Doctors want the state and central governments to give priority to improving the infrastructure and faculty recruitments in existing medical colleges rather than establishing new institutions.
Rajanna Sircilla Medical College and Kamareddy Medical COllege. (Sumit Jha/South First)
The National Medical Commission’s (NMC) medical education reforms and subsequent faculty issues have left the medical teaching fraternity in India fuming.
Some even felt that the NMC — the country’s medical education and medical professionals regulator — has been acting to meet the target of more medical colleges set by Prime Minister Narendra Modi.
The All India Federation of Government Doctors’ Association has submitted a representation to the president of the NMC’s Undergraduate Medical Education Board. The representation, prepared based on a NITI Aayog report and Rajya Sabha standing committee’s observations, highlighted urgent issues that required the NMC’s immediate intervention.
Central to the doctors’ discontent was the NMC’s perceived negligence in addressing the critical faculty shortage and the overwhelming workload plaguing medical educators.
Dr Kiran Madhala, an anaesthesia professor at Government Medical College, Nizamabad, and coordinator for medical teachers attached with the All India Federation of Government Doctors’ Association, highlighted in the representation NITI Aayog’s alarming report that revealed that every second medical faculty member leaves their position within a decade. Only 40 percent of students consider teaching as a career.
The report also noted a significant urban preference among the faculty, with “85 percent of faculty preferring urban areas”, exacerbating regional disparities in medical education.
Madhala emphasised the urgency of addressing faculty shortages and enhancing the appeal of academic medicine. The representation sought a shift towards sustainable and effective policies, ensuring the quality and integrity of medical training in India.
The doctors’ discord stemmed from the NMC’s policies that led to an unsustainable increase in student-to-teacher ratio, putting undue pressure on existing faculty and compromising the quality of medical education.
Dr Madhala said the overall patient-care workload for the faculty was three to four times higher than reasonable limits, a situation that severely impeded the educators’ ability to fulfil their teaching responsibilities.
Dr Arjun Prakash, a radiologist from Bangalore Medical College, in a media statement, criticised the NMC for doubling UG and PG seats without due consideration for recruiting faculty members and improving the infrastructure.
“The state and central governments should give priority to improving the infrastructure and faculty recruitments in existing medical colleges rather than building new medical colleges. The new NMC rules are leading to the downfall of the medical profession,” he said.
“They increased the student-to-teacher ratio, and all colleges applied for an increase in UG and PG seats. Both got doubled,” he explained.
Remuneration and incentives, or a lack of it, added fuel to the dissent. The medical fraternity has been aggrieved by the discrepancies in salary structures, the inadequacy of “pay-for-performance” schemes, and the unattractive non-practising allowances compared to the lucrative opportunities in private practice.
Madhala explained the contrasts between the higher packages offered to senior residents under contractual appointments and the inadequate salaries and incentives for regular assistant professors, leading to inter- and intra-departmental dissatisfaction.
“The ‘pay-for-performance’ model successfully implemented in institutions like The Institute of Liver and Biliary Sciences (ILBS) in New Delhi, and institutions under Tamil Nadu’s comprehensive health insurance scheme, is the best practice that could potentially motivate the faculty and improve the quality of care in government hospitals,” he opined.
The issues highlighted in the representation have led to a demoralising environment for medical educators, making teaching an unappealing career.
Dr Bala Krishnan, former Tamil Nadu Medical Council chairman, voiced a common sentiment. “The basic problem with the government is salary. The teaching staff should be provided with adequate incentives and the doctors interested in teaching will continue in service,” he said.
Dr Madhala also mentioned about the Rajya Sabha standing committee’s findings, which criticised the NMC’s frequent regulatory changes and exiguous faculty strength across medical colleges.
These observations highlighted the need for a more stable and consistent regulatory environment that would foster the development and retention of high-quality faculty.
The rampant authorisation of new medical colleges without adequate faculty and infrastructure has also angered the fraternity.
Dr Anwar, president of the Telangana Teaching Government Doctors Association, criticised the NMC for its hasty permissions, which not only diluted the quality of medical education but also risked public health by producing underqualified graduates.
In his representation, Madhala pointed out that the “Speed at which the NMC has sanctioned permission to medical colleges after 2014 has increased six times in comparison to the pre-2014 period. The faculty cannot be made instantly with that speed.”
“Moreover teaching is not a choice for most medical students. Most of the faculty are not interested in continuing teaching,” he said.
Madhala demanded the NMC not liberally permit medical colleges. He wanted the body to be strict.
Joining the chorus of disapproval, Dr RK Sinha, a nodal officer of the Bihar government, criticised the NMC’s focus on quantity over quality. “It seems like the NMC is only fulfilling the vision of achieving the target set by the Prime Minister of India,” he said.
“No doubt, the number of colleges has increased. It seems the only focus is on creating the hardware. The software is equally important to run it properly,” he added.
Sinha expressed concern over the irregular recruitment and promotion of faculties. He said the private institutions managing the faculties were an open secret.
“To address the national health scenario, we need both numbers and quality, not only of doctors but also paramedics, nursing and others,” he added.
Meanwhile, Dr Madhala also spoke about the members of NMC and the problems in framing guidelines.
“Presently, the NMC is filled with members from autonomous institutes, where the work pattern, pay pattern, residence pattern, students pattern, staff recruitments, infrastructure patterns are all different than the state medical colleges,” he pointed out.
He said the NMC structure made medical education more problematic as the guidelines framed by its members won’t fit in. He requested the NMC to take suggestions from each state-run medical college/medical association at the grassroots level before framing the guidelines.
Dr Vijay Rao, the secretary general of IMA Telangana, told South First that quality was more important than quantity in medical education. “The NMC should take the opinion of every stakeholder before releasing any circular and concentrate more on teaching and research. The medical fraternity is always in panic mode over NMC’s policies and circulars,” he said.
Teaching doctors explained that in the NMC’s recent evaluations, the District Residency Programme (DRP) in India aimed at bolstering healthcare in district hospitals, faced criticism for not meeting its objective.
Despite the noble intention behind the DRP, Madhala said it involved trainees and not main treating doctors. He opined there were risks in appointing junior residents to the districts instead of senior doctors.
“This puts the health of a large population at risk, Madhala told South First.
The teaching doctors have made several other requests to the NMC. The doctors’ representation implored the NMC and the Central government to undertake a more pragmatic and holistic approach towards medical education reforms.
It called for uniform guidelines, better faculty planning and retention strategies, and the establishment of a medical recruitment board to address the systemic issues.
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