Costly medical studies in govt colleges is leaving Punjab short of doctors

A part of the reason why India is short of doctors is that medical education is expensive and those who have the means to acquire it either prefer to work in private health facilities or migrate

Shortage of medical staff in the public health sector has been one of the impediments in India’s Covid-19 containment strategy. Insufficient health workforce, among other issues, has been a long-standing problem, particularly in government health facilities that remain overburdened and understaffed.

A part of the reason why India is short of doctors is that medical education is expensive and those who have the means to acquire it either prefer to work in private health facilities in the country or migrate overseas, said experts, citing how the increasing fees in government medical colleges in the country is keeping the poor but deserving students out while creating health-services inequality between urban and rural areas.

We report from Punjab, which has increased the MBBS (Bachelor of Medicine and Bachelor of Surgery) course fee in its state-run medical colleges by 78%--from Rs 4.4 lakh previously to Rs 7.81 lakh--for the 2019-20 session. Punjab’s fee structure is the among the highest in the country, an IndiaSpend analysis of data from the Medical Council of India’s (MCI) website shows.

Punjab’s government medical colleges most expensive in the country

On May 27, 2020, Punjab raised the fee for MBBS course in the state-run medical colleges by 78%, from Rs 4.4 lakh previously to Rs 7.81 lakh for the next academic session. The revised fee for the four-and-a-half years course will be split thus: Rs 1.5 lakh the first year, Rs 1.65 lakh the second year, 1.80 lakh the third and 1.95 lakh the fourth year, and Rs 91,000 for the final six months. For context, Punjab’s per capita income currently stands at Rs 1.67 lakh per annum, data from the state government’s Economic and Statistical Organisation show.

In private medical colleges, the fee for the 50% government quota--seats controlled by the state government for ‘domicile candidates’ (state residents)--was hiked from Rs 13.4 lakh to Rs 18.55 lakh (38% increase). For the management quota--seats which college authorities have the liberty to fill at their level based on candidates’ NEET (National Eligibility-cum-Entrance Test) rankings--the course fee is now Rs 47.7 lakh instead of Rs 40.3 lakh earlier (18% hike).

This excludes students’ average monthly expenditure of Rs 10,000-Rs 12,000 on accommodation, books, food, etc.

Punjab has seen a 479% fee hike in state medical colleges in the past decade (table 1). In 2010, the MBBS fee in government medical colleges was increased from Rs 68,000 to Rs 1.35 lakh, a figure that was raised to Rs 4.4 lakh in 2015.

Calling the latest fee hike reasonable, in an official statement on June 4, medical education and research minister Om Parkash Soni said that the hike under the Shiromani Akali Dal (SAD) and Bharatiya Janata Party (BJP) alliance government was even higher--98% in 2010 and 225% in 2015.

While the political blame game continues, only three government medical colleges in Uttarakhand and two in Tamil Nadu have a higher annual fee--Rs 4 lakh to Rs 4.26 lakh, and Rs 3.85 lakh to Rs 4 lakh, respectively, and IndiaSpend analysis of fee structure for the 2019-20 academic year shows.

While IndiaSpend could not trace any government-commissioned report on the socio-economic condition of students who enter medical colleges in Punjab every year, a 2008 research project--by Jaswinder Singh Brar, Ranjit Singh Ghuman and Sukhwinder Singh--of Punjabi University, Patiala, showed that just 4.27% of the total students who entered medical courses that year were from a rural background, even though 62.5% of the state’s population lives in rural areas.

There is no further study to back whether the number has gone up or down, but the overall situation continues to be unfavourable for rural students, said Brar, professor of economics at Punjabi University, Patiala.

Another 2006 research project by the university noted that when institutions hiked fees, they accelerated the ‘exclusion process’ of students from the marginalised sections of society from acquiring higher education, even those who were talented and hardworking.

The findings of the study remain relevant, said Ghuman, the principal coordinator of the study and now professor of economics at the Centre for Research in Rural and Industrial Development (CRRID), Chandigarh. With fees rising over the years, the gap between the haves and have-nots has widened. “We conducted one more study for the Association of Universities, New Delhi in 2007 on ‘unit cost of higher education in Punjab’, which revealed that only 10% to 15% of Punjab households could then afford the fee of an MBBS course. The situation has deteriorated since then.”

A presentation made by the Punjab chapter of Indian Medical Association’s (IMA) medical students network (MSN) on the latest fee hike--to register their dissent--showed that in 2019, of the 4,560 aspirants who applied to participate in the Punjab state medical admissions process--termed “counselling”--30% were from the “lower-middle-class income bracket”.