Uneven MBBS seat distribution to high fees: Parliamentary panel flags medical education challenges

The Committee urged the National Medical Commission to frame clear guidelines for establishing new medical colleges in states with fewer than 100 MBBS seats per million population and recommended opening more medical colleges in Delhi. 

Expressing concern over affordability, the panel noted that MBBS education costs Rs 60 lakh to Rs 1 crore in many colleges, effectively excluding poorer families. It recommended applying state government fee structures to 50 per cent of seats in private medical colleges, regulating the remaining seats through state fee committees, and introducing need-based scholarships.

The report also highlighted faculty shortages, especially in remote areas, calling for better incentives, job security and structured career progression. It endorsed NMC’s Aadhaar-based biometric attendance system to curb ghost faculty, supported expansion of domestic medical education to reduce reliance on foreign medical graduates, reiterated backing for the NExT exam, and proposed an AIIMS-led mentorship model to ensure uniform education standards nationwide.

Seat distribution:

Flagging the seat distribution issue, the department-related Parliamentary Standing Committee on Health and Family Welfare in the 167th report presented to Rajya Sabha on December 11 stated that while some states have a high concentration of medical seats, some are severely lacking against the national average of 75 MBBS seats per million population

According to PTI report, the panel suggested the government open up new medical colleges to provide quality medical education in Delhi so that students from the national capital do not have to travel to other states or even other countries to pursue medical education.

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Not accepting the Action Taken by government on the its recommendations/observations contained in the 157th Report on "Quality of Medical Education in India", the panel strongly recommended that the NMC must come forward with guidelines for establishing new medical colleges in states where there are fewer than hundred MBBS seats per million population.

It observed that Karnataka, Telangana and Tamil Nadu have approximately 150 MBBS seats per million and Puducherry has close to 2,000 or even more MBBS seats for a population of just about one million.

While some other states have less than 50 seats per million population, Bihar has only 21 seats per million, it stated in the report.

New Medical Colleges:

"The committee further suggests that the government may consider to plan to open new medical colleges to provide quality medical education in Delhi so that students from Delhi have not to travel to other states or even other countries to pursue medical education," the report said.

The Committee appreciated the UG-MSR 2023 guidelines regarding setting up of new medical colleges providing approval for annual intake capacity of 50/100/150 MBBS seats.

Notwithstanding the same, it stated that as per the guidelines, given that the infrastructure and faculty position required are in place, a college, whether old or new, may be considered for granting permission to increase the undergraduate MBBS seats up to a maximum of 250 in a phased manner.

It further recommended that adequate attention must be given for opening of medical colleges in underserved districts which can be encouraged to use the locally available government medical colleges and hospitals for imparting healthcare services.

Cost of medical education:

The committee further reiterated that the affordability of medical education in the country continues to a matter of concern due to huge cost of medical education that ranges between Rs 60 lakhs to Rs 1 crore or even more, "as if, there is no takers for the poor guardian to get their off-springs admitted in the medical colleges".

It endorses that the government may apply the fee structure to 50 per cent of seats in private medical colleges and the state government fee may be levied to this 50 per cent of MBBS seats while the other 50 per cent to be decided in consultation with the fee regulatory committee of each of the states.

The panel reiterated its recommendation that the ministry in collaboration with states consider need-based scholarships to deserving students.

Other suggestive options that can be explored were running the medical college and hospital on a PPP model, giving tax benefits to the company/group, etc, it stated in the report.

Faculty shortage:

On the issue of addressing faculty shortages in medical colleges, especially in remote areas, the panel stressed that it is essential to provide incentives for teaching positions and opined that competitive salaries, job security, and structured career growth need to be prioritized over ad-hoc or contractual appointments for streamlining and strengthening the faculty.

The Committee reiterated that clear criteria and milestones for promotions by recognizing and rewarding excellence in teaching, research, and clinical work are required to be embedded in the system.

Moreover, streamlining the sanctioning of posts and ensuring a balanced reservation policy will facilitate the timely filling up of vacancies, ultimately strengthening medical education and healthcare services, it underlined.

Ghost Faculty:

"The committee is in agreement with the Health ministry that ghost faculty is undoubtedly a curse to the medical education, however, it believes that recently introduced 'Aadhaar-based Biometric Attendance System by NMC' regarding attendance, would go a long way in combating and curbing the problem of ghost faculty and zero attendance," the panel said in its report.

Administrative monitoring by way of most robust IT solutions -- like face recognition and geo positioning monitoring of attendance -- would definitely give impetus to the sensitivity of monitoring the faculty attendance and hence mitigate the menace of ghost faculty, it suggested.

FMG internship and registration:

The committee also observed that, in view of huge number of MBBS aspiring students and limited MBBS seats in various colleges, high number of students seek admission outside the country.

However, the foreign medical graduate have to face the herculean challenges in passing license examination and seeking permanent registration across various states.

The Foreign Medical Graduate Regulation 2021 mandates one year of compulsory rotating medical internship as an additional training in medical education hospitals or in big non-teaching hospitals.

Since, to some extent, foreign medical graduates is useful in maintaining the doctor to population ratio, therefore, the committee reiterated its recommendation that FMG Regulations 2021 should act as facilitator thereby streamlining the registration and internship procedures while keeping the quality assurance of the Indian healthcare system.

"In order to improve the doctor-to-population ratio and to reduce the reliance on foreign medical graduates it would be appropriate for the government to encourage expansion of medical colleges in the country to accommodate the education of MBBS aspiring students in the country itself," the panel said.

NExT exam:

Reiterating its earlier recommendation, the panel further stated that introduction of NExT will instill a universal and standardized assessment of medical graduates having uniform level of knowledge and skills and ultimately leading to quality medical education and training across the country.

In its report, the panel said that it was in agreement with the Health ministry that NExT indicate a paradigm shift in teaching methods, learning approaches, critical assessment through MBBS courses.

It therefore, recommended that the committee reconstituted under the Chairmanship of Members, NITI Aayog submit its recommendation at the first opportunity for implementation of NExT Exam as per pre-conceived schedule.

AIIMS as mentor institute:

"The committee reiterates its recommendation that the government should divide India into different zones and in each zone reputed institutes like AIIMS can function as mentor institutes for all the other medical colleges in that zone.

"Mentor institutes shall play a significant role in monitoring the standard of education and the classes in the newly set medical colleges or private medical colleges," the report said.

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