Government plans to double PG medical seats in next five years

Amid concerns that there may be a glut of MBBS doctors in India, the Union health ministry is working on an ambitious plan to double the number of post-graduation (PG) seats in medicine over the next five years.

The move will address the acute shortage of specialist doctors in the country, especially in small towns and rural areas, and help more MBBS doctors secure a PG seat.

Under the plan, the government is looking to raise the number of Diplomate of National Board (DNB) seats, which are considered equivalent to post-graduate degrees in medicine (MS and MD), identify facilities where new seats can be created and relax norms for MS/MD seats.

For the 2022-23 academic session, 91,927 MBBS seats were on offer in India’s medical colleges but the MS/MD (Master of Surgery/ Doctor of Medicine) seats were 46,118, which is just half that number of MBBS seats.

However, when 12,246 DNB seats offered by tertiary care hospitals are taken into account, the total number of PG or equivalent seats rises to 58,364.

“Our initial homework suggests that the number of PG seats can be doubled over the next few years and it will ensure that majority of the MBBS pass-outs will stand a chance of securing a PG seat, which is not the case now,” said a senior official in the medical education division of the ministry.

Addressing the shortage of specialist doctors

The official said the move would also address the shortage of specialists, especially in rural areas and cities beyond metros.

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As of March 31, 2021, there were just 4,405 specialists at rural community health centres, a whopping 80 per cent less than the requirement of 21,924, according to the rural health statistics 2020-21.

Government officials say the situation, if not worse, is similar in the private sector as well.

Other health experts, too, feel that raising the number of PG seats in medicine may be crucial to address this disparity.

“The country has been facing a severe shortage of specialist doctors, and hopefully more numbers will ease a major constraint,” said public health researcher Oommen C Kurian.

Many states are also experimenting with compulsory service bonds for PG and DNB candidates to improve the supply of specialists at the district level, which has been a major policy concern, he said.

Stretching the existing capacity

The government is already relaxing norms to raise the number of PG seats.

Starting 2019-20, the medical education regulator has raised the teacher-student ratio from 1:2 to 1:3 for PG students, enabling colleges to admit more students.

Officials say this criterion may be relaxed further.

The government is also asking the private colleges, which have the majority of DNB seats, to double their intake. Plans are also afoot to identify government set-ups such as Employees' State Insurance Corporation (ESIC) and hospitals run by departments such as Railways among others where new DNB seats can be started.

Officials said some hospitals with a bed capacity of 100 beds have been permitted to start diploma seats over the last two years. “The number of such hospitals can also go up significantly,” said the official quoted above.

The ministry is hoping to come up with a detailed blueprint in the coming few weeks.

‘Nobody wants only MBBS anymore’

Dr Thomas Chacko from Kerala, a medical education expert, said that raising PG seats may be a good idea because a large number of MBBS graduates have to compete for a fewer number of PG seats now, which means that they keep appearing for PG entrance exam for 2-3 years or more and it often leads to frustration.

He said the test questions in PG entrance exams are designed to be difficult to produce a relative ranking and to exclude rather than to select as the number of seats is limited compared to aspirants.

This is unlike the United States Medical Licensing Examination, the test for postgraduate training in the US, where the examination checks whether the MBBS graduate knows what they are supposed to know for patient care.

In this situation in India, only the PG entrance coaching centres gain as they have a large number of aspirants who pay hefty fees to get a slight advantage compared to others to crack the National Eligibility cum Entrance Test (NEET-PG).

“Patients don't go to plain MBBS doctors anymore. They go to specialists, even for fever and other minor conditions and so the solution is to increase the number of PG seats,” Dr Chacko said.

Nuanced approach

Dr R V Asokan, a senior member of the Indian Medical Association, the largest network of doctors in India, said that there are two alternatives before India.

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“We can either introduce Universal Health Care and increase the number of doctors in government health services to an appropriate level as well as bring in something like the National Health Services (NHS) of the UK,” he said. “Both will have a decent placement for MBBS graduates; else if we continue with the anarchy that prevails now, we will end up like Cuba, which is supplying doctors for other countries.”

NHS is a publicly funded healthcare system whose founding principle is to offer comprehensive and universal healthcare which is free at the point of delivery, based on clinical need and not ability to pay.

Under NHS, patients are not allowed to go to a specialist without first going to a general physician, who then decides whether there is a need to refer the patient to a specialist for further investigation and specialised treatment.

The majority of the cases, suggest figures, can be managed by a GP and only a few need specialist attention.

What needs to be done in India, said Dr Chacko, is bringing more PG seats in specialties like general practice (to produce GPs) and family medicine as the majority of the patients need a broader holistic, low-cost approach to patient care.

“It will keep the cost to the patient and the health system low rather than the present system, where more PG aspirants opt for remunerative specialties like cardiology, radiology and neurology where the specialists are trained to suspect and treat rarer and complex cases and order more tests,” he said.