Why Indian Medical Students Are Forced To Study Abroad And How Good Policies Can Change The Situation

The plight of thousands of Indian students who were stuck in Ukraine amid the Russian invasion and who are now being brought back by commendable efforts of the government has again brought to attention the fundamental weaknesses and problems associated with the education system in the country.

Every year, thousands of students go abroad to study. This is not the surprising part. What’s interesting is the field of study they go out to study - medicine - and the countries they are opting for their higher education - China, Ukraine, Azerbaijan, even Bangladesh, etc.

Prime Minister Narendra Modi also raised this point while inaugurating a webinar on 26 February on budget announcements for the health sector.

“Our children today are going to small countries for study, especially in medical education. Language is a problem there. They are still going…Can our private sector not enter this field in a big way? Can our state governments not frame good policies for land allotment regarding this,” he said.

It’s commendable that PM Modi is exhorting the state governments to frame good policies. Unfortunately, at the Centre, he has doubled down on some of the same old policies that have kept the medicine sector hobbled. To PM Modi’s credit, undergraduate seats and postgraduate seats have increased by 72 per cent and 78 per cent respectively since 2014 and will further increase when all the colleges that have been approved and sanctioned start functioning. But most of this capacity expansion has happened for government seats which come with their own problems, some of which have worsened due to Central government’s recent moves.

There are layers within layers when it comes to classification of medical seats in India. At the basic level, there are two main divisions - government seats and seats in private sector. Under government, there are seats exclusively with Central government (where Centre’s quota policy is followed and 60 per cent seats are reserved), seats in All India Quota which is a pool formed after states surrender 15 per cent of the seats in colleges that come under them (here, only SC/ST quota was followed until the Modi government introduced the OBC quota last year) and then there are 85 per cent seats with the state governments who follow their own quota policies and give admissions to their domiciles (with Tamil Nadu having the most reserved seats).

This means that when new colleges and new seats get added in Tamil Nadu, there is little incremental benefit for students in unreserved category as compared to when other states expand capacity. Moreover, Modi government’s move to implement OBC reservation in AIQ has also lessened the capacity that would’ve been otherwise available for unreserved category students in light of addition of tens of thousands of seats since 2014. Effectively, it has been a ‘two steps forward and one step backward’ approach. Overall, it’s still progress but it would require significant expansion in seat capacity over the next few years to compensate for the limitations of the quota system.

That leaves the private sector as a useful avenue which could’ve acted as a fruitful partner for the government where the latter could focus on giving quality medical education to economically and socially backward at affordable prices and letting the former to cater to those who missed out on government seats. But private sector is also hobbled by two chief problems.

First is artificial scarcity that has been ensured for decades because it’s extremely hard for genuine edu-preneurs to open medical colleges thanks to suffocating regulations - one requires hundreds of crores of initial investment, annual license approvals, requirement of setting up various teaching departments, setting up an attached hospital with certain number of beds, more approvals to even add seats/beds in already functioning colleges/hospitals, etc to name just a few.

When Modi government junked the Medical Council of India and replaced it with National Medical Commission (NMC), it had a historic opportunity to bring a transformational change. Not only it didn’t do that, earlier this month, it issued exhaustive guidelines for regulating fees for 50 per cent seats in private medical colleges which will be forced to charge fees equal to what the government colleges do. The government thinks that it is helping subsidise seats for 50 per cent students studying in private colleges but has lost sight of the fact that colleges will be forced to increase the fees for remaining 50 per cent seats by a huge amount and there may not be many takers for them. Even without such cross-subsidising, students are forced to go to Ukraine, Bangladesh, China et al because of low fees.

The second issue in the private sector space is the dual regulatory structure that governs minority and non-minority colleges where the former is at much bigger advantage because the protection given under Article 30 of the constitution allows minorities to run their colleges with great autonomy (and there is a good chance that they will be exempted by the judiciary from NMC’s fee regulation which will further put them at advantage). It’s not without reason that minority-run colleges rule the roost in medical education and are almost at par in numbers with non-minority ones. Moreover, majority of the seats in minority colleges are reserved for people of their own religion - For ex: around 84 per cent of the seats in CMC Vellore are reserved for Christians. PM Modi should’ve done away with this discriminatory legal regime on the first day in office. Alas!

Essentially, in India, one’s caste dictates the admission to government medical seats and religion/riches in private medical colleges.

It’s still not too late. Rather than exhorting the state governments to frame good policies, PM Modi will be well advised to actually start with his government. Otherwise, we will continue to see the exodus of students abroad.