Turmoil as medical degree places cut in quality drive

Moves by the regulatory body the Medical Council of India, or MCI, to scrap almost a third of medical degree places across the country in order to improve the quality of medical education have thrown this year’s admissions into disarray.

In early June, the MCI withdrew permission for 15,890 of the 49,950 MBBS undergraduate medical degree seats in medical colleges, saying the institutions had failed to maintain the minimum infrastructure requirements, or had poor faculty-to-student ratios.

Colleges had until 15 June to appeal and show they would be able to comply with MCI standards by July. But it emerged that 6,300 places could still be culled, with institutions unable to meet the strict criteria. Government-funded medical schools were the worst affected.

In addition, MCI looked set to deny permission for up to 50 new medical colleges that would have added between 5,000 and 7,500 more undergraduate places.

MCI action to enforce standards comes after 523,700 medical school aspirants took the medical admissions examination in May with results announced in mid-June. Admissions decisions will be taken in the next few weeks for the academic year beginning in early September.

Successful candidates – just one in eleven who took the exam qualified – said their plans had been thrown into turmoil and some feared ‘cut-throat’ competition this year for medical places.

With competition for places already intense, teachers said candidates were panicking, as the number of places at many medical institutions was still unclear.

Although state governments were trying to update figures, even the health ministry in New Delhi was forced to admit that it did not have a “clear picture” about the number of places for this year’s admissions round.

The seat-cull is also a setback for government attempts to improve health care in the country by increasing the number of medical degree seats – from 32,900 in 2010 to almost 50,000 – with 46 new medical colleges established by the previous government between 2010 and 2012.

States affected

The number of seats slated to be abolished included 2,100 in the southern state of Andhra Pradesh, 1,650 in Karnataka and 1,600 in the western state of Maharashtra which includes Mumbai and which lost 28% of its places.

Newspapers in Mumbai reported that this was because “several departments were functioning without professors and vital equipment” and up to 20% of teaching posts were vacant.

Among the hardest hit is the state of West Bengal, where a large proportion of medical institutions are government-funded. The number of places initially slashed amounted to almost 50% of the state’s medical undergraduate intake. Of 2,400 places last year, MCI said in early June it would approve just 1,355.

All new admissions to seven medical institutions, including four state-run ones in West Bengal were barred altogether – a loss of 750 places, although students already at the institutions are not affected.

In a bid to calm the resulting furore, at a two-day meeting in New Delhi with the MCI executive committee, West Bengal’s chief secretary Sanjay Mitra promised that government-run medical colleges would meet MCI infrastructure criteria within three months and requested the MCI to “give the state a chance” as the seat crunch would “hit students hard”.

This resulted in the MCI agreeing to restore some 400 seats it had cut from state-run colleges and two private colleges in West Bengal. Now 1,755 seats in total will be on offer if MCI criteria can be met by the extended deadline of September negotiated by Mitra.

However, MCI sources said medical colleges in Bengal had given similar undertakings in the past and had failed to meet their own deadlines. This is not the first time the MCI had attempted to tighten up on standards by slashing admissions.

Low doctor-patient ratio

The central government has been increasing medical training places to improve health care in the country. The country’s new Health Minister Harsh Vardhan said the MCI cuts were “unjustified”.

"The MCI wants an ideal situation where all colleges should have adequate facilities. The government, on the other hand, is aiming at a patient-doctor ratio of 1,000:1,” said one doctor, referring to the World Health Organization recommended norm.

India’s current ratio is almost 1,700:1 on average. But it is far worse in rural areas.

The newly elected government in New Delhi has said it will release funds to improve infrastructure at many institutions under threat.

The seats-cull has also sparked a flurry of negotiations by publicly funded institutions in other states, asking health ministries for funds to repair the deficiencies in time for the current admissions season.

State governments are also scrambling to find the funds to allow colleges to appoint faculty members in cases where the staff-student ratio has fallen below the norms required by the MCI.

However, some states’ new medical colleges scheduled to open this September have been told they cannot enrol students until their entire infrastructure is in place and MCI guidelines have been met.

For example, student recruitment for five urgently needed medical colleges planned for the Jammu and Kashmir region may have to be postponed for up to three years until all facilities are in place.

Guidelines

MCI guidelines require that each medical college has a central lecture room with gallery, departmental library, central laboratory, blood bank, central casualty department, central hospital pharmacy, incinerating plant, hostel for students, and residential accommodation for interns, among other things.

The MCI also stipulates that each department has one professor, one associate professor, two assistant professors, and four demonstrators. Many colleges do not meet all the criteria.

Some medical institution heads said the deficiencies cited by the MCI were mostly minor and could be adjusted to ensure ‘total compliance’.

"Most of the so-called deficiencies pointed out by [the MCI] are merely advisories,” said Bihar state Indian Medical Association Vice-president Dr Sunil Kumar Singh, quoted in local media. “Every year MCI issues such threats and later it gives permission.”

However, it hits the credibility of medical education of the state badly, Singh said.

It was not clear how private institutions would raise the money to comply as state governments had no role in funding them and the MCI was demanding compliance by mid-July. Private institutions had been accused in the media of hiring doctors just to pass MCI inspections.

India has some 390 medical colleges. Just over 180 are government run.