Daybreak - India set up a new body to fix medical education. It now needs to fix that body

Episode Date: December 2, 2024

Four years ago, India set up a new body to fix medical education. It was called the National Medical Commission (NMC) and it was meant to replace the Medical Council of India and bring reforms in this sector.  The goal, at the time, was to bring some order to the chaos. But so far, it seems like the body has only been able to do the opposite. Between vacancies, a series of poor decision and a general lack of coordination — the laundry list of criticism from people in the medical fraternity is only getting longer. It seems like the body that was meant to cure medical education in India, is dealing with a chronic illness of its own. But is it terminal?  Tune in. Daybreak is now on WhatsApp at [phone]. Text us and tell us what you thought of the episode!Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first video. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Four years ago, the National Medical Commission or NMC was set up to replace the Medical Council of India. It was meant to revamp medical education in the country and bring some order to the chaos.

But so far, it seems like the body. has only been able to do the opposite. Between vacancies, a series of poor decisions and a general lack of coordination, the laundry list of criticism from people in the medical fraternity is only getting longer. For instance, just this year, the Medical Assessment and Rating Board, which is one of the NMC's four autonomous boards, decided to approve 60 new medical colleges in the country. Now, straight off the bat, that sounds like a great decision.

More medical colleges should be a good thing, right? Well, turns out it isn't really that straightforward. You see, people in this space say that this decision wasn't well thought out, particularly because eight of these 60 colleges were in Maharashtra alone. Now, Maharashtra already has the third most medical colleges in the country. It's home to the highest number of doctors. So the doctor-to-population ratio here is way higher than the. the national average. People in the medical fraternity said that the medical assessment and

rating board or MARB didn't quite think this decision through. But how could it? You see, critics of this decision will very quickly point out that the MARB, the body that grants permission for medical colleges, has been functioning without a president or full-time members. It also doesn't help that the tenure of the two part-time members of the board ended just a couple months ago. And this isn't just a marb problem. The NMC has a major vacancy issue. And that a lot of people in the fraternity believe

has led to some poorly thought-out decisions just like the Maharashtra example I just gave you. Let me give you a quick overview of how the NMC is structured. Like I mentioned a little while ago, it comprises four autonomous boards, Marb being one of them.

Altogether, there are 19 key posts across these boards. Today, as things stand, only nine posts are filled so far. Eight of those posts are held by part-time members who've already completed their tenures. Now, it isn't unusual for there to be vacancies in government departments like these. But the thing is, these bodies are meant to be independent. Kvi Babu, an ophthalmologist from Kanur Kerala explained to the Ken reporter Alifia Khan why independence is so important here. It's pretty simple actually. If there's

just one member on the committee that is approving new medical colleges, then who will order inspections, scrutinise and finally approve them? When Alifia asked B.N. Gangadhar, the current chair of the NMC, why it was taking this long to fill out all these different posts, he didn't give too much away. He said that at present, all of these appointments are in process. But while the NMC takes its time, these vacancies have led to a whole host of problems for the medical fraternity. It seems like the body that was meant to cure medical education in India

is dealing with a chronic illness of its own. But is it terminal? Welcome to Daybreak, a business podcast from the Ken. I'm your host Rahil Philippos, and I'll be joining my colleagues Nikta Sharma every day of the week to bring you one business story that is worth understanding and worth your time. Today is Tuesday, the 3rd of December. Since the primary role of the NMC is to regulate medical education,

let's take a look at where things stand in that department. Well, Alifia spoke to multiple doctors and former NMC members and the running concern among a lot of them is the rate at which the NMC is approving medical colleges and courses. Kiran Madhalla, national coordinator of the All India Federation of Government Doctors Association, pointed out that some states, particularly in South India, just don't need any more medical colleges. They have way more seats than required.

Like in the case of Maharashtra, the doctor-to-population ratio is where it needs to be, or in some cases, even better than that. Yet, in 2024 alone, five southern states, Telangana, Andhra Pradesh, Karnatica, Tamil Nadu and Kerala, got 12 new medical colleges. Now, apart from the fact that there are several other states that actually need more medical education, the big problem with setting up a bunch of new institutions is that there's. just isn't enough faculty to go around. In fact, Kieran said that what ends up happening

is that the same faculty is rotated and shown on fake documents. He says that this is an open secret within the medical fraternity. These fake teachers are actually widely referred to as ghost faculty. And it's not just faculty that is missing. These fancy buildings are built, but there isn't enough equipment or drugs. And more often than not, it is junior doctors that are made to work in these hospitals, attached to medical colleges, both government and private.

These are young doctors still learning the ropes. But they are being put in ill-equipped hospitals with minimal infrastructure and a lack of proper supervision from seniors. I think you know where I'm going with this. Now, the government is cognizant of this problem. In fact, in February 2024, a parliamentary standing committee report even made note of it. In its report, the committee said despite NMC's efforts to install surveillance cameras and enable a biometric attendance system, the problem of GOS faculty has only increased.

The NMC did try to address this issue. They imposed stricter rules, like doubling the faculty numbers and beds to set up new medical colleges. But they had to backtrack later. Now, all of this comes back to independence. A former NMC, a former NMC, member whose tenure recently ended told Alifia that these boards are meant to be autonomous. They should be able to take these big decisions. But in their absence, the NMC has just become a body that toes the government line. Now, I'm sure you've heard Prime Minister Modi say that the government's goal is to add 75,000 new medical seats across the country over the next five years.

By relentlessly approving these new medical colleges, the NMC seems to be taking that goal very seriously. But the manner in which these approvals are being made has raised some eyebrows. At least four medical professionals, Alifia spoke to, said that they've been made without any inspections and based on self-declarations. What that means is that the NMC's policy allows it to approve a medical college if it claims to have the required faculty and infrastructure, even without conducting a physical inspection. So generally, the commission decides whether to approve a college based on a digital inspection. Now, this is quite unlike the erstwhile Medical Council of India, which was far more

particular about carrying out a site inspection prior to approval. In the NMC's case, it may carry out one later, even in a couple years after said approval is granted. Now, that's a pretty risky bet from a student's perspective. Because hypothetically, it means that a college is given the green light without having proper infrastructure or faculty in place. Medical practitioners feel this is the result of a quantity over quality problem. The sentiment was also echoed by Kieran Madhava,

who also happens to be a professor at Sikandrabah's Gandhi Medical College. He said that in the last four years, there's barely been a single inspection by the NMC at the college. People in the nose say that the fact that multiple roles are lying vacant does have a big role to play. But there's also the fact that the four boards that form the NMC don't seem to get along. Two former NMC members told Alifia

that there are some major discrepancies in the working of the boards. More on that in the next segment. In December 20203, a strongly worded letter was shot off to the health ministry by Wipul Agarwal, the former secretary of the NMC. He complained that the boards

were acting independently of the commission, which he wrote ultimately led to poor transparency and accountability. He wasn't the only one who noticed, this. You see, the NMC's main council would meet up every two months and it was at these meetings that members could bring up their issues. Generally, the board would take a decision and then put it before the council before notifying it. But a former member Alifaya spoke to said some board started acting independently. They were putting out notices without the committee's

approval. For instance, the UG board once fined a medical college for certain shortcomings, But then the PG board granted the same college additional seats. So these boards just did not seem to be in sync. When Alifia spoke to Gangadhar, the chair of the NMC, he said there wasn't really any infighting, but he did agree that the coordination between the boards could be made better. One of the other concerns among state-level medical professionals is that the NMC, unlike the Medical Council of India,

had poor representation of states. You see, the former body had over 110 members. And generally, whichever state had more medical colleges, the larger would be its representation in the board. But the current NMC structure only allows a total of 33 members, which includes the presidents of its four boards, most of whom are nominated. Put simply, not more than six to seven state medical councils

get representation at the national level. What that means is that every state gets a representative only every three to four years. So who then represents the concerns of the other states? As one of its former members puts it, it is a structural issue. And then on top of that, we have the vacancy issue. Typically, a vacancy in any of the NMCs boards

has to be advertised at least six months before the sitting members' term expires. But that isn't always the case. Take the ethics and medical registration board, for instance. Four out of five positions lay vacant, but it wasn't until November, more than a year after the member's tenure's laps, that the posts were actually advertised.

Kvi Babu, the ophthalmologist from Kanur, Kerala, that we quoted earlier, also happens to be an RTI activist, and he made a very valid point. He said, if a majority of the posts are awakened, who then will look into cases of professional misconduct of doctors? Babu has fired over two dozen such applications with the NMC over its vacancies and other shortcomings in the last two years. But until these seats are filled, chaos becomes the new order for India's medical colleges.

Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform. What you're listening to is just a small sample of our subscriber-only offerings. A full subscription unlocks daily long-form feature stories. newsletters and podcast extras. Head to the ken.com and click on the red subscribe button on the top of the website. Today's episode was hosted by Rahil Filippos, produced by me Snikda Sharma and edited by Rajiv Sien.