The decision of Medical Council of India (MCI) to allow “for profit” institutions to run medical colleges is timely and one that I personally feel should be commended. For a long time in India, we have left education to ill-funded state-run or charitable institutions. We place restrictions on them in terms of the money they can generate by capping the fees severely, imposing large quotas, and then blame them for not being able to recruit faculty or when it comes to medical colleges, run a hospital that actually has patients in it. One could further argue that the state and the charitable institutions do not simply have the resources to educate everybody in such a large country as ours and if a section of the society can ease this burden on the state by paying for its education, why should we not encourage it? The two systems can perfectly work symbiotically without any apparent clash.
Education, in the modern world, costs money. The “brain deposit” alluded to by Prime Minister Modi recently will only return to work in India if the remunerations were adequate by global standards. Innovation and research are the other big responsibility of educational institutions and that again needs money. The state of our educational establishments is such that most lag far behind their western counterparts in terms of research output and that lies at the root of why we are still a “developing” country.
By allowing educational establishments freedom to operate like businesses, we can correct these imbalances. Education is now a globally competitive market and students can often choose from a number of providers in different countries. It will be in the interest of these private medical colleges to ensure their institutions are well equipped, have adequate infrastructure, high-quality faculty, and facilities for cutting edge research if they wish to attract meritorious, dedicated students willing to pay large amounts of sums as fees.
We should no doubt ask these institutions to also make provisions for scholarships and bursaries for students from less privileged backgrounds, and perhaps take some students (probably 10%) from the state quota. But fundamentally we have to understand that the responsibility of providing education to the less well off children rests with the state. Within this context, I have previously argued that our state educational institutions should also be given freedom to charge higher fees from the students and generate revenue from other sources. This will, of course, have to be done concurrently with the mechanisms like student loans for students from the poorer background. These loans should be at a very low interest rate and students should only be asked to repay them when earning over a certain basic amount.
Given that the standards of medical education in the country can be very variable, I further feel we need to have a robust entrance and exit tests with adequate cut-off points at the national level for all state, charitable, and “for profit” medical colleges. This will ensure that only those who can withstand the rigour of medical education are given a place and that only properly qualified doctors are returned to the society.
I further reject the argument that paying high fees for medical education encourages students to become unethical. The privately funded expensive medical education cannot be an explanation of free fall of medical profession into an ethical abyss because the number of such individuals in our current medical establishment is far lower than the extent of unethical practices and medical corruption.
With such financial autonomy, we should then rightfully expect these medical colleges to have world-class academicians working in globally competitive research and academic facilities; and patients being looked after by competent professionals in a clean, caring environment. This will need regular monitoring by an authority with probably slightly better credentials than the MCI itself and needless to say, should also be applied with the same rigour to our state medical colleges and institutions to avoid creating a two-tier healthcare system.
Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.