Remedy to keep Indian students from heading abroad for medicine

Even as Prime Minister Narendra Modi calls for increased private participation in India so that students don’t feel the need to head overseas for medical studies, the industry believes the onus lies with the government.

“Our children today are going to small countries to study, especially in medical education. Language is a problem there. They are still going... 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?” Modi said at a webinar recently.

Several industry observers and stakeholders, however, say state governments providing for cheaper land alone might not bridge the existing price gap between government and private or self-financed medical colleges.

While medical seats in government colleges and government quotas cost Rs 15,000 per annum for a 4.5-year MBBS programme, in private colleges the cost is between Rs 5-6 lakh and Rs 15-17 lakh per annum.

“Setting up a private college, even in a rural area, requires crores of rupees, and land is the least of the issues here,” said the dean of a self-financed college in Gujarat who did not wish to be named. “The government norms under National Medical Commission (NMC) regulate that for every medical seat the college has, it also needs to run a hospital with 4-5 times the number of beds. In addition, there are laboratories, libraries, other infrastructure and faculty salaries. 

For instance, our own library costs us Rs 80-90 lakh a year,” the dean added.

China and smaller countries like Ukraine, the Philippines and Kyrgyzstan offer far more affordable options, while not requiring Indian merit standards.

While private medical education in India costs between Rs 80 lakh and Rs 1 crore, in countries like China and the Philippines, it cost Rs 25 lakh, said Ahmedabad-based overseas education consultant Sameer Yadav. In Belarus, it is Rs 30 lakh and in Russia, Rs 40-45 lakh. “Besides, medical programmes in these countries are recognised in the US and the UK with graduates needing to only clear a licensing test in the western countries,” Yadav added.

Gaurav Tyagi, founder of Career Xpert, an overseas medical education consultant, is of the view that the government needs to expand the number of state-run colleges and medical seats with affordable fees.

Quoting multiple sources, including the Ministry of Health and Family Welfare (MoHFW), a working paper published in the National Medical Journal of India and co-authored by Aruna Vanikar, president of undergraduate medical education board of NMC, said that in 2020, while 80,312 MBBS seats were available in India (roughly 51 per cent of these were government quota), the number of students who took the National Eligibility cum Entrance Test (NEET) was a whopping 1.4 million.

According to latest estimates, while the number of NEET applications has risen from 1.33 million in 2018 to roughly 1.6 million in 2021, the number of MBBS seats available is just over 88,000.

“Students who travel abroad for medical education largely go to countries like China, Russia, Ukraine, the Philippines, Kyrgyzstan, Uzbekistan, Turkmenistan, Tajikistan and Georgia,” said Tyagi. “This is despite several of them, including China, Russia and Ukraine, requiring them to learn their local language, which Indian students do in the first 5-6 months because of lack of enough seats in India and poor performance in NEET.” To stem this outflow, he said, there is a need to not only increase the number of government seats but also regulate the fee private colleges charge, besides revisiting the merit cut-offs.

NEET cut-off passing marks and percentile in 2021 were 720-138 and 50th, respectively, for general category, and 137-18 and 40th for SC/ST/OBC.

Adding to the students’ woes is the gap in the standard of curriculum taught in these countries against the requirement by India through bodies like NMC.

For instance, according to the working paper, a dismal 18-20 per cent of medical graduates who studied abroad could clear the foreign medical graduate examination (FMGE) in India. FMGE is a licentiate examination conducted by the National Board of Examinations (NBE) in India as one of the mandatory requirements for Indian citizens who obtain a medical degree from a college overseas to practice medicine here.

The NMC is trying to address this issue by “removing the age bar for entry to MBBS” and “recommending lowering of fees for MBBS in government quota”, the paper said.

The dean quoted earlier said the government also needs to ease the norms for setting up private medical colleges, given the cumbersome process and huge investments required.

“An application for a private hospital to set up a medical college goes through multiple stages and takes 2-3 years along with huge investments,” the dean said, adding, “This acts as a deterrent for even big corporate hospital chains to set up their colleges when they can enjoy better ROI (return on investment) through their hospitals alone. The government could provide support in the form of subsidies for setting up colleges and also ease the process.” 

The paper suggests some measures including building a robust system to improve upon the quality of medical education imparted across the country and minimising the gap between the level of education in different institutions.

“The undergraduate medical education board (UGMEB-NMC) is planning to address these issues. It is also planning to remove the upper age bar for aspirants seeking admission to medical graduate courses,” the paper said. “Thus, students can try to make as many attempts as they desire, if they are keen to pursue medical graduation. This option can be taken by aspirants instead of going to these countries,” it added.