More Population, more medical colleges, less population, less medical colleges- Is it good for advanced states?

Chennai: With the defining of medical colleges as per the population in the National Medical Commission's UG-MSR Regulations, 2023, states having more population will have more medical colleges and the states which have less population ratio will be having lesser number of medical institutes.

With this rule, the Southern States of India such as Tamil Nadu, Karnataka may lose their eligibility to apply for any new government or private medical colleges or add more than 150 MBBS seats in the existing medical colleges.

This is due to the National Medical Commission's (NMC) rules regarding the prescribed ratio between the population and the number of medical seats in a particular State/UT. Further, the Apex Medical Commission also clarified that the colleges seeking increase of medical seats cannot exceed a total of 150 MBBS seats from the next academic year.

Medical Dialogues had earlier reported the "Guidelines for Under Graduate Courses under Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations, 2023" were published in the official Gazette on August 16, 2023.

These guidelines specified that the intake capacity for the new medical colleges being set up from the academic year 2024-2025 will be restricted to a maximum number of 150 MBBS seats.

These guidelines also clarified that colleges seeking an increase in the number of seats cannot exceed a total of 150 MBBS students from the year 2024-25. However, NMC has offered an exception to the colleges who have already applied for the academic year 2023-2024 for increased seats but failed to get the same. It mentioned that such colleges can ask for the same number (totalling 200 or 250) that was in their previous application for one time in the year 2024-25 only.

Meanwhile, these guidelines also specified that the medical colleges have to follow the ratio of 100 MBBS seats for 10 lakh population in that concerned State/U.T.

Also Read: NMC Notifies Guidelines for MBBS Course under Establishment of New Medical Institutions, Starting of New Courses, Increase of Seats, Assessment and Rating Regulations 2023

"After A.Y. 2023-24, Letter of permission (LOP) for starting of new medical colleges shall be issued only for annual intake capacity of 50/100/150 seats; Provided that medical college shall follow the ratio of 100 MBBS seats for 10 lakh population in that state/ U.T.," stated the Guidelines.

Tamil Nadu has a population of a little more than 8 crore. Earlier this year, the Union Minister of State for Health and Family Welfare, Dr Bharati Pravin Pawar informed the Parliament about the number of available seats in India and in respective States/UTs. According to the data shared by MoS Health, Tamil Nadu has the highest number of 11,225 MBBS seats in 72 medical colleges. Among these, 5225 MBBS seats are in 38 government medical colleges and altogether 6000 MBBS seats are in 34 private medical colleges.

Therefore, considering the NMC rule regarding the ratio of MBBS seats and the total population, Tamil Nadu is no more eligible to apply for new medical colleges.

As per the latest media report by the Times of India, while the NMC notification does not offer any justification for the decision, senior doctors in the NMC said that the decision was made to ensure that resources are spent judiciously to ensure uniform distribution of doctors across the country.

Commenting on this, Dr. K Senthil, who is a member of the NMC PG Board and also the president of the TN Government Doctors' Association told TOI, "TN has more than 1.8 lakh doctors registered in Tamil Nadu and among them, 1.5 lakh are still practicing. The recommended ratio of doctors is only 1:1000 and we already have 1 per 600."

"In ten years, TN will have 1 doctor for every 350 people because every year 10,000 MBBS graduates and 1,500 foreign medical graduates apply for a medical license," he said. The southern states must use this as an opportunity to increase post-graduate and super specialty seats," he added.

However, the Health Secretary of Tamil Nadu Gagadeep Singh Bedi referred to the State's policy of setting up a medical college in every district to ensure equal distribution of doctors and tertiary care facilities, and added, "Also, why should we look at Tamil Nadu data alone? The country needs more doctors. If Chennai can work well as a medical hub for the rest of India, doctors from here can work in other states too. When we have the facilities and requirements we must be permitted to start new facilities."

This new rule will not only affect the State of Tamil Nadu, but States such as Andhra Pradesh, Karnataka, Kerala, and Telangana might also lose their eligibility to set up a new medical college since all of them have crossed the ratio prescribed by NMC.

As per the latest media report by The South First, not only the Southern States, but due to this new NMC rule, smaller States and UTs such as Himachal Pradesh, Manipur, Puducherry, and Sikkim may also become ineligible to have more medical seats. These States/UTs also have more seats than prescribed by the new norm.

The projected population of Andhra Pradesh is 5.34 crore and as per the data shared by MoS Health Dr. Pawar earlier this year, the State has altogether 5635 seats. In the case of Karnataka, the projected population is 6.76 crore, and on the other hand, the total number of medical seats in the State is 11020. Therefore, both of these have crossed the mark set by NMC. As per the rules, Andhra Pradesh should have 5346 medical seats and Karnataka should have around 6770 medical seats.

In the case of Kerala, against the projected population of 3.57 crore, there should not be more altogether 3,577 medical seats. However, according to the data by MoS Health Dr Pawar, the State has 4605 medical seats.

Also Read: 101,043 MBBS, 45,471 MD, MS, PG Diploma, 4,997 SS seats available across 660 medical colleges in India

In the last few years, Telangana has also been adding MBBS seats and it also has plans to add another 800 seats next year. The State has a population of 3.8 crore and as per the NMC norm, the State should have around 3,809 MBBS seats. However, the data shared by MoS Health revealed that the State already has 7415 medical seats.

Meanwhile, Uttar Pradesh has a projected population of around 23.5 crore and as per the norm, it can have 23,568 MBBS seats. However, the State only has 9253 MBBS seats, as per the data shared by Dr Pawar.

Doctors Upset with NMC Rules: 

This decision by NMC has upset the doctors and taking to social media they expressed their displeasure in this regard. “What nonsense. First tax rich states and transfer to poor states now prevent them from investing further in human development? Is the government of India determined to drag everyone to the level of the bigoted least common denominator? This is unacceptable @ptrmadurai,” a user commented on X (formerly Twitter).

"NMC has no business to tell a State what its health policy should be. If a State feels it needs more Medical seats it should be able to get them as long as due process is followed. Health is a State subject," wrote another user.

Commenting on the matter, Hyderabad-based neurologist Dr Sudhir Kumar said that the most crucial point was that a doctor educated in one State in India is not bound to practise in the same State.

“India is a free country, and a doctor trained in Tamil Nadu can practise in Delhi, just as a doctor trained in Bihar can practise elsewhere. There are no restrictions: Doctors can work in any state and even go abroad. So, the key point is that training doctors in one state doesn’t mean that the doctor-to-population ratio will increase in that state,” Dr. Kumar told South First. 

“Some doctors may choose to settle where they see a demand for their services. I’ve seen this first-hand: 20 years ago, many districts had no neurologist in Telangana. Today, there are multiple neurologists in the same district,” he added.

Explaining how this happened, he further mentioned, “Because doctors can freely choose where to practise. I, for instance, trained in Tamil Nadu but am now serving in a different state because the Indian Constitution allows doctors to practise in any state of their choice. There are no restrictions on doctors’ mobility, and the same goes for patients. Patients often travel to different states for treatment, exercising their freedom of choice."

While some of the associations of doctors welcomed the NMC move, majority quietly opposed it. The Tamil Nadu branch of the Indian Medical Association (IMA) welcomed the decision for MBBS admissions and the establishment of new medical colleges in Tamil Nadu. The association opined that the NMC decisions aimed to prevent the oversaturation of the doctor population in Tamil Nadu as the State already boasts about 1.5 lakh actively practising medical doctors, as per the TN Medical Council.

Commenting on this, IMA Tamil Nadu president Dr T Sethamil Pari told South First, “In Tamil Nadu, the doctor-patient ratio remains 1:600 every year, with over 10,000 doctors graduating from medical colleges, including foreign medical graduates. The continued influx of doctors could lead to an oversaturation of the medical community, resulting in unnecessary expenditure by the government on constructing additional medical colleges.”

He further added that the oversaturation could ultimately lead towards unemployment for young doctors and a decline in the doctors' salaries. Pointing out that currently doctors get only Rs 20,000 as monthly salary, Dr. Pari added, “This situation may worsen over the next two to five years, with salaries potentially dropping to ₹15,000 or even ₹10,000 per month. We have seen similar issues in the engineering sector, where graduates are now working for ₹10,000-15,000 per month due to oversupply. To avoid such a situation for doctors, we lend our full support to these decisions.”

However, the move has been opposed by IMA Telangana President Dr. BN Rao, who added, “I am strongly opposing the very existence of and functioning of the NMC itself, so no further discussion.”

Meanwhile, questioning the NMC move, Tamil Nadu-based Congress leader P Chidambaram questioned, "Why should a State not start a new medical college out of its own funds and for the its own students? The Centre and its agencies are undermining federalism. The assault on States' rights continues under the Modi government."

Also Read: NMC Guidelines Put 150 MBBS Seats Intake Cap on New Medical Colleges set up from next year