Medical education corruption in India!
India is witnessing the criminalisation of medical education that begins with licensing of colleges by the Medical Council of India (MCI), regulator of medical education and medical profession. According to sources in the Ethics Committee of MCI, this criminal nexus includes MCI, promoters of private medical colleges, real estate lobbies, local politicians and serving or retired doctors from government medical colleges. Large amounts of money changes hands at every stage of the medical education chain.
Private medical colleges are charitable enterprises in name. It is no secret that their investors make tons of money in under-the-table deals selling admissions with capitation fees ranging from Rs.25 lakh to over Rs. 1 crore for an MBBS seat depending on the solvency of the candidates and public credibility of the institute concerned. It is Rs.2 crore and more for a postgraduate seat in super-speciality. Such investment has to give returns. In stead of strong steps against corruption, the Union Government’s think tank, NITI Ayog has taken the medical education corruption one step further by proposing setting up of ‘for profit’ medical colleges across the country.
It is learnt officially that privatisation of medical education has resulted in shifts in the examination process and technologies enabled cheating of the Vyapam type. The use of multiple choice questions simplifies copying and changing answers. Coaching class has become intrinsic part of education system with those who attend are promised success, possibly even a seat in the college of their choice. Those who choose not to attend or cannot afford coaching class, there is unspoken threat that they will fail. Owners of such classes, by advertising the toppers among their students, imply that they have access to the system and could even manipulate marks to obtain admission.
According to sources, the most common method of cheating all over Indian medical college examinations is to leak the question paper in advance to those willing to pay for it, another is to have ‘jockeys’ who sit in a nearby room to answer the questions that are handed over to the paying candidates to submit. A third is to have doctor or high achieving senior students take the examination in place of the candidates by replacing the photo with the impersonator’s on the admission cards and reversing the process once the paper is submitted. A fourth of the modus operandi includes ‘engine bogey’ system in which high-scoring candidates would be given seats that allowed candidates who paid to copy their answers. And the fifth does away with matters of chance to manipulate simply the marks in the system. For such manipulations, candidates are told to leave blank the questions that they could not answer. Such manipulated correct answers would be inserted and the so corrected answer sheet entered in the computerised system.
Aspiring students for medical education sit for a number of examinations hoping to get into medical schools. There are separate examinations for admission to various state and national medical colleges including the private ones. According to official data available, in 2014, more than 617,000 students competed for 25, 000 seats in the All India Pre-Medical Entrance Tests, indicating lakhs of students attempt entrance tests for 57,000 seats in 422 government and private medical colleges.
Private medical colleges started in 1980s and got rapid boost for expansion in 1991 with the process of globalisation of Indian economy. It’s legitimacy commenced with the Supreme Court of India judgment in T.M.A.Pai Foundation vs the State of Karnataka in 2002, in which the apex court accepted the contention that the government alone could not meet the needs for higher education and the private sector had an essential role as well. The Supreme Court also held that private institutions that did not receive government aid had a fundamental right to determine their own admission policies, their own governing bodies, faculty and fees. Following this, private medical colleges started dominating the medical education sector so much so that in 2015-16, there were 222 private medical colleges with 29,995 seats, and 200 government medical colleges with 27,143 seats. The MCI is regulatory body for licensing new medical colleges and ensuring their adequacy in infrastructure, staff strength and curriculum. As a body dominated by private doctors and their investors, the MCI lends itself to rampant corruption of the highest order.
The foregoing confirms that medical education is a business, which is run by politicians. Money is made by subverting the very values that doctors are supposed to uphold when they go out in the world to heal the sick. In the circumstances, even the most persistent bold anti-corruption steps by the government and civil society are unlikely to make a difference to corruption in medical education. Corruption in medical education and healthcare is worldwide without exception. However, in India it is at its nadir!