also improved from 124 to 154 during the same period. This shows that there is an expansion in capacity, both in terms of the number of colleges as well as the seats.
Around 60% of the seats are in just 8 states:
While there is a significant expansion in the medical colleges in India, this expansion has not been equitable. Out of the total 86,649 medical seats, nearly 51,262 seats are located just in 8 states, translating to around 60% of the total seats. The Empowered Action Group (EAG) States comprising of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttarakhand, and Uttar Pradesh account for only 27% of the total medical seats in India.
In terms of Zonal division as per the Socio-Economic Caste Census, the South zone, as well as the west zone, account for nearly 60% of the total medical colleges in India. One peculiar pattern about the south zone is the dominance of private medical colleges over government medical colleges.
‘Per Seat’ competition in NEET is rising
National Eligibility cum Entrance Test (NEET) had undergone significant changes from its inception. History dates to 1987, when the first All-India Pre-Medical Test (AIPMT) was conducted for admissions into government colleges in India. In 2010, the then Medical Council of India proposed NEET as a single examination for admission into all colleges under the ‘Regulations on Graduate Medical Examination, 2010’. Later in 2013, when MCI conducted the NEET for the first time, the Supreme Court squashed the exam. But in 2016, the exam took a re-entry and in 2017, the Supreme Court held that NEET as a single examination is mandatory.
For 2017 & 2018, the CBSE conducted the examination, while the National Testing agency was entrusted with this task from 2019. Data from the past five years clearly indicates that the number of applicants for the examination is rising, along with the competition per seat, which increased from 17.5 in 2017 to 21.7 in 2019. Thanks to capacity expansion during 2019-20, this ratio has slightly reduced.
There is a common misconception that students move to foreign universities to escape the competition in NEET, however, this is not true. As per the National Medical Commission, any student wishing to pursue education abroad on or after 2018, shall have to mandatorily qualify in NEET.
Increase in students appearing & passing Foreign Medical Graduate Examination (FMGE)
As per the answer given to the parliament, the number of Indian students going abroad for studies has been increasing. This figure was 3,71,506 in 2016 which grew to 5,88,931 in 2019. This data includes all students pursuing any kind of education abroad.
However, any student who did their medical education in foreign countries other than Australia, Canada, New Zealand, the United Kingdom, and the United States of America, and who wishes to practice medicine in India are required to qualify for the FMGE exam. It is a statutory requirement under section 13(4A) of the Indian Medical Council Act, 1956 and is conducted by the National Board of Examination (NBE).
The data collated from NBE shows that the number of students attempting FMGE has been on rising for many countries while the pass percentage is below 20% on average. Particularly, for students who completed their medical education from countries like China, Russia, Ukraine, the pass percentage in FMGE has been slightly improving over the last few years. However, the pass percentage is still only around 20% on average.
What are some of the important issues concerning Medical Education?
Fee regulation: One of the primary challenges of medical education is affordability. The cost for medical examination in private institutions in India can be anywhere between Rs. 50 lakhs and a few crores, while the same would be around Rs. 30 lakhs from foreign universities. The primary quantum of such hefty fees is the capitation fee, which is acknowledged by several committees.
The following is an excerpt from the Yashpal committee report that was set up to advise on ‘Renovation and Rejuvenation of Higher Education’ in 2008.
Accordingly, the government tried to bring a legislation, ‘The Prohibition of Unfair Practices in Technical Educational Institutions, Medical Educational Institutions and Universities Bill, 2010’ to protect the interests of the students admitted. The legislation sought to prohibit the capitation fee. But with the dissolution of the government in 2014, this bill got lapsed.
The NITI Aayog preliminary committee on Reform of the Indian Medical Council Act, 1956, also talks about the fee regulation. It calls for achieving a balance between promoting institution founders’ interests as well as students’ interests. Accordingly, it recommended that the National Medical Commission (NMC) should be empowered to regulate fees for seats not exceeding 40% of the capacity.
However, the NMC act 2019 act empowers the NMC to determine the fees in 50% of the seats in private and deemed to be universities.
Relaxation of Minimum Standards Requirements (MSR): It takes around Rs. 300-400 crores to establish a new medical college and another Rs. 50 crores as the operating recurring cost annually, as per estimates of experts. The cost includes the land requirement criteria, the space requirements for different functional areas and the mandatory clause to run a hospital attached to the medical college. As a result, private participation is very low. To encourage more participation, the government has undertaken the rationalization of the MSR in terms of bed, faculty & land requirements.
Featured Image: Pass percentage in FMGE