Even as states are trying to improve their health infrastructure by producing more doctors, the national-level governing body on medical education appears to have put a stop to it.
The states from south India that are going to start more new medical colleges faced this exact jolt from the National Medical Commission (NMC).
According to the commission’s Extraordinary Gazette Notification dated 16 August, 2023, Guidelines for Undergraduate Courses under the Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations, 2023, medical colleges shall follow the ratio of 100 MBBS seats for every 10 lakh population in that state or Union Territory (UT).
“After AY 2023-24, the Letter of Permission (LOP) for starting new medical colleges shall be issued only for an annual intake capacity of 50/100/150 seats: Provided that the medical college shall follow the ratio of 100 MBBS seats for every 10 lakh population in that state/U.T,” reads the notification.
It has put the southern states, which have more seats in MBBS courses, in a conundrum.
If the formula of 100 MBBS seats for every 10 lakh population in that state is followed, all the southern states — Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana — will not be able to start a new medical college: They have crossed the mark.
Apart from the southern states, smaller states and UTs like Himachal Pradesh, Manipur, Puducherry, and Sikkim also have more seats than prescribed by the new norm.
More medical seats than NMC norm
According to the Lok Sabha answer provided by Union Minister of State for Health and Family Welfare Dr Bharati Pravin Pawar regarding the seats in Medical Colleges and the projected population till 31 March, 2023, by the Unique Identification Authority of India (UIDAI), all the South Indian states have more seats than the NMC’s new norm.
In Andhra Pradesh, the projected population is 5.34 crore, which means that the state should have 5,346 seats, but the current number of MBBS seats is 6,435.
In Karnataka, where the projected population is 6.76 crore, the number of MBBS seats is 11,695 — the highest in the country. According to the NMC norm, the state should have 6,770 seats, around 5,000 seats less than the current number.
In Kerala, the projected population is 3.57 crore, while the current MBBS seats are 4,655, more than the 3,577 prescribed by the norm.
In Tamil Nadu, the projected population is around 7.68 crore, and the number of current MBBS seats is 11,600, around 4,000 more than the 7,686 that the norm allowed.
Telangana, which has been adding MBBS seats in the last few years and has plans for another 800 seats next year, has a population of only 3.8 crore, and the seats should be around 3,809 seats.
However, the state currently has 8,540 MBBS seats, around 5,000 more than the required seats. The state, meanwhile, has already sanctioned the construction of eight new medical colleges to add the aforementioned 800 seats.
The largest state in India, Uttar Pradesh, whose projected population is around 23.5 crore, has just 9,703 seats, around 14,000 less than the 23,568 seats, as per the norms.
Doctor-patient ratio in South India
States that are better off in the health sector are expected to be impacted more. The World Health Organisation recommends a doctor-to-population ratio of 1:1,000, and southern states have crossed it properly.
According to NMC data, Andhra Pradesh had 1,05,799 registered doctors as of June 2022, while Karnataka had 1,34,426, Kerala had 42,596 doctors, Tamil Nadu had 1,48,217 doctors and Telangana had 14,999 doctors.
This means one doctor was available for 505 people in Andhra Pradesh, 503 people in Karnataka, 839 in Kerala, 600 in Tamil Nadu and 2,540 in Telangana.
It should be mentioned that Telangana doctors’ registration only started after 2014, after the formation of the state. The doctors practising in Telangana before 2014 are registered in Andhra Pradesh.
Meanwhile, the decision seemed to have irked the masses, who took to social media to express their displeasure.
“What nonsense. First tax rich states and transfer to poor states now prevent them from investing further in human development? Is the government of India determined to drag everyone to the level of the bigoted least common denominator? This is unacceptable @ptrmadurai,” said an X user.
What nonsense. First tax rich states and transfer to poor states now prevent them from investing further in human development? Is the government of India determined to drag everyone to the level of the bigoted least common denominator?
This is unacceptable @ptrmadurai https://t.co/aPfjbLKaS1
— rathin roy (@EmergingRoy) September 25, 2023
Another user said: “NMC has no business telling a State what its health policy should be. If a State feels it needs more Medical seats it should be able to get them as long as due process is followed. Health is a State subject. [sic]”
NMC has no business to tell a State what its health policy should be. If a State feels it needs more Medical seats it should be able to get them as long as due process is followed. Health is a State subject. https://t.co/V6z6usCPCA
— Sumanth Raman (@sumanthraman) September 25, 2023
Not a right move
Hyderabad-based neurologist Dr Sudhir Kumar said the most crucial point here was that a doctor educated in one state in India isn’t bound to practise in the same state.
“India is a free country, and a doctor trained in Tamil Nadu can practise in Delhi, just as a doctor trained in Bihar can practise elsewhere. There are no restrictions: Doctors can work in any state and even go abroad. So, the key point is that training doctors in one state doesn’t mean that the doctor-to-population ratio will increase in that state,” he told South First.
“Some doctors may choose to settle where they see a demand for their services. I’ve seen this first-hand: 20 years ago, many districts had no neurologist in Telangana. Today, there are multiple neurologists in the same district,” he noted.
How did this happen? “Because doctors can freely choose where to practise. I, for instance, trained in Tamil Nadu but am now serving in a different state because the Indian Constitution allows doctors to practise in any state of their choice,” he told South First.
“There are no restrictions on doctors’ mobility, and the same goes for patients. Patients often travel to different states for treatment, exercising their freedom of choice,” said Kumar.
He added that patients choose where they receive treatment, considering convenience, accessibility, and other factors. “Therefore, making state-wise seat cuts based on doctor-patient ratios is questionable,” explained Kumar.
He further pointed out that if there are criteria, they should be at the national level, considering India’s population of 143 crore.
Kumar also pointed out: “We do need more doctors; we lag behind many countries in doctor-to-population ratios. Yes, that’s right. So, if India has enough doctors, does it mean we’ll only produce doctors for India?”
TamilNadu can’t add more medical colleges: National Medical Commission (NMC)
Reasons given by NMC
1. There should be uniform distribution of doctors across the country. The recommended ratio of doctors is 1:1000 and TN already has 1 per 600 population,
2. Medical colleges shall… pic.twitter.com/QXQ14LToKd
— Dr Sudhir Kumar MD DM (@hyderabaddoctor) September 25, 2023
The reality is different
However, in practice, India’s hospitals are often overworked, and doctors see a significant number of patients every day. In comparison, US doctors typically see fewer patients per day and spend more time with each patient.
“Even US patients have complaints about doctors rushing through consultations. The situation in India is different: Doctors here often see 30-40 patients per day due to high demand. So, the argument that we have enough doctors is not convincing,” noted Kumar.
“If we have surplus seats, why do numerous students fail to secure admission? Many candidates sit for medical entrance exams, but only a fraction gain admission. For every student who gets a seat, many others do not,” he told South First.
There is a high demand for medical seats and more doctors even today, even as practising doctors work long hours, he said.
“Doctors in India are overworked, and there are still more patients seeking medical care. So, the idea that we have enough doctors doesn’t hold,” said Kumar.
He claimed that the data indicating an excess of doctors was outdated and didn’t reflect the current situation.
“If we have an oversupply of doctors, why are doctors still working long hours? This issue arises because there are more patients than doctors to attend to them,” said the doctor.
Some doctors support the move
Speaking to South First, some doctors’ associations welcomed the move by the NMC, while the majority quietly opposed it.
The Tamil Nadu branch of the Indian Medical Association (IMA) welcomed the decisions concerning MBBS admissions and the establishment of new medical colleges in Tamil Nadu.
It said the decisions aimed to prevent the oversaturation of the doctor population in Tamil Nadu, which already boasts of 1.5 lakh actively practising medical doctors, according to the TN Medical Council.
“In Tamil Nadu, the doctor-patient ratio remains 1:600 every year, with over 10,000 doctors graduating from medical colleges, including foreign medical graduates. The continued influx of doctors could lead to an oversaturation of the medical community, resulting in unnecessary expenditure by the government on constructing additional medical colleges,” IMA Tamil Nadu president Dr T Sethamil Pari told South First.
He added that the oversaturation could result in unemployment for young doctors and a decline in doctors’ salaries. Currently, doctors are earning only ₹20,000 per month, it said.
“This situation may worsen over the next two to five years, with salaries potentially dropping to ₹15,000 or even ₹10,000 per month. We have seen similar issues in the engineering sector, where graduates are now working for ₹10,000-15,000 per month due to oversupply. To avoid such a situation for doctors, we lend our full support to these decisions,” said Pari.
Meanwhile, IMA Telangana president Dr BN Rao opposed this move. He told South First, “I am strongly opposing the very existence of and functioning of the NMC itself, so no further discussion.”
Calls to the NMC went unanswered till the publication of this article. It will be updated if a response is received.
New source of revenue?
Dr Sudhir Kumar also said that India could consider opening up its medical colleges to foreign students.
Countries like China, Russia, Ukraine, and even Croatia are already attracting Indian students and providing them with medical education. Many Indians choose to study medicine in these countries, noted Kumar.
“Even if we have a sufficient number of Indian doctors for our population in the future, our medical colleges can continue to enrol international students. This can serve as a significant source of revenue. It’s a mutually beneficial arrangement,” he explained.
“Currently, we have a shortage of doctors in our country, as we’ve discussed. However, even if we eventually produce enough Indian doctors to meet our needs, our medical colleges can still function as global institutions, offering medical education within the Indian education system. This approach would reduce the need for Indian students to seek medical education abroad,” said Kumar.
“To achieve this, we need to focus on both quantity and quality. By increasing the number of colleges and improving the quality of education, we can attract the brightest minds from around the world to come and study here,” he told South First.
He added that in this way, India could become a global hub for medical education, benefiting both it and the international community.
The NMC decision also invited flak from political quarters, with Tamil Nadu-based Congress leader P Chidambaram taking serious umbrage to it.
The Rajya Sabha member said the commission’s move “amounts to punishing good performance”.
In a post on X, he asked: “Why should a state not start a new medical college out of its own funds and for its own students?”
If reports are true that the National Medical Commission has decreed that:
(A) no more new medical colleges in Tamil Nadu and
(B) no more additional seats in existing medical colleges in TN
then it amounts to punishing good performance
This is another serious encroachment on…
— P. Chidambaram (@PChidambaram_IN) September 25, 2023