Medical education in India at crossroads

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The recent Supreme Court judgment, albeit a split verdict, has thrown more issues to ponder. The question of whether the Supreme Court rightly held that MCI has no mandate to intervene in admission process or otherwise is a matter of legal debate. Although the health ministry may file a review petition against the judgment, it is time for the government to go back to drawing table to clear the medical education mess.
Apart from legal aspects, the Supreme Court in its recent judgment also considered the practical aspects of holding single National Entrance Test for admission into medical courses. By endorsing arguments of the states and private institutions on the possible increase of urban-rural divide and disparity in educational standards of states, the Supreme Court seems to have ignored the ground realities and the greedy manipulations of private institutions.
If we look at the context of the case, the petitioners only sought relief on the ground that the students had to appear in multiple examinations and wanted to have only one single examination for admission in medical courses. By making invalid the single entrance examination, the top court brought the issue back to square one, giving undue advantage to private institutions. Besides the issue of admission process, the government has to seriously look at the aspect of fee structure and capitation fees charged by private institutions.
In Inamdar case, delivered in 2005, the apex court, while answering the question on fee structure, observed “To set up a reasonable fee structure is also a component of the right to establish and administer an institution within the meaning of Article 30(1) of the constitution, as per the declared law in Pai Foundation. Every institution is free to devise its own fee structure subject to the limitation that there can be no profiteering and no capitation fee can be charged directly or indirectly, in any form (Para 139)”. The apex court went on to observe “capitation fee cannot be permitted to be charged and no seat can be permitted to be appropriated by payment of capitation fee. “Profession” has to be distinguished from “business” or a mere “occupation”.
A student who gets a professional degree by payment of capitation fee, once qualified as professional, is likely to aim more at earning rather than serving and that becomes a bane to society. The charging of capitation fee by unaided minority and non-minority institutions for professional courses is just not permissible. Similarly, profiteering is also not permissible. Despite the legal position, this court cannot shut its eyes to the hard realities of commercialisation of education and evil practices being adopted by many institutions to earn large amounts for their private and selfish ends. If capitation fee and profiteering is to be checked, the method of admission has to be regulated so that the admissions are based on merit and transparency and the students are not exploited. It is permissible to regulate admission and fee structure for achieving the purpose just stated (Para 140).
Every institution is free to devise its own free structure but the same can be regulated in the interest of preventing profiteering. No capitation fee can be charged (Para 141)”.
In the context of admission process and fee structure, in its concluding paragraph, the apex court observed in Inamdar case “..It is for Central government, or for the state governments, in the absence of a Central legislation, to come out with a detailed well thought out legislation on the subject. Such a legislation is long awaited. The states must act towards this direction. The judicial wing of the state is called upon to act when the other two wings, the legislature and executive, do not act. The earlier the Union of India and the State Governments Act, the better it would be. The committees regulating admission procedure and fee structure shall continue to exist, but only as a temporary measure and an inevitable passing phase until the Central government or the state governments are able to devise a suitable mechanism and appoint a competent authority in consonance of observations made herein above ...(Para 155).”
After eight long years of the delivery of Inamdar’s judgment, the Central government has a golden opportunity to make necessary changes in the existing statute or come out with a new legislation to streamline admission process and the fee structure in medical profession. The latest judgment of Supreme Court on NEET resulted in steep increase in the capitation fee, clearly defying the logic of economics where increased supply is supposed to reduce the demand. The government’s claim that in four years, the under graduate seats in MBBS profession has increased from 26,000 to about 50,000 would have reduced the cost of per medical seat in private sector. However, the ever increasing demand for medical seats by aspiring students and their anxious parents created a window of opportunity for the private institutions to charge exorbitantly which has been highlighted by various media exposes. It is not a surprise that an MBBS medical seat which is to be “sold” for about `25-30 lakhs few years ago, is now for grabs for `65-70 lakhs, leave aside steep increase in prices of PG seats.
Although capitation fee is not paid through cheque, it is charged under hand by various private institutions in the name of so called development charges and black money is flowing to the private institutions. The government cannot turn a blind eye to this fact and has certainly a role to play to curb this malpractice.
The government has many options to make necessary corrections; firstly, it can enact a new legislation, preferably at Central level, on fee structure and admission process. The new law should enable setting up of a National Examination Authority and also make an enabling provision for setting up a Medical Education Commission to assist the poor students by way of giving scholarships or loans there by subsidising the high fee structure. The government can also think of classifying the colleges according to infrastructure, teaching, research, academic standards and hospital facilities as in the case of hotel classification done by ministry of tourism.
Secondly, in the year 2000-01, a number of students from Russia and other CIS countries had agitated against the screening test being conducted by Government of India as a prerequisite for registering the primary medical qualification in Indian medical register. Even the Supreme Court has observed that standard of medical education in private institutions is not up to the mark but relied upon MCI’s wisdom to claim that every year the examinations conducted by the health universities are fair and transparent. This is a questionable observation by the MCI.
Lastly, many of the medical professionals studied their MBBS Course at a period when technology and developments in medical field were not as advanced as of today. As such, there is a need to have a re-registration system of doctors after every 10 years followed by 30 hour CME to get acquainted with the latest medical techniques etc.
The bottom line is that the government has to wake up and review the medical education profession in a pragmatic and realistic way.
The writer is a joint secretary in the ministry of health and family welfare