The recent statement by the Health Minister of Delhi, calling for an increase in the number of post-graduate (PG) seats is positive and encouraging. This is indeed the need of the hour. PG qualifications are, today, the minimum qualifications necessary for success in the medical profession. Owing to the difficulty in obtaining admission to PG courses, given the sheer paucity of seats—undergraduate seats are more than double the PG seats, including postgraduate NBE seats—the medical profession is fast losing its charm among our brightest students in schools. Students are opting for other streams, like engineering, commerce or management courses, because of better professional opportunities in those fields. A pressing need, therefore, exists for increasing the number of PG seats in the country.
Nonetheless, an increase in the number of seats cannot be a mechanical exercise, and certainly cannot compromise merit and the quality of professional training. The minister thinks that in order to make available more teachers for PG students, the existing specialist doctors can be re-designated automatically as teaching/faculty positions, as MCI allows re-designation as professor those who are specialists for 18 years or more. It is true that this method of re-designating existing specialists was used in Safdarjung hospital and RML hospital in Delhi, in order to have UG/PG courses at these institutions. This was permitted by the Medical Council of India (MCI).
It so happens that, since then, the MCI has prescribed (among other requirements) a minimum number of research publications for designation as associate professor or professor in any speciality. This is necessary for ensuring a demonstrable minimum level of academic interest and achievement among our teachers. Of course this approach inevitably compromises the quality of teachers, as those who have never been involved in teaching/academic activity are suddenly designated as professors/junior professors. This, thus, seriously impacts the quality of teaching and training. This approach of automatic re-designation is, thus, not in the interest of the profession. We need good teachers who can be role models for budding students/residents. Thus this requires a relook.
The medical profession is fast losing its charm among our brightest students in schools. Students are opting for other streams, like engineering.
Instead of pursuing automatic re-designation of faculty, the following steps that would help increase PG seats without requiring much in terms of extra resources, should be seriously considered:
1. Certain new emerging and important disciplines like family and emergency medicine must be adopted and expanded in India. The faculty and infrastructure are already available in post graduate medical colleges. The existing faculty in medical/surgical disciplines can be co-opted for these disciplines and can train specialists in these disciplines as well. Further, employment positions for these professionals should be created within the government system, to make these disciplines attractive among the medical graduates. For instance, family physicians would play the role earlier played by general practitioners (GPs).
2. The student-teacher ratio can be modified, in all medical disciplines, from 1:2 to 1:3. This has already been done for a few disciplines like anaesthesia, radio therapy and forensic medicine. This will not have any significant deleterious impact on teaching and training, while, at the same time, help increase MD/MS seats in all disciplines particularly in paediatric, obstetrics and gynaecology and others.
3. Aggressively adopting computers and IT systems for teaching/training purposes. Use of video conferencing and telemedicine/tele-education can easily complement traditional teaching methods. Utilised smartly, these can significantly help optimally utilise the existing resources and faculty.
4. Creation of adjunct faculty positions is another important step. Adjunct faculty can be drawn from various scientific institutes for the basic departments, and eminent faculty from the major private hospitals in the clinical departments. There are many distinguished scientists from the fields of biochemistry, pharmacology, microbiology, physiology, pathology etc., working in various institutes under ICMR, DST/DBT & CSIR, who can be considered as adjunct faculty in medical colleges. Similarly, many eminent teachers, who have left teaching institutes and now work in private hospitals, can be considered for appointment as adjunct faculty. The ratio of adjunct and regular faculty can be fixed for each discipline in the medical colleges. The adjunct faculty can be appointed by evolving a fair and objective system.
5. At present, we have two PG streams, i.e. the MCI regulated PG (MD/MS) and super speciality degrees (DM/MCh) on the one hand, and Diplomate National Board (DNB) in specialities and super specialities under the National Board of Examination (NBE) on the other. Though the NBE was started by Government of India to initiate PG programmes in private hospitals to expand clinical specialities, the DNB qualification was not, earlier, considered adequate for teaching positions in medical colleges. As of today, both degrees are almost equivalent. It would only be fair, and efficient, to move towards merging/unifying the PG training programmes under one regulatory body. Merging the two streams would also avoid confusion at the international level i.e. having two streams for post graduate specialisations in the same subject, from the same country.
To start with, there are many private hospitals/institutes having excellent faculty providing state of the art clinical services. These hospitals are even attracting patients from abroad. Of these hospitals, those that are already running NBE programmes should be made eligible for MD/MS, DM/MCH courses.
Medical professionals of excellence are a national asset. Not only do they serve the ailing in our country, they are an important facet of our “soft power” in the world. Through the dedicated and tireless efforts of previous generations, India attained a well deserved position of respect and importance in the world of medicine. A decline in standards and quality would be an unforgivable man-made tragedy. I believe we are at a crossroads. History, and future generations, will judge us harshly if we do not get our act together and implement the necessary reform and growth measures, many of which are long overdue. Governments at the state and Central levels, as well as regulatory bodies like the MCI would do well to act swiftly.
Dr K.K. Talwar is Chairman, Department of Cardiology, Max Healthcare Institute Ltd and former Chairman, BOG, MCI.