What’s the news?

• The demand for doctors exceeds the supply in large parts of India.

Central idea

• The demand for doctors in India consistently surpasses the available supply, while the pursuit of medical education often outstrips the number of seats available. Reducing this demand-supply gap in medical education has proven to be a challenging endeavor, with potential implications for the availability of healthcare professionals.

Expanding Medical Education

• Over the last decade, India has made significant strides in expanding medical colleges and seats at both undergraduate (UG) and postgraduate (PG) levels.
• UG seats have nearly tripled, PG seats have almost quadrupled, and the number of medical colleges has doubled since 2010-11.
• Despite this expansion, in 2021, India had only 4.1 medical graduates per lakh population, falling behind countries like China, Israel, the US, and the UK.

Challenges in scaling

• Regulatory and Financial Constraints: On average, Indian medical colleges offer 153 UG seats per college, significantly fewer than Eastern Europe (220) and China (930). This discrepancy is a result of regulatory and financial constraints.
• Infrastructure Limitations: Expanding UG seats in a public medical college from 150 to 200 required additional resources, such as a larger library, increased daily outpatient department (OPD) footfalls, and more nursing staff, as per the draft guidelines for establishing new medical colleges in 2015.
• Quality Maintenance: Concerns that disproportionate scaling can impact the quality of pedagogy and, subsequently, the quality of doctors produced
• Faculty Shortages: Both public and private colleges face teaching faculty shortages, despite better remuneration structures in public colleges. Scaling up can further strain the already limited pool of qualified teaching staff.
• Economic Viability for Private Colleges: Investing in scaling can be risky for private colleges if seats remain vacant and costs aren’t recovered. This can lead to high capitation fees and price distortions.
• Curriculum Limitations: The nature of the competency-based curriculum dictates constraints on scalability. For example, there can’t be more than 15 students surrounding a bed or in any other practical class.
• Equity Concerns: The goal of producing doctors evenly across regions might not result in efficient production. Migration of doctors from states with higher production can be an issue.

Value addition box

Quality vs. Scale vs. Equity: A triad of challenges

• Quality:
• Ensuring the highest standards of medical education, which translates into competent, skilled, and ethical practitioners.
• The competency-based curriculum in India requires small-group teaching to ensure a thorough understanding and hands-on experience for students.
• There’s a concern that rapid scaling could lead to a decline in the quality of education and subsequently the quality of doctors produced.
• Quality assurance becomes even more critical given the life-and-death implications of medical practice.

• Scale:

• Increasing the number of medical graduates to meet the country’s healthcare needs.
• Despite the expansion of UG and PG seats in medical colleges, the demand-supply gap persists.
• Regulatory, infrastructural, and financial constraints pose significant challenges in scaling up.

• Equity:

• The National Medical Commission prioritizes an even distribution of medical colleges and seats. They aim for localized doctor production to ensure different regions have adequate healthcare.
• Policies such as the cap on UG seats and the location restrictions of new colleges highlight this focus.
• However, this might not lead to efficient doctor production due to phenomena like interstate migration of doctors.

Way forward

• Regulatory Reforms: Streamline regulations to facilitate the establishment and expansion of medical colleges while ensuring quality standards.
• Faculty Development: Prioritize investment in faculty development programs to address shortages and retain experienced educators.
• Technology Integration: Embrace technology to enhance scalability and access to medical education, including e-learning and telemedicine tools.
• Competency-Based Curriculum: Continue to implement competency-based curricula to produce doctors with practical skills and real-world readiness.
• Incentives for Rural Service: Develop and implement policies that incentivize medical graduates to serve in underserved rural areas, addressing healthcare disparities.
• Public-Private Collaboration: Foster collaboration between public and private sectors to expand the availability of medical education seats and improve educational infrastructure.

Conclusion

• Bridging the gap between the demand for doctors and the supply of medical education is a multifaceted challenge in India. To meet the growing healthcare needs of the population, policymakers must carefully consider the trade-offs between quality, scale, and equity in medical education.

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