Teaching Shops Of Medicine

Before the guards began shouting at us, we jogged through. Every ward was locked. There was no electricity, no equipment바카라�just a few stretchers inside locked wards, furniture piled on top of them. No ceilings, no glass panes. It was like being inside a big, concrete pipe-organ바카라�the wind whistled through, blowing dust around.

DJIMSR had applied to the Medical Council of India (MCI) to start an MBBS course this September. Records show the hospital was set up in 2010; it had first applied for permission to start a college in 2012. They were denied permission every year, including in 2016. In August, the Supreme Court-appointed Over­sight Committee (OC) headed by Justice R.M. Lodha also turned it down. The DJIMSR website shows a host of facilities, but lists no phone numbers. When Outlook visited the chairman바카라�s office, we were told he was not available. They never got back. The telephone number medical superintendent Manoj Govil had submitted to the MCI turned out to be a wrong number. The principal listed in the MCI forms told us he no longer works there.

DJIMSR is just one among hundreds of private 바카라�medical colleges and hospitals바카라� that exist out there바카라�claiming, almost magically, to operate. Don바카라�t ask about infrastructure, faculty or patients. But do ask how they manoeuvre the system to open 바카라�medical colleges바카라� and churn out batches of young doctors. Out of 10 lakh registered doctors from 400 colleges in India, thousands have got their degrees from institutes that function as little more than teaching shops. The traditional picture of medical education바카라�a robust hospital with a large clientele, organically developing an associated medical college바카라�does not apply automatically now. Today, colleges are set up almost immediately after hospitals are opened. They may have no patients for students to practise on. But if you have the money, a piece of paper certifying you as an MBBS awaits you at the end of five years .

This May, the Supreme Court had come down heavily on the MCI바카라�the apex body responsible for regulating medical colle­ges바카라�and declared that under it, the system fails 바카라�to produce a competent basic doctor바카라�. That바카라�s when it set up the three-member OC, to go through MCI recommendations. Just as well, for this is an entity famed for its corruption, with over 3,000 cases pending against it around India. And yet, the granting of permission to medical colleges isn바카라�t vulnerable to corruption alone. Criteria of judgem­ent differ; it바카라�s a delicate balance bet­ween quality and availability.

Proof of this deeper tension came when the OC, in a decision that surprised many, overturned the MCI ban on 63 colleges, opening up nearly 8,000 seats (see 바카라�It바카라�s Inspector vs Inspector바카라�). And it did so on the basis of self-assessments by colleges and their web­sites. 바카라�What colleges show us is the Taj Mahal,바카라� says MCI head Jay­sh­ree Mehta. 바카라�When we go there, it might be locked up.바카라� But Justice Lodha insi­sts there바카라�s 바카라�no compromise바카라� on quality. What governs this move towards partial relaxation is, of course, the acute shortage of doctors in India. The doctor-population ratio in India stands at 1:1674 whereas the WHO norm is 1:1000. While 8,000 young students may be moving fast to fill these new seats, they also risk being suddenly cast adrift바카라�these colleges can lose their permissions anytime after October if a spot-check by the OC finds them lacking.

Take a case where the OC overturned an MCI ban: NC Medical College and Hospital in Panipat, Haryana. With MBBS classes slated to begin this month, there is a lot more life here. It has a building with running electricity and equipment. Nurses sit around chatting. It has one thing in common with DJIMSR, though: no patients, no doctors in sight. After a flurry of activity in the administrative block, the chairman and principal meet the Out­look team but refuse to take questions. The principal says they are busy preparing for a 바카라�surprise check바카라� (sic) by the affiliating unive­rsity (PBDSUHS, Rohtak) the following day. How does she know in advance? She doesn바카라�t answer.

They are hiring, big time. Some 100 young men are filling up forms to join as tutors or junior residents. Many from Kerala, Telan­gana and Haryana itself바카라�rec­ent graduates from universities in Russia, Ukraine and China바카라�are signing up for Rs 50,000-60,000 a month. 바카라�There aren바카라�t many people who live around here,바카라� says a young doctor, exp­laining the absence of patients. 바카라�But since we바카라�re on the highway, we may get accident cases.바카라� Why come all the way from Andhra Pradesh? 바카라�Work here will be less stressful. We are anyway preparing for our PG ent­rance test. We바카라�ll stay here for a while and see if it works out.바카라�

In Israna village nearby, some are happy that healthcare is now nearer home. Others are unimpressed. 바카라�We can tell if it is a good hospital based on how many patients go there. Whenever I went there, it was pretty empty,바카라� says Ram Kumar, a grocer. One might imagine a private hospital is expensive for villagers, but they all say tests바카라�from X-rays to ultrasounds바카라�and treatment are mostly free. The college has filled all 150 of its new MBBS seats. A week after Outlook바카라�s visit, the college has a new principal. Dr Mukesh Yadav says the hospital had been running losses in crores and the OC바카라�s perm­ission came as a surprise. 바카라�We are working on a war footing to improve morale,바카라� he says. 바카라�To attract faculty to this remote area, we offer higher salaries, good facilities. We organise buses to bring poor patients.바카라�

Last year, Dr Raj Bahadur received an SMS he wasn바카라�t expecting. The message said a college in Andhra Pradesh was inviting him to engage classes for two days, as a professor. On offer: Rs 4 lakh. Bahadur is the vice-chancellor of the Baba Farid University of Health Sciences in Faridkot, Punjab. 바카라�It came from an unkn­own number, and had no contact details.  It must have been an agent who was sending out bulk messages to doctors listed on a database, hoping to trap some,바카라� he says.

This practice has caught on. 바카라�Doc­tor-hop­ping바카라�, they call it바카라�doctors fly in and out of medical colleges around India, posing as staff and faculty. They are paid well and disappear after their cameo appearance. A retired government orthopaedic surgeon says, 바카라�I can actually moonlight and earn 10 times the salary I get every month.바카라� A sharp MCI inspector can see through it, though. An MCI report on a college had these words: 바카라�The resident doctor claimed he had been working there eight months. But he was unable to name a single colleague.바카라�

The shortage of faculty in India바카라�s medical colleges바카라�over 35 per cent바카라�stares at the authorities like the symptom of an acute disease. A report of the National Commis­sion for Macro­econo­mics and Health says, 바카라�Even state governments feel compelled to indulge in irregular practices­바카라�mass transfer of teachers of different speci­alties from one college to another on a temporary basis바카라�at the time of inspection. Keeping fake rolls of teachers and showing expenditure under the salary head is common.바카라�

Students at a medical college in Karnataka, recall how their cam­pus would come abuzz every time on insp­ection day. The college always seemed to know in advance. 바카라�We바카라�d see seniors and old friends...they candidly say they바카라�d come for inspections. The college usually calls in local graduates or those preparing for their PG,바카라� says an ex-student, who is now preparing for his own PG exams. After his MBBS, he had worked at a hospital in Kerala, where he saw another version of the game. 바카라�I worked in the casualty ward but they paid me Rs 30,000 in cash for three days to pose as a faculty member. I wasn바카라�t keen but was persuaded by colleagues,바카라� he confides.

Dr Imtiaz ul Haq, the principal, has been an MCI assessor himself for many years. He supports the idea of inspections. Asked about what former students say, he answers, 바카라�I have been in charge here since 2013. Maybe these dishonest practices were happening earlier, not in my time.바카라�

As president of the Punjab Medical Council, Dr Gurinder Singh Grewal found a high traffic of doctors bet­ween his state and Himachal Pradesh. Cross-checking TDS papers against the time doctors were registered in Punjab, Grewal was able to weed out hundreds of doctors who had been popping up in Himachal colleges around the time of inspections. Several show up on the rolls of Maharishi Markandeshwar University (MMU) in Solan, for example. 바카라�Unless they have a helicopter, there is no way they could be running clinics here yet teaching there. If you start searching for thieves here, you almost end up finding RDX. That바카라�s how corrupt this field is,바카라� he says.

As per the Indian Medical Council Act, a doctor can practise anywhere in India. State councils like Punjab바카라�s also ask doctors to register themselves in any new state they work in, to ensure that doctors don바카라�t fly through hospitals and colleges for brief periods. As per the MCI rules, a doctor can바카라�t be on the faculty of more than one college in the same year. If caught, they risk losing their place in the Indian Medical Register. (Shrewd doctors have, of course, found ways to work around this.)

At MMU, dean Dr Kiranjeet Kaur, also principal since 2014, has been served a notice by the Punjab Medical Council for not having registered herself in Himachal. 바카라�Himachal Pradesh is not a big state, so we can바카라�t get all the faculty we need here,바카라� she says. 바카라�Most of our doctors eventually get admitted to the medical council here. If not, it still doesn바카라�t make them culprits. I don바카라�t think there바카라�s any hard and fast rule.바카라�

The parliamentary standing committee on health and family welfare puts its finger on a key enabling factor. Its 2016 report said, 바카라�Medical colleges have prior information of inspection dates and are thus able to keep ready the required number of ghost faculty and fake patients.바카라� They called it out for being among the 바카라�worst kind of gross unethical practices.바카라� Hospitals and attac­hed colleges are required to maintain a certain ratio of students to doctors and pat­ients. 바카라�Our college would go pati­ent-shopping, looking for 바카라�interesting바카라� cases, who바카라�d be brought to campus during MCI inspections. On these days, where there was usually enough room to play football, there would not be space to even drop a pin,바카라� says the doctor from Karnataka.

Students from Bangalore to Hapur talk of a similar mode of operation. Nearby villagers are often lured with free medical camps. Bulletin boards at NC Medical College in Panipat display newspaper reports on their free health camps. The Karnataka graduate adds: 바카라�In my five-plus years at the college, I never saw a single patient in the burns ward. The ICU has a capacity of eight beds but it would be full only during inspections. As interns we even picked them up ourselves from government colleges. Contractors also helped bring patients in buses.바카라�

But a fake patient is not fully packaged until she is also accompanied by a full case file of her medical history. MCI assessors often check these. The Karnataka graduate recalls, 바카라�Only a few interns would be posted on duty, the rest of us stayed back writing up fake case files. Ten of us would write nearly five files a day. Just imagine, in a month we create case files for at least 1,500 patients, who simply didn바카라�t exist. The assistant professors would give us the diagnosis and we would work backwards to write imaginary case histories that fitted the diagnosis. We wrote fake details on everything from height to bowel movements.바카라�

Again, it does not always work. Seasoned inspectors check for freshness of paper, similarity in ink and handwriting, says an assessor from a private medical college in Bangalore. 바카라�When I am on inspections, I might see records for supplies showing a large number of items. But if I suddenly call for, say, 바카라�Paraffin block number 1357바카라�, they would not be able to produce this immediately if they바카라�d fudged their books.바카라� she says.

India바카라�s demand-supply dynamic in medical education is heavily skewed. The gover­nment and medical fraternity see this as  a key factor that spurs on the competitive market of corruption. A health ministry official explains that creating more medical seats and fast is priority. At present, there is a bottleneck between undergraduate and postgraduate levels, with only 25,000 PG seats available against 55,000 UG seats. 바카라�Supply is of a pyramidal nature. This means thousands of students will just not get seats. We need to increase seats바카라�and through private medical colleges. Then even cost of education will reduce,바카라� he says.

This urgency is what has changed the policy perspective. The traditional 바카라�inspector raj바카라� model of the MCI is being challenged by almost everybody, including the health ministry, NITI Aayog, the standing committee and the OC. MCI inspections are tedious; checks for 바카라�minimum standard requirements바카라� run to things as minute as the thickness of partition walls, distance between two beds, the number of books and journals in the library or if the lecture hall is set in a gallery formation or not. The standing committee says such rigidity, in fact, motivates colleges to cheat. 바카라�Despite all these tight controls, can anyone say from their heart that the quality of medical education has improved?바카라� asks the official.

A rush for quantity is risky turf. A draft bill prepared by NITI Aayog in August to rep­lace the Indian Medical Council Act, 1956바카라�currently inv­iting comme­nts바카라�says there should be no ceiling or regulation of fees, for-profit organisations should be allowed to set up medical colleges and the practice of shutting down colleges that fall short of requireme­nts should give way to a market-oriented policy in which all colleges would merely get a rating. Students with money will be free to sign up even at the worst college. 바카라�Deviation from standards need not necessarily result in derecognition,바카라� says NITI Aayog.

 Medical education operates on a peculiar business model. Colleges charge a bomb for admission, but function as teaching shops, offering little to the student exc­­ept the cer­tificate. And yet, they offer free or subsidised healthcare to the few poor and rural patients who come in, as Outlook observed in the colleges visited. Herein lies a hint. One would imagine the money for faculty, staff and infrastructure comes from a bustling hospital spanning 20 acres바카라�the minimum prescribed norm. But a pharma specialist in Bangalore expla­INS: 바카라�The hospital is never the money-maker. They start colleges because it is from here that they expect money to fund everything else.바카라� The possibility of earning crores via illegal capitation fees explains their impatience to start a college even when the hospital may not have pati­ents for students to learn on.

바카라�When we graduated, we came out of the college worse than when we went in,바카라� says the graduate from Karnataka. 바카라�Where we studied would not even qualify as a nursing college.바카라� For a young student preparing for a life in healthcare to say this should alarm us to the imm­inent and long-term danger to public health. It may be easy to pin blame on single institutions or individuals for this spectre of total systemic collapse, but the reality is that this situation was brought about by failure at several levels over decades, especially by governments at the Centre and in states. Somewhere, the system needs to find a way 바카라�to produce a competent basic doctor바카라�.

By Anoo Bhuyan in Ghaziabad & Panipat