Six years ago, when he was preparing to sit for multiple medical entrance examinations, Dr Vishal Swaroop had not heard of Liaoning province in China, five hours east of Beijing. Today he has a medical degree from Liaoning Medical University in the coastal city of Jinzhou.
“China was nowhere on my radar. But I did not qualify in the medical entrance exam in India. When I started exploring options for medical education abroad, China had a lot to offer,” says Swaroop, who is back in India and preparing for his postgraduate medical exam.
Tough competition, few seats and rising costs of medical education have prompted Indian students to look at education abroad, and countries like China and Russia are attracting Indians, with a host of student-friendly measures.
Swaroop is one of the thousands of Indian students pursuing medical education in China, which has emerged as a preferred destination for Indians. More than 8,000 Indian students enrolled to study medicine in China in 2010.
Consultants estimate that seven out of 10 mobile Indian medical students are opting for China for undergraduate medical education. Many are also choosing Russia and former Soviet Union countries.
Affordable costs of education and living, and easy access to admission, are the two important factors attracting Indians to Chinese and Russian universities.
“The Russian government heavily subsidises education and hence it is affordable to a middle-class foreign student,” said Asish Sondhi, director of the International Foundation for Studies and Culture (IFSC), an Indian-based organisation that helps to promote premium Russian universities and academies in India.
“In India, the demand for medical education exceeds the current supply. Also with the private and deemed universities, which charge a heavy capitation fee [charging money in exchange for admission], the middle-class section of the society is deprived of quality medical education,” Sondhi said.
Compared to the US, UK and other European countries, the cost of medical education in countries like China and Russia is much lower and varies from US$3,400 to US$6,000 per year.
Indian students have to satisfy minimum qualifications but are not required to clear any entry tests for either Chinese or Russian universities, which is a big attraction for many students.
Overcoming the language barrier
Neither Russian nor Mandarin is a popular foreign language in India. But universities have overcome this by teaching in English.
“The teaching is in English. But we are also given language classes to learn Mandarin. By the time you enter the fifth year of internship or practical work, you are fluent enough in Mandarin to be able to intern at a local hospital,” said Dr Pradeep Banerjee, an alumnus of China Medical University who is now practising in a private hospital in Hyderabad.
For Dr Mathari Sanjeev Kumar, who graduated from Odessa State Medical University in Ukraine in 2009, adjusting to the language, food and culture took some time.
“The culture and language is so different to ours. But these can be overcome because you get admission and the course structure is similar to that of India. Moreover, compared to private medical colleges in India I had to pay much less,” said Kumar, who is now working as a junior resident in Ram Manohar Lohiya hospital in New Delhi.
According to Sondhi of the IFSC, Russian-speaking countries have woken up to the potential of international students, especially from Asia, and more universities are opting to teach in English.
China opened medical education to Indian students in 2004, with four universities offering English medium education. The number has since grown to 50 universities, which are approved by the Chinese government and the Medical Council of India (MCI).
The MCI has a list of the 50 approved Chinese institutions, where fees are regulated by the government. The MCI provides eligibility certificates, which all students need before enrolling in a medical university abroad, to only these 50 institutions.
The Chinese government has also ensured quality education and better standards for international students.
“In 2006 complaints started coming in about the problems faced by foreign students, and the Ministry of Education intervened,” said V Rajaram, managing partner at Medico-Abroad, an education firm based in Hyderabad.
“It scrutinised and approved a list of institutions which could admit foreign students. It also streamlined the fee structure, curriculum and duration of medical courses.”
Notably, each university in China is allotted seats depending on infrastructure and teacher-to-student ratio. The number of seats can be reduced or increased depending on the status of the university during scrutiny.
Undergraduate versus postgraduate medical education
Indian students completing an MBBS degree in a foreign country have to clear the Foreign Medical Graduate Examination (FMGE) before they can register with the MCI.
“Clearing the FMGE is not difficult since the syllabus is similar to that of India. However, getting a postgraduate seat in India is a challenge,” said Kumar, who is busy preparing to sit for a postgraduate exam.
In the state of Andhra Pradesh, for instance, there are 5,000 MBBS seats but only 2,000 postgraduate seats, equally divided between clinical and non-clinical subjects.
A student’s options are further limited because India recognises postgraduate medical degrees from only five countries – the US, UK, Canada, Australia and New Zealand.
According to Sondhi, allowing postgraduate degrees from only these English-speaking countries is a restrictive practice. But this has not deterred Indian students from going to China, Russia and other European countries.
“Getting a postgraduate seat in any of the five approved countries is very difficult and very expensive. Although you cannot teach or hold any academic position if you have a postgraduate degree from other countries, you can practise,” said Rajaram.
Doctors are allowed to practise in private nursing homes, private practice, and rural health services due to a shortage of doctors. It is mandatory to mention the name of the country on the nameplate.
“The growing popularity in India has encouraged a number of Chinese medical schools to recruit Indian and Nepalese medical professors to teach in their institutions,” Rajaram added.
Addressing shortage at home
Aware of the increasing demand for medical education and the need for more doctors, the MCI added 3,595 more MBBS seats and 1,442 new postgraduate seats this year.
The number of MBBS seats in India will now rise to 45,464. By 2021, the MCI aims to take the overall availability of MBBS seats to 80,000 and postgraduate seats to 45,000 to help tackle the doctor shortage problem.
A recent Planning Commission report highlighted that India is short of 600,000 doctors, a million nurses and 200,000 dental surgeons. Indian doctors, however, form 5% of the medical workforce in developed countries. Nearly 60,000 Indian physicians are working in countries like the US, UK, Canada and Australia.
India thus has twin challenges: how to create adequate capacity in medical institutions, and how to retain the doctors and nurses it trains.
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