The story so far: The war in Ukraine has turned the spotlight on something that has been the trend for about three decades now. When students from India studying in Ukraine cried out for help, it became clear that there were a large number of them trapped in a war zone. According to estimates from Ukraine, reported in the media, around 18,000 Indian students are in Ukraine. It may be safe to assume they are pursuing medicine, at least anecdotally, going by interviews with students who have returned. Hundreds of students are still stuck in several regions of Ukraine, while for those who have returned, an uncertain future threatens, unless the Government finds a solution soon.

Which countries do Indian students prefer?

For about three decades now, Indian students have been heading out to Russia, China, Ukraine, Kyrgyzstan, Kazakhstan, the Philippines to pursue a medical degree. The medium of education for these students is English, a language they are comfortable with, and the amount spent on living and the medical degree are far more affordable than paying for an MBBS seat in private medical colleges in the country.

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The desire to study medicine still holds a lot of value in the Indian community. While it retains the prestige of an honourable profession, there is a great deal of aspirational zeal in taking up medicine. The lack of equal opportunities exacerbated by the caste factor in the Indian context, has a great deal of impact on the prestige still associated with being a doctor, says G.R. Ravindranath, of the Doctors’ Association for Social Equality. “For years, certain communities were denied the opportunities, and finally they do have a chance at achieving significant educational status. People still think it is good to have a ‘Dr.’ attached to their name, even if they do not specialise. In many rural areas, people still look at doctors as god’s incarnate.”

Doesn’t India have enough colleges?

There are certainly far more MBBS aspirants than there are MBBS seats in India. In NEET 2021, as per a National Testing Agency press release, 16.1 lakh students registered for the exam, 15.4 lakh students appeared for the test, and 8.7 lakh students qualified. Bharati Pravin Pawar, Union Minister of State for Health, told the Lok Sabha in December 2021, that as per data from the National Medical Commission (NMC), in 2021-22, there were 596 medical colleges in the country with a total of 88,120 MBBS seats.

While the skew is in favour of Government colleges, it is not greatly so, with the number of private medical institutions nearly neck-to-neck with the state-run ones. That means over 50% of the total seats are available at affordable fees in Government colleges. Add the 50% seats in the private sector that the NMC has mandated must charge only the government college fees. Assuming each one of these seats is also available at this reduced fee structure, that could be another 20,000 odd seats. In effect, roughly 65,000 seats are available within the affordable fee segment.

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Additionally, these colleges are also not distributed evenly across the country, with States such as Maharashtra, Karnataka, Tamil Nadu and Kerala having many more colleges.

What about costs?

The cost factor on both sides of an MBBS degree is significant. The costs of an MBBS degree in a Government college tot up to a few lakhs of rupees for the full course, but in a private medical college, it can go up to ₹1 crore for the five-year course. In case it is a management seat, capitation fees can inflate the cost by several lakhs again.

Whereas, an MBBS course at any foreign medical university in the east and eastern Europe costs far less. Students from Tamil Nadu who returned from Ukraine said on an average they had to spend close to ₹30lakh-₹40 lakh, inclusive of lodging and boarding. A majority of the students had written NEET at least twice, and only decided to move after they could not get an MBBS seat. On return, the requirement is to clear the Foreign Medical Graduates Examination, a licensure examination held for students who have studied medicine abroad, and for most countries, also a house surgency stint.

Dr. Ravindranath explains that in India the disparities in income of doctors, and others, like nurses and allied health professionals, is also a key factor in making an MBBS degree alluring. People are willing to leave their home to study far away in much colder places and with completely alien cultures and food habits. The ability to practise as a doctor, in Government and private sectors simultaneously, and the scope of earning a life-long income are also powerful incentives, in addition to the social status it confers.

Is the solution more private medical colleges?

While Prime Minister Modi emphasised that more private medical colleges must be set up in the country to aid more people to take up MBBS, medical education experts have called for pause on the aspect.

If the aim is to make medicine more accessible to students of the country, the path ahead is not in the private sector, but in the public sector, with the Central and State governments’ involvement, they point out. From 2003, the Centre’s Pradhan Mantri Swasthya Suraksha Yojana has been working to augment facilities for quality medical education in the country.

“Starting private medical colleges by reducing the strict standards set for establishing institutes may not actually be the solution to this problem, if we think this is a concern,” says Dr. Ravindranath. Going overseas to study does have advantages, it could broaden students’ mind and thinking, expose them to a whole range of experiences, and their approach to issues and crises is likely to be far better.

However, creating more medical colleges will be beneficial for the country, if access and availability can be ensured. This will not be possible by resorting to private enterprise only. He adds that State and Central governments can start more medical colleges, as recommended by NITI Aayog, by utilising district headquarters hospitals, and expanding the infrastructure. This way, students from the lower and middle socio-economic rung, who are otherwise not able to access medical seats, will also benefit.