Shriya Sharma, TwoCircles.net
New Delhi: Medicine has historically stood as one of the most esteemed professions worldwide. The allure of perpetual learning and the fulfilment derived from easing human suffering serve as primary motivations for students opting for medicine over other careers promising quicker and more stable financial rewards. The excitement of exploring the mysteries of life at various levels — technical, emotional and philosophical — also entices many towards this field.
However, the road to becoming a doctor and the subsequent journey are frequently obscured and fraught with myriad challenges in India.
Fierce Competition and Limited Seats
The journey begins with intense competition for limited seats in medical schools, compounded by reservation policies for various castes and communities in both central and state government colleges, as mandated by the Constitution of India.
“When I was preparing for the NEET-UG (National Eligibility cum Entrance Test-Undergraduate) entrance examination, approximately 16 lakh students were competing. Securing a government seat was nearly impossible if your rank was over 16,000, especially for those in the unreserved category,” explains Smriti Sharma, a third-year MBBS student at Government Medical College in Rajasthan’s Kota.
With the number of aspirants increasing annually — 23 lakh students appeared for the NEET-UG in 2023 — the pressure only intensifies, she said, adding despite their diligent efforts, many students find themselves unable to secure a government seat due to systemic issues such as examination scams and leaks. Those ranked beyond 17,000 or 18,000 must either afford the exorbitant fees of private colleges or face the daunting task of pursuing MBBS abroad.
“Once you obtain the title of ‘Doctor’, another struggle begins with the competition for entrance examination for post graduation,” adds Sharma.
Corruption and Financial Barriers
Corruption within the medical education system further complicates the journey. India stands out among countries where medical seats are openly sold, placing money above merit. “It has become a game of money. The battle is no longer about merit but finances,” laments Dr Prachi, 32, a dental surgeon based in Kota with seven years of practice.
In private medical colleges, a substantial number of seats at both undergraduate and postgraduate levels are paid seats, far beyond the financial reach of an average individual. This practice not only demoralises deserving students but also compromises the calibre of medical professionals, ultimately undermining public healthcare standards.
“Children are driven to addiction and depression when they witness their peers achieving medical seats through less effort,” she says, highlighting that the ongoing trend of lowering qualifying percentiles in MD examinations has led to specialisations being “purchased” rather than earned, thereby diluting the quality of doctors and posing risks to public healthcare.
Inadequate Infrastructure in Medical Colleges
The challenges extend beyond securing admission. Many public hospitals and medical colleges suffer from poor infrastructure and insufficient facilities. Junior doctors, who are the backbone of the healthcare system, frequently work under deplorable conditions.
“Shortages of medicines, malfunctioning lab equipment and a lack of beds are common issues,” says Dr Amit Singmar, 25, who recently completed his MBBS from a government medical college in Karnataka.
Overcrowding and inadequate doctor-to-patient ratios exacerbate the strain. Junior doctors sometimes see nearly 20 patients per hour and endure gruelling shifts, often working up to 60 hours consecutively. The living conditions provided to these doctors are often substandard, contributing to significant dissatisfaction.
“We don’t even have proper time for studying or for personal life with family and friends. The mental stress and sleep deprivation lead to mental health issues, compounding the challenges. Moreover, the stipend is a mere Rs 30,000, and in some states, even less, with frequent delays,” he complains.
The Government-Private Divide
A shift in legislation during the 1990s facilitated the establishment of private medical schools, leading to a surge in such institutions funded by businessmen and politicians without prior experience in medical education. From 100 government medical colleges and 11 private ones in 1980, the Medical Council of India (MCI) reports a doubling in government schools and a twenty-fold increase in private institutes.
This commercialization of medical education means that financial means, rather than merit alone, can secure a student a place. “Not everyone can afford a seat in a private medical college, exacerbating the disparity in doctor-to-patient ratios,” notes Rishit Tripathi, a third-year MBBS student at Saraswati Medical College in Uttar Pradesh’s Hapur district.
Despite these challenges, the medical profession remains highly esteemed by the younger generation, their parents and the public at large. The government has taken steps to address these issues by expanding seat numbers and planning new medical colleges.
However, Dr. Ramnivas Sharma, assistant professor at Autonomous State Medical College (ASMC), Auraiya, UP, believes that the focus should prioritise enhancing existing institutions. “The priority should be ensuring the efficient functioning of current facilities, including infrastructure, equipment availability and faculty,” he stresses.
He also advocates reassessing the system of mandatory ‘bond’ service in government hospitals post-MBBS and MD degrees to streamline the path to medical qualification. This would alleviate the current burdensome and protracted journey for aspiring doctors.
Navigating the path to becoming a doctor in India is fraught with challenges, from intense competition for limited seats to financial and infrastructural hurdles within medical institutions. Addressing these issues is pivotal to ensuring equitable access to medical education and enhancing healthcare quality across the nation.