MCI approved degree mandatory for admission to superspeciality courses

In an important judgement, the Bombay High Court on Monday held that only the students who have MD or MS degree from a college recognized by Medical Council Of India (MCI) can be admitted to post-graduate ‘Doctor of Medicine (super-speciality) courses.

Bhavin Pujara, a doctor, had filed a petition in the High Court challenging merit list of candidates selected for super-speciality course in 2008. He contended that many candidates in the list did not have MD or MS degree from MCI-recognized colleges.

Directorate of Medical Education and Research relaxed the rule in 2008 by allowing candidates from non-recognized colleges, he said.

A Division Bench, led by Justice D K Deshmukh, held that in future, candidates for the super-speciality course must have degree from a college recognized by MCI, said petitioner’s lawyer Mukesh Vashi.

Dr Mukund Bajaj is fortunate but he is perhaps the last candidate to get admission to a super-speciality course without having a post-graduate degree recognised by the Medical Council of India (MCI). Bajaj retained his seat at Grant Medical College because the Bombay High Court did not feel it fit to take away his seat after he had completed a year in the course. Also, the MCI had said that the seat could not be given to any other candidate after the admissions were completed.

The TOI expose: Part 3 – Is MCI hand in glove with the erring colleges?

More from the Times of India- Times Now expose:

Even as questions swirl over the impunity with which private medical colleges are charging illegal donations the Medical Council of India (MCI) — themselves have strong links with the offending institutions. ( Watch )

Two senior officials of MCI, the authority tasked with keeping a vigil on medical education, are currently board members of one of the colleges caught demanding capitation fees in a TOI-Times Now investigation. MCI president Ketan Desai and vice-president P C Kesavankutty Nayar are on the board of management of Sri Ramachandra University, which demanded Rs 40 lakh from students seeking MBBS admission.

Incidentally, Desai was asked to step down from the MCI president’s post in 2001 following corruption charges, but was re-elected in March.

‘‘It’s not surprising that we have not had a strong reaction from MCI even three days after the expose,’’ said Dr Sunil Pandya, a member of the Forum for Medical Ethics Society based in Mumbai, which has been fighting for transparency in the functioning of MCI.

Asked about his presence on the SRU board, Desai denied any conflict of interest. ‘‘I am the UGC nominee and my colleague, Nayar, is the MCI nominee. It’s just like how the Dental Council of India members are on the board of several dental colleges. But I have never attended board meetings of SRU for at least three years now. We are there only as ex-officio members,’’ he said.

Dr Sunil Pandya, a member of the Forum for Medical Ethics Society based in Mumbai, which has been fighting for transparency in the functioning of MCI says that these connections are the root cause for the lack of adequate oversight in medical education. ‘‘Why should heads of MCI be members of any medical colleges? There will be bias. An undoctored version of the minutes of the meeting with regard to decisions taken on SRU will probably show how MCI is biased,’’ Dr Pandya said.

Interestingly, he is seconded by former Union health minister Anbumani Ramadoss, who agrees there is no need for MCI members to be on the board of any college. When asked why he had not made an attempt to reform the system during his tenure, he said, ‘‘I have won many battles including the one against the tobacco lobby. But I failed with a corrupt body like MCI.’’

MCI’s role in overseeing the sector includes issuing licenses of recognition, reviewing infrastructure and quality of faculty. The TOI bemoans the state of affairs thus:

Six years ago, the Supreme Court ordered an unambiguous ban on capitation fee. But as you can see, it is still thriving — seats in medical colleges are still being sold or even hawked to the highest bidder. This is making a mockery of merit in education and eroding trust in specialized studies in India. And all concerned parties seem to be complicit in this ugly money-making racket that passes off as education.

According to the Delhi High Court, MCI is a ‘den of corruption”, and yet the government has done nothing to clean it up and add moral fibre to the regulator.

Actually, the government is possibly more culpable than just being negligent. It has granted “deemed university” status to unproven and at times questionable educational bodies. The status of “deemed university” is usually given to an institution which has been attached to a university, and over a period of time, proved to be sufficiently efficient, mature and responsible to be able to work autonomously. There are now instances of educational institutions starting off as deemed universities! This makes sarkari recklessness, if not complicity, pretty apparent.

In 2002,Dr Sunil Pandya and Dr Samiran Nundy wrote a piece in the Issues in Medical Ethics . What they said then still holds true-

As is common knowledge, elections to our national and state-level medical councils are fought with just one aim: to enrich oneself personally. Expenditure of huge sums; a total lack of scruples; political connections; a compulsive desire to grab power by any means, both fair and foul and finally, ruthless pursuit of the goal of personal enrichment are absolute necessities.

Given these conditions, it is not surprising that our medical councils are hopelessly corrupt, incompetent and disinterested in the common good. No wonder, the Delhi High’ Court in a recent judgement labeled the Medical Council of India as ‘a den of corruption’.

The reported sum spent by candidates for election as President of the Medical Council of India exceeds a crore of rupees. Were the actual figure even a tenth of this amount it is easy to see how no honest individual can ever aspire to serve in this position. It is also obvious that a person spending such a huge sum will have as his primary goal the recovery of his capital investment along with ‘adequate’ returns on it in the shortest possible period. The seeds of corruption have already been sown.

People who are in this field are quite aware of all that happens in the domain of the MCI. A cursory look through the reader comments responding to the TOI article will be an eye opener. There are names of colleges, there are names of people— all in the open, but yet, nothing will be done. The puppeteer who handles the strings makes the decisions. And the puppeteer is corrupt!

What we knew all along (Part 2): Postgraduate admissions

The previous post on the TOI report on MBBS seats being barely exposes the tip of the iceberg. Here’s the next one:

The scam gets bigger, and more brazen as medical graduates embark on specializations that are necessary for a successful career.

The price this year for a post-graduate seat in radiology in most leading private colleges across the country is Rs 2 crore while in cardiology, gynaecology and orthopaedics are priced around Rs 1.5 crore.

We always knew that postgraduation seats were available for a hefty price. And if you had to succeed in your career, you had to get an MD or an MS after your name. The sad part is that a ‘plain MBBS’ is a nobody in Indian society today.

The main reason for such high rates is the dearth of seats for PG programmes. The average ratio of undergraduate (MBBS) seats to those for post-graduate is 100:29. In effect, nearly 32,000 doctors graduate from medical schools across the country every year, and the number of PG seats available to them is roughly one-third of the requirement.

Across India, there are 9,085 seats for clinical courses like cardiology, radiology, orthopaedics and gynaecology; a mere 662 seats for pre-clinical courses such as anatomy and physiology, and 1,303 seats in para-clinical programmes like pathology, micro-biology and forensic medicine. Of these, a large percentage are in private institutions which enjoy the freedom to charge hefty donations — which means, a bright MBBS graduate with no means to pay has few options.

Overall, less than 10% of the graduating medical batch gets PG seats through the general (government) pool. Most PG seats, in simple terms, are auctioned or sold to the highest bidder. It’s a system of exploitation that finds its eventual victim in the patient.

Another senior expert, who has held prestigious posts at the national level, says he has urged the UGC to hold centralized examinations like JEE for admissions to both MBBS and PG courses. “It’s a national shame to commercialize education. Besides, death of merit affects the quality of medical education. When money is paid, these colleges ensure that the exit is definite. The students pass, qualified or not,” he said

In a country which needs more doctors who will serve in rural areas and more family doctors; MBBS doctors are denied the prestige offered to their postgraduate counterparts. And in any case, being a general practitioner is far more difficult and requires a lot of ‘people skills’ than being a specialist is.

My own view is that general practitioners ought to be accorded more dignity, prestige and monetory benefits to attract more medical students to the profession. Look at the UK- they produce doctors in accordance with what they need. India’s strange policy means we have seats in specialities according to the number of guides. And quite obviously, the number of guides are more in subjects which are more paying. We need more community specialists than superspecialized doctors in medicine or surgery. Our needs assessment has never been done.

Until we treat MBBS doctors at par with postgraduates, this mad scramble for seats will continue.

India’s worst kept secret: Payment seats

Another tehelka style operation. This time by Times Now. Something we already knew. Just documented now for posterity.

It is a fact that merit takes a back seat in India. You can buy your way into becoming a doctor or an engineer. If you have enough dough to pay for your seat, your career is guaranteed.

Dhanya Rajendran’s report says it all (Watch) :

Less than a week after the Tamil Nadu state government put in place a system to curb the collection of capitation fees by private medical colleges, a TIMES NOW-Times of India joint investigation has caught the officials of two leading medical colleges demanding money to admit students.

In one of the most reputed deemed medical universities in Tamil Nadu, Sri Ramachandra University, the price of a seat here is anything between 40 and 75 lakh rupees. But we found out that is just the money to secure a seat. The advertised tuition fees of 18 lakh rupees is over and above this.

Now this is one of India’s worst kept secrets. And this is not the only college where this murder of merit occurs. These educational business places are in all the states. And yes, the people running them are bigshots- politicians, medical administrators, filthy rich people. With the right connections. Very influential and very powerful. Not very easily pinned down.

And we are all to blame. Not just the administrators in these colleges. The students and their parents who are willing to go any extent to secure seats are equal party to this ugly practice. And yes, we do know the kind of doctors that are being produced from these markets. What would you expect from a student who has paid so much for his education? Wouldn’t his first priority be to ‘recover’ that amount from his patients? Where does ethics, professionalism and transparency go now— out of the window, of course. My head hangs in shame. But till we accept this as a normal practice in society, I expect nothing to change.

The scourge of leprosy

“You are a leper!”, he screamed at me, “Don’t even touch my child! We will not eat anything prepared with your hands”. I looked up, first startled and then stunned, not knowing how to react (It sounded worse when said in Hindi). This was a graduate, net-savvy professional’s idea of a joke. I didn’t find it funny then. I still don’t find anything funny. What struck me was the viciousness and the vileness with which these words were flung at me.

No, I do not suffer from leprosy. I am afflicted with a skin ailment which causes the skin on my palms to thicken abnormally and then break up into painful deep fissures. But that is not the point. What if the ailment I have was actually leprosy? Wouldn’t that person’s reaction have been the same?

The whole issue is the insensitivity with which patients of leprosy are treated by society. The word ‘leper’ has become synonymous with being unclean. It is ridiculous in these times given that leprosy now has a cure and is just other infectious disease which can be treated. The disfigured hands and feet can be a thing of the past if the disease is diagnosed and treated early. But what cannot be cured so easily is the disease in our own minds.

The stigma of leprosy is hard to erase. Patients are ostracized and shunned by society and their own families. One patient summed it up like this, ‘We can endure losing fingers and toes, eyes and nose, but what we cannot endure is to be rejected by those nearest and dearest’.

I have seen an excellent effort at rehabilitation of patients of leprosy, at Anandwan in Warora in Chandrapur district. The dream village set up by Baba Amte continues to function even after his death. As a child I met him a couple of times. I always remember him saying “Work builds, charity destroys”. He used to shun charity and has taught thousands of patients to live independent lives with dignity. Each time I visit Anandwan, the cleanliness of the place never fails to catch my attention. And the beauty of their self sufficient enterprise is amazing- the grow their own crops, make their own furniture, weave their own cloth, print handicraft paper, create beautiful footwear, and grow lovely flowers. And you always come back ashamed of humanity when you hear how each person there was thrown out of their own houses and earned a life of respect at Anandwan.

As a pathologist, in a leprosy endemic area, I come across these cases regularly, and I can never forget my teachers telling me to label them ‘Hansen’s disease’ instead of leprosy. I don’t know how much of a difference the altered nomenclature made, but it is an indicator of how deep the stigmatization of leprosy has percolated. The way you teach medical students about leprosy also affects our mindset. My favorite teacher in dermatology used to take his patients into an area with bright sunlight and examine his patients carefully. And he did it with so much sensitivity. I remember overhearing a comment from one of my fellow students- “Look! He isn’t scared of touching his patients when he can avoid doing so.” There are these unsaid things– and my teacher was a perfect role model— teaching by example to empathize with your patients. Sadly, the same cannot be said of all medical teachers and doctors.