While 8.70 lakh candidates cleared NEET-UG in 2021, there were only 88,120 undergraduate seats in medical colleges in India as of December.

Two doctors walking on the road in Kozhikode: Why Indian students go abroad for MBBS: The inadequacy of opportunities at homeImage for representation/PTI
Delve Education Wednesday, March 02, 2022 - 12:07

As thousands of Indian students stranded in war-hit Ukraine await evacuation, the popularity of countries like Ukraine, China, Russia, Georgia, and the Philippines for medical education among Indian students has emerged as a major talking point. On February 26, Prime Minister Narendra Modi alluded to the phenomenon and said that Indian students are going to “small countries for study, especially in medical education.” Speaking at the inauguration of a webinar on Union Budget announcements in the health sector, he urged the private sector to enter the field of medical education in a big way. 

While the Prime Minister did not refer to the students in Ukraine in particular, the country which is now under attack from Russia ranks fourth in Europe for having the largest number of graduate and post-graduate medical students, according to Ukraine's Ministry of Education and Science. The Ministry’s data also says that there were around 18,095 Indian students in Ukraine before evacuation efforts began, and that in 2020, 24% of its overseas students were from India, according to IANS. And now, while many students are stranded in Ukraine, thousands who’ve returned from both Ukraine and China are dealing with an uncertain future. 

The reason thousands of students go abroad for MBBS degrees is very straightforward, say experts: the shortage of seats in India, coupled with the relatively affordable fees in Ukraine and other countries when compared with private colleges within India. 

Opportunities for medical education in India fall inadequate 

According to the Ministry of Health, there were 88,120 undergraduate seats in medical colleges in India as of December 2021. On the other hand, over 15.44 lakh candidates appeared for NEET-UG (National Eligibility cum Entrance Test - Undergraduate) in 2021, an exam which even students who wish to pursue a medical degree abroad are required to clear, in some countries. Around 8.70 lakh candidates cleared the exam last year. This means the number of undergraduate medical seats available (88,120) can only accommodate around 10% of the total qualifying candidates. 

Pointing to the magnitude of the gap in demand and availability for MBBS seats in the country, education strategy specialist Ramachandran Krish says, “Even if we assume some of the candidates are writing the exam only out of parental pressure, even if only about 5 lakh candidates truly want to pursue MBBS, that’s still a huge shortage,” he notes. 

The National Medical Commission’s website shows 43,310 MBBS seats available in 284 government medical colleges in India, and 41,065 MBBS seats in 269 private medical colleges. This means only about half of the already meager seats are in affordable government colleges. And there’s a massive difference in the cost of studying in “small countries”, as PM Modi referred to them, when compared to private colleges in India. 

Ramachandran says that the cost of the entire MBBS degree in countries like Ukraine and Russia can be as relatively low as one-third of the cost in a private college in India. Speaking to IANS, Omkar Jilla, a third year medical student from Maharashtra studying at the Ivano-Frankivsk National Medical University in Ukraine, said, “Where we have to spend Rs 10 lakh to Rs 15 lakh per annum in private medical colleges in India, here it costs Rs 3 to Rs 4 lakh only.” Moreover, the quality of education at Indian private colleges can also be dubious at times, making students and parents opt for relatively affordable colleges abroad of similar or better quality, says Ramachandran. 

On returning to India, students would still have to clear the Foreign Medical Graduates Exam (FMGE) for a license to practice medicine here. FMGE is now proposed to be replaced by the National Exit Test (NExT), an exam which is also likely to become a qualifying final exam for MBBS students who have studied in India, and also possibly replace the NEET-PG exam. In the midst of the Ukraine crisis, Union Parliamentary Affairs Minister Pralhad Joshi claimed that 90% of Indian students who study abroad don’t pass India’s qualifying examinations, a remark that was heavily criticised by the Progressive Medicos and Scientists Forum (PMSF). 

PMSF slammed the “insensitive and inappropriate questions” being directed towards students facing the horrors of war in Ukraine, asking them why they go to “small foreign nations” to become doctors instead of studying in India. In a statement issued on March 1, Tuesday, the doctors’ forum pointed out: “Limited government MBBS seats and lack of affordable medical education in India forces thousands of MBBS aspirants to seek help from agencies that arrange their admission in medical colleges in eastern Europe, south east Asia and Oceania.” It also said that these countries, unlike India, have “relatively adequate number of medical universities, most of them entirely public funded,” and that they use their additional capacity “to train foreign students on a monetary basis.”

Can the private sector fix the shortage? 

Speaking after the war on Ukraine commenced, PM Modi had said, “Our children today are going to small countries for study, especially in medical education … Can our private sector not enter this field in a big way? Can our state governments not frame good policies for land allotment regarding this?” Incidentally, the PMSF in its statement said that by finding fault with the choice of students who study medicine abroad, the Government of India “is feigning ignorance from the rampant commercialisation of medical education and health care here in India.”

Although more private colleges can help meet the demand for medical education in theory, Paul Chellakumar, Chairman of Chennai-based overseas education consultancy Campus Abroad, notes that in the case of engineering and business education in India, quality of education has become increasingly unreliable with growing privatisation and lack of proper regulation of private colleges. “Managements of private colleges are often not very invested in ensuring quality education, as they run these institutions like a business. With management quota seats being so expensive, many countries including Bangladesh are trying to attract students from India. If the demand leads to rise in private medical colleges, there has to be a proper mechanism for fees and quality regulation. But in India, no one hesitates to pay a capitation fee, which has become very normalised as part of our culture, despite being illegal,” Paul notes. 

At present, the number of medical colleges is hugely disproportionate across Indian states, with a large number of them concentrated in Karnataka (63 colleges with 9,795 MBBS seats according to NMC), Maharashtra (61 colleges and 9,600 MBBS seats), Tamil Nadu (69 colleges and 10625 MBBS seats), Telangana and Andhra Pradesh (34 colleges and 5,340 seats; and 31 colleges and 5,210 seats respectively), and Uttar Pradesh (67 colleges and 8,678 seats). In October 2021, NITI Aayog member Dr Vinod K Paul had said that the Indian government aims to achieve the doctor patient ratio of 1:1000 as prescribed by World Health Organisation (WHO) by 2024. 

Ramachandran says that if the National Medical Commission (NMC) were to take the scarcity of MBBS seats seriously, in order to provide enough opportunities for every student who aspires to a medical education in India, while also aiming to achieve the required doctor patient ratio in proportion with each state’s population, it would at least have to start adding around 30,000 MBBS seats every year if not more for the next few years, and funds would have to be allocated accordingly. 

“Alternatives to the existing education system must be considered,” Ramachandran says, adding, “The NMC can consider adding a few colleges through a public–private partnership. The government could ask large hospital groups to set up colleges and provide incentives, while keeping the fees affordable.”

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