Cost-Benefit Study of MBBS Degree Abroad : The Tribune India

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Rakesh Kochar

President, Indian Society of Gastroenterology

The recent death of an Indian student in Ukraine has shed light on the plight of thousands of medical students stranded there. Ukraine attracts a large share of Indian medical students, although Russia and China are the most popular destinations. Many students also travel to Kyrgyzstan, Kazakhstan, Nepal, Bangladesh and the Philippines.

Currently, there are 605 medical colleges in the country with the recruitment of 90,825 students every year for the MBBS course. Almost half of the colleges are run by state governments and the other half are private or run by a trust/corporation. MBBS fees in government medical colleges range from less than Rs 10,000 (AIIMS) to Rs 1.5 lakh (Kerala) per year, but can go up to Rs 83 lakh (Mullana) to Rs 1.15 crore ( DY Patil, Navi Mumbai) for the entire course in private institutions.

Why do students go abroad for medical training? This year, more than 15 lakh students are expected to appear in NEET, the combined qualifying entrance exam for just over 90,000 places. Due to different reservations and high cost of education in private colleges, students with ranks as good as 35,000 fail to secure a place while those with lower rank are admitted in reputable or quota university Management. Those who cannot afford a private college are attracted to foreign shores since the expenses there are Rs 20-30 lakh for the entire course. Then there is another category of students, who are not NEET or have such a low ranking that they would not get a seat locally.

It was in 2002, in the TMA Pai case, that the Supreme Court ruled that unsubsidized private institutions could set their own fees for vocational courses. Subsequently, a fee-setting committee was formed in each state which was authorized to take into account existing infrastructure and expansion plans, etc. to set the fees. The purpose was to discourage capitation fees and promote merit. The National Medical Commission (NMC) which replaced the much maligned Medical Council of India last year formed an expert committee to give recommendations on setting fees for 50% of seats in private medical colleges including the report was submitted in November. In each private college, 50% of places are awarded on merit (NEET rank) with fees up to Rs 6-10 lakh per year. The rest of the seats are the management quota seats with a fee of Rs 15-18 lakh per year. Fees at reputable universities are up to Rs 25 lakh per year. Until 2016, private colleges were mandated by law to deliver the course on a not-for-profit basis. However, the government removed this clause and also allowed fees to increase by up to 10% each year.

Foreign-trained doctors are only allowed to register in India to practice or do post-graduate studies if they pass the Foreign Medical Graduates Examination (FMGE). Over the past five years, the average pass rate for the FMGE has been around 16%. Pralhad Joshi, Minister of Parliamentary Affairs, recently stated that 90% of students who study medicine abroad fail qualifying exams in India. This reflects poor teaching standards as well as the poor aptitude of students who, despite their low NEET rank, aspire to become doctors. Thus, out of nearly 30,000 foreign graduates, only less than 5,000 can officially practice medicine. The others would retake the exam or practice medicine illegally in a small place or change professions. Their chances of getting a post-graduation degree are extremely low.

It has been suggested that India should increase the number of places in medical colleges. According to the suggested doctor to patient ratio of 1:1000, India needs 1.38 million doctors. It has 1.2 million registered allopathic physicians. Over the past eight years, the number of MBBS seats in the country has increased from nearly 51,500 to over 90,000. There is debate among experts whether there should be a further increase or not. Adding seats not only requires infrastructure, but also adequate faculty. And if only a small proportion of those seats are affordable, that will only make the problem worse.

The other related issue is graduate school places (MD/MS). Today, we demand specialists and super-specialists. As a result, every MBBS doctor wants to be one. But the number of PG seats is currently only about 55,000 (MD/MS/DNB/diploma). Last year, 1.75 lakh MBBS doctors appeared for the NEET PG. Thus, there is an ever-growing backlog of aspiring PGs which is compounded by the number of foreign-trained doctors joining the pool. Increasing MBBS seats will further aggravate the problem.

Another serious issue that has not been discussed much is the return on investment of Rs 50 lakh to Rs 1 crore in an MBBS degree. An MBBS doctor receives 30,000 to 40,000 rupees in a private hospital (more if he invests in his own clinic) and about double that in a government job.

To recoup the cost of his education, some doctors often engage in unethical practices. A few years ago, the BMJ published the testimony of Dr. David Berger, an Australian doctor intern in an Indian government hospital (“Corruption is ruining doctor-patient relations in India”, BMJ 2014). He was surprised to see routine hypertensive patients being referred for echocardiography at a private facility every three months. He was told by other government doctors that each referral earned them a few hundred rupees. He had commented: “The country’s doctors live in an ‘unvirtuous circle’ of referrals and bribes.”

We have to find a way out of this situation. Although the revamped NMC has been proactive recently, it needs to do a lot more. It is imperative that medical education be streamlined, starting with the rationalization of private college tuition fees and the mismatch of MBBS/PG seats. The need for increasing the number of MBBS seats should be assessed with employability in mind. Parents and aspirants should be informed about the prospects after graduation from foreign colleges.

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