Dr. Mohan Ram, classmate, friend and now a colleague, came to office in the morning and he was agitated. Now, Mohan is the just the opposite of me, not given to emotional ranting or outbursts. The reason for his losing cool is the proposed legislation (National Medical Commission bill) which was passed in the lower house of parliament yesterday.
Some of the proposals in the bill are commendable, which should have been brought in a long time ago. The problem is how they are proposing to do it. The Medical Council of India which oversees all Medical Education in the country is corrupt beyond imagination. Few years back the chief of the council was arrested after half a ton of gold and other assets were seized from his house. The essay is not about that.
One of the proposals in the new bill is allowing people from medical industry to practice medicine after making them go through a crash course. I am not making this up. The section I think it is 32, states as follows:
Community health providers: Under the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine. These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare. In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.
Who are these mid-level practitioners. Mohan Ram is saying the interpretation is, if you are a nurse or a pharmacist or optician you can take this course, pass it and put a board Dr. AAA and start a medical practice. No wonder this has hugely upset doctors who have gone through the grind, spent hundreds of hours in studying and in residency to call themselves ‘Doctors.’
Till a few decades back, in India, we had these doctors called RMP (Registered Medical Practitioner). While some were good most of them had dubious credentials and it took years for the government to get rid of them. Now we are finding a way to bring them back with an act of Parliament. Why? Because we want to solve the problem of abysmal doctor to general population ratio in India. I will come to that in a minute. First a scene from Mohammed Bin Tughlaq, a Tamil political satire movie which came in 1971. The movie featured Cho Ramasamy who also directed this brilliant film.
In the movie, Cho and his friend appear one day in public and declare that they are actually Tughlaq and his aid Batuta. They con the people and Tughlaq becomes Prime Minister of the country. Now as the PM, he has to solve the problems faced by the people and he goes about the job in full earnest. One of the problem he solves is the Language problem. This was a period when anti Hindi agitation was at its peak. The scene:
Members of Parliament from North and South give their opinion on national language; while the MPs from North insist on Hindi the MPs from South say it should be English. After listening to both sides, Tughlaq declares, “OK I have listened to you. I declare that Persian will be our National Language.”
Now everyone is agitated and ask him how this is possible? Tughlaq explains, “This is one language everyone has to learn. North Indians will be happy that now people from South also have to learn a new language and people from South will be happy that North Indian language has not become the national language. “
The members continue to agitate and one of them declares, “Every country has its own language. People in China speak Chinese and in Russia they speak Russian.”
Tughlaq replies, “If you can go to China and Russia just to quote and example you can go to Persia to learn a language. Nothing wrong. I have solved the Language problem. What is next?”
Developed countries of the world spend about 4% of their GDP in public health. In Europe and UK the government take care of public health from minor fever to major surgeries. We spend a fraction of our GDP on health and for a country which had socialism as governing principle we depend on private healthcare providers to take care of our medical needs. While the population was growing at breakneck speed we had only handful of Medical Colleges in India so the doctors to population was coming down all the time. So Government allowed private institutions to teach medicine which only the super rich could afford. The private hospitals mushroomed and though it addressed the needs, the cost of treatment went through stratosphere. The insurance companies pitched in and the hospitals raised the fees even higher thinking the cost is paid by insurance anyway. So this unholy alliance of pharmaceutical, hospital and insurance fed on each other’s greed. Just like Military Industrial complex alliance, this new alliance has become a powerful one. The government instead of being a watchdog, just watched all the happenings, happy that someone is taking care of what they are supposed to do i.e. provide basic amenities to the people who voted them to power.
One fine day the government woke up to the reality and wanted to set this mess alright. First they declared there would be an entrance exam which will be common to all the states. Only those who qualify, can aspire to become doctors. It was the supreme court which actually trigged this. Any sensible government would have explained that we can’t have a common test across the states at all level till we make the quality of education equal. No student from a poorly run, infrastructure leaking government school will have the same level of knowledge like the rich kid who passes out from the elite schools. So we will draw a roadmap and get these schools to a minimum standard and then we can have these tests. In eight or ten years (actually it would need more) they could have trained the teachers from these rural schools, provided them infrastructure (labs etc.) and coached them so eventually we will have level playing field at least close enough field. No they did nothing like that. They just passed the legislation and the results are there for everyone to see.
Not a single student from Government run school could clear the entrance test in Tamil Nadu, my native state. There must be hundreds of students in Tamil Nadu and millions across India from these school who would have nurtured an ambition to become a doctor. They had scored about 99% marks in the final exams but failed in the entrance test, because they could not even understand, in some cases the questions. In one full swoop, the government killed their ambition and drive. The rich kids or at least affluent and middle class go to coaching classes and clear these exams. How can poor people compete with this elitism?
The next target for the government is to pass the doctors/population ratio. But this is a very difficult task. Creating teaching hospital require huge infrastructure, faculty and other resources. There are great medical schools in India; BJ, Miraj and KEM in Maharashtra, Staley, MMC and KMC in Tamil Nadu are just a few examples readily come to mind. There must be equally good colleges across the country. Even if the government had decided to build these type of medical schools from the time we breathed free economy in the nineties we could have built hundred colleges across country like this. As usual nothing was done except allowing private medical colleges which did not serve the very purpose of what teaching hospital should do.
So they have found a quick fix and passed a legislation saying, anyone who is associated with the industry can practice medicine by passing a six months bridge course. Does this ring a bell? Yes exactly how Tughlaq solved language problem. So when next elections comes they can proudly declare, “from one doctor for hundred thousand people, our government has improved the situation to one doctor for every hundred people. That is a thousand fold increase in 5 years. So vote us back to power.“
On the one hand we are making it difficult for everyone to get into Medical school. Only the brightest with deep pockets can get in. Oh yeah we have an exit exam also coming in. So you just can’t get in and ace all the exams. We will check if you have really studied for five and half years. Only then we will allow you to practice. This will allow us to produce a couple of thousand great doctors. Oh sorry but we need not thousand but hundred thousand doctors. No problem, we have licensed everyone to practice medicine, even if the guy has stood as a watchman in hospital compound for couple of weeks.
Yes. You have a choice. Either you can go to world class doctor (for the privileged) or go to one of the quacks that we will produce in millions.
As a natural progression we will solve all the problems that we face in the same manner. Shortage of Engineers? No problem! Anyone who has done plumbing work for two years can become an engineer after passing the bridge course. Shortage of lawyers? No issues. If you have worked as driver to leading lawyer for two months you can take our bridge course to become a lawyer. Judges shortage! Why are you even saying this. Anyone who has typed judgements in the court for six weeks can become a judge. But mind you. You have to first pass the test.
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Thanks Ramesh for writing this blog. This is jugaad at mass level. Taken to new heights. The nexus in the industry will get stronger too