Letter from Chennai

INDIAN MEDICOS FROM UKRAINE

The Russian invasion of Ukraine has raised many problems for India, but one has affected Tamil Nadu more than any other part of the countiy. Eveiy state in India except ours has accepted the National Eligibility cum Entrance Test (NEET) as the ideal test to equitably decide on the merit of candidates from different examination systems to enter medical colleges. We have resisted this. I have discussed this in many of my previous letters and will not go into it again, except to reiterate my view that, while NEET is not really ideal, there is no obviously better method, and it is only sensible for us to cease making representations to government and courts to exempt Tamil Nadu. Whatever the reason, more students from here seek medical degrees from other countries than those from other states in India. China, particularly Wuhan, and Ukraine are the most popular places, and there seem to be many more Tamil students in Ukraine than in China. Two years ago, a student from Kerala returned from Wuhan when his university closed down due to Covid-19, and brought home the virus concealed in his body. There was no public furore at that time, and I assume this was because there are fewer Tamil students in China than in Ukraine.

The students from Ukraine are almost all back home now. They suffered considerable privations during their journey, and also experienced colour prejudice as they competed for transport and limited supplies with white people. However, they are now safely back home, and the question of their future arises. Our Prime Minister (PM) has already appealed to all states to increase the number of medical seats in the country so that no one need go abroad for undergraduate medical education. Tamil Nadu’s Chief Minister (CM) says the whole problem has risen because of NEET, and this should be abolished forthwith. I have no standing to question my two leaders, yet nagging doubts arise.

The President of the Tamil Nadu Medical Council, Dr K. Senthil, was quoted by The Hindu as saying that there are 90 000 medical seats and 0.9 million (9 lakhs) students take the NEET examination. That means that 90% of medical aspirants do not get admission to our medical colleges. Does our sympathy for the travails of our refugees from Ukraine override the claims of the 0.81 million (8.1 lakh) students who accepted the NEET verdict and took some other choice of career? Has the PM thought over how many more medical seats we must create to accommodate all of them? Do we have the wherewithal in the government (state and Central) or the private sector? And while the CM finds it politically convenient to rail against NEET, can he accommodate all the medical aspirants from those who pass the State Board examinations? His thesis is that they would not have gone abroad for studies if not for the cruelty of NEET.

An occasional student who fails to qualify in the NEET commits suicide, and our politicians immediately raise an uproar against NEET. These suicides have nothing to do with NEET. Perhaps because of parental pressure or their own unreal expectations, even from my student days some youngsters who fail to get a coveted admission or who get admitted and then fail an examination have killed themselves.

A government release states that 1921 students from Tamil Nadu went to Uraine for medical studies; 1890 have been evacuated, and the state paid the expenses of 1524. However, 366 met their own expenses and 31 decided not to return.

Dr Ravi Wankhedkar, a former president of the Indian Medical Association (IMA), told The Hindu that students who graduate overseas have to clear the Foreign Medical Graduates Examination (FMGE) here before they can register and practise in India, and only 20% of candidates pass this examination. What happens to the remaining 80%? Do they hang up a board and practise illegally, as so many compounders and quacks, or do they find another profession? I know one candidate whose scores were inadequate to get into a government medical college, and whose parents were affluent enough to pay for entry into a college in Moscow, much cheaper than our capitation fee colleges. He studied there in the English language. He says the standard of education there was as good as in our colleges, though the clinical material was far less than in our colleges. He did creditably in his examinations there, then passed the FMGE, one of just 15% that year. He was good enough to go on to obtain a postgraduate degree in medicine and then in one of the sub-specialties (I think the term super specialty smacks of arrogance. We actually know about a smaller part of the human body than does a general physician.) That should place him in the 90th percentile among Indian doctors, at least. He is now a consultant in his specialty. He does not wish to be named. He thinks the FMGE is unnecessarily difficult. With 80% to 85% failing, that leaves a large number of unsuccessful people who apparently pass the qualifying examinations of other countries and get jobs there, and he knows of many who work in the UK or other European countries and some in the USA or Canada. Some people keep trying and ultimately get through the FMGE on the third or fourth attempt. Some settle for paramedical professions such as laboratory medicine or hospital administration, and some just hang up a board and practise anyway.

He put me in touch with one Mr Rajat Sharma of Haryana, who got out from Uraine with difficulty and is now back home. His education was also in the English medium. He feels there is less pressure on students there because they face evaluation at shorter intervals and do not have to face a major examination with the material of several years to be studied. He says there is less spoon feeding, less is taught and students are expected to read more on their own, though they have to pass the periodical tests. If they fail, they have to catch up with the subject within 6 months. He admits that some of his contemporaries were distracted by the pleasures of life in the more developed countries and did not work hard enough.

Both these gentlemen felt the students from Ukraine should be admitted to medical colleges here and allowed to continue their studies in India. This is what both the PM and my CM want, and it raises a question. There must have been a number of other aspirants who scored as much as these two, but could not raise the funds for a private college here or even the lesser but still large amount for education in Ukraine or Russia or China. They perhaps went on to other courses of study and other professions. Some may have realized that medicine is not necessarily the best profession for them and might be happy with their second choice, but many might still feel that they would have preferred to do medicine. Would it be fair to them to now admit people who might have done just as well or not as well as they into government medical colleges? For that matter, would it be fair to those who are in the government colleges now, who are already struggling in overcrowded classrooms with an inadequate number of teachers?

The PM wants to have enough medical seats here to admit everyone who wants to study medicine. My CM wants to abolish NEET. Would they provide admission for every youngster who wants to study medicine, or would they still have some sort of qualifying examination for medical admission? What if someone who fails in that qualifying examination commits suicide? In an ideal world, every young student should be able to take the profession he or she wants, and should find a place near home to get trained for that profession. Would the PM and the CM then say there should be no test of his or her suitability to practise the profession after training?

Meanwhile, some 1500 doctors who were employed on a temporary basis to tackle the Covid surge are now facing unemployment. They are agitating for the government to absorb them into the permanent service. The government has no funds to employ so many more doctors permanently. If government service is so desirable, what will the additional surge of doctors from Ukraine do when government jobs are not available? If there are inadequate opportunities for doctors to make a good living, and if they feel government jobs are so good, what will happen when thousands more enter the profession and compete with them?

There are a few facts we have to take into account. The people need doctors to treat them, and those doctors should have a certain standard of skill and care. That means they must be properly trained, and should then be tested to make sure they have the required ability to be let loose on the public. The government has the responsibility to ensure that. It is not fair to a candidate to let him into a course of study if he does not have the capacity to absorb what he is taught, and we should not lower the standards of medical teaching and examinations to allow substandard students to pass and then treat the public.

When I was a junior doctor, the then CM was annoyed with the profession because too few doctors were willing to go to villages. In a speech at one of the medical college functions, he said he would open so many medical colleges and produce so many doctors that they would not be able to earn a living in the cities and would be forced to go to the villages. If the PM and the CM have their way, we will perhaps have so many doctors that we will have the ideal population-doctor ratio, but how good will they be? Meanwhile, most of the politicians I know flock to the best private hospitals when they fall ill, and seek the best doctors. I will feel reassured about the system when all politicians, and senior government servants, go to government hospitals for their treatment.