The National Medical Commission’s (NMC) decision to allow and allocate medical education seats according to the population of a State or Union Territory is turning into a southern States versus the Centre debate on the freedom to provide healthcare and education to people. The order comes into effect from the next academic year.
Some of the States and Union Territories that are likely to be hit by the decision are Karnataka, Tamil Nadu, Andhra Pradesh, Kerala, Telangana and Puducherry. They want to appeal against what they claim is discrimination for doing well. In these States, the number of medical seats have exceeded the ratio as recommended by the NMC order. Experts note that apart from these states, Himachal Pradesh, Manipur and Sikkim will also be adversely affected.
The NMC notification covers both government and private medical colleges and was issued last month. It says, “After 2023-24 (which means from the 2024-25 academic year), a letter of permission for starting of new medical colleges shall be issued only for annual intake capacity of 50/100/150 seats [new medical colleges will only have 50-150 seats] provided that medical colleges shall follow the ratio of 100 MBBS seats per 10 lakh population in that State/Union Territory”.
While the Commission didn’t respond to queries about the rationale behind the move, various social media posts on the subject by senior Congress leader P. Chidambaram, senior doctors and experts working in the field of education have called this “punishment for good performance, serious encroachment on the powers of the State Government and the State Legislature”. They have also asked why State governments can’t start new medical colleges out of their own funds and for their own students.
“The Centre and its agencies are undermining federalism,” noted Mr. Chidambaram in his post while senior officials in the Karnataka government have indicated that they would appeal against the order.
Tamil Nadu has 11,600 seats for a projected population of 7.64 crore as of 2021 according to data provided in the Lok Sabha by the Health Ministry. Karnataka has 11,695 seats (6.76 crore), Andhra Pradesh has 6,435 seats (5.34 crore), Kerala has 4,655 seats (3.54 crore) and Telangana has 8,540 seats (3.77 crore).
According to the new guidelines, Tamil Nadu should only have around 7,600 seats, Karnataka (6,700), Andhra Pradesh (5,300), Kerala (3,500), and Telangana (3,700). Also, according to NMC data, Andhra Pradesh had 1,05,799 registered doctors as of June 2022, while Karnataka had 1,34,426, Kerala had 42,596 doctors, Tamil Nadu had 1,48,217 doctors and Telangana had 14,999 doctors.
The latest order comes at a time when Health Minister Mansukh Mandaviya earlier this year met with representatives of over 50 private and charitable hospitals or chains and urged them to start undergraduate and postgraduate medical courses.
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Sudhir Kumar, a neurologist at Apollo Hospital in Hyderabad, said that the country has to look at the overall picture to provide its citizens with doctors and not go State-wise. Additionally, doctors migrate for work across the country.
“Patients also travel. We still don’t have an optimum doctor to patient ratio. A good number of people who want to become doctors still don’t get a seat. We should actually work towards giving the best quality and quantity of medical education and become world leaders in this field,” he said.
Senior vascular surgeon J. Amalorpavanathan said, “Medical education is closely tied to public health. Hence, States should have the freedom to decide how many doctors they should produce — for public health, for specialities and super-specialities and for the private sector. Each State can plan accordingly and produce optimum numbers. These can be revised every decade. The NMC must stick to deciding syllabus and recognition.”
K.R. Antony, public health consultant, Kochi, said that availability of trained doctors for postings in the vast rural areas of the country cannot be assured by merely opening new medical colleges.
“It will degenerate medical education as a profit-oriented commercial activity with a compromise in the quality of education and ethical standards. Such commercial production of doctors only leads to export of Indian doctors for Western countries and not for our under-served areas. Need-based training of doctors and their rational deployment for service to the community in India is the need of the hour,” he stated.
Highlighting the need for standardised facilities at medical colleges across India, Lakshya Mittal, president of the United Doctors Front Association, said, “Opening new medical colleges across India is a great initiative by the government; however, it will be a great boost for healthcare if the NMC also enhances the facilities in the existing medical colleges side by side.”
