Competition since time immemorial has forged the spirit to excel. It has driven us to learn, to evolve, to survive.
In every aspect of life, from sports to politics to education, competition plays its part. After all, it was competition which put man on the moon.
So naturally, medicine, and more precisely medical education, also has competition. All of the examinations, tests and everyday learning involve some form of competition. Competition motivates us to learn and learn more. Competition, therefore, is a positive force. However, it is a law of nature and, like every law of nature, it has a dark side to it, a negative impact.
To explore the problem of competition, let us look to the contemporary Indian medical education system and the population and infrastructure challenges it faces.
Before we dive deep into the rights and wrongs, let me first explain the basics of medical education in India. In India, you get into medical school straight after high school; there is no undergraduate degree required. After completing five and a half years of medical school, which includes a one-year internship, you are awarded an MBBS degree, which stands for “Bachelor of Medicine, Bachelor of Surgery” in Latin. With an MBBS degree, you are a full-fledged general practitioner and can own a clinical practice. However, you are not a specialist physician and cannot practice in gynecology, pediatrics, pathology, cardiology, neurology, oncology and so forth.
To become a specialist, you need to get another degree, called the “post-graduation degree,” which requires you to clear a postgraduate examination. This is where the problem begins.
Each year in India, around 100,000 MBBS students sit for the postgraduate examinations aspiring to become specialists in their field of choice and competing for around 22,500 postgraduate positions all over the country. Though only about 45,000 MBBS graduates are produced every year, the unfair proportion and the difficulty of these examinations have created a backlog of students sitting for the exams, increasing the number year after year.
As if 22,500 seats for 100,000 students was not a drastic enough problem, there are additional problems, including a certain number of seats reserved for minority students and the selling of seats to the highest bidder without consideration of merit.
All these problems together have forced the Indian medical graduate to flee to countries like the United States and the United Kingdom where the system is comparatively fairer and merit, not money, is the deciding factor. This has caused a massive brain drain in the Indian medical community.
There have been large-scale agitations by student bodies all over India, with students becoming disheartened by the struggle of becoming a specialist. Since it sometimes takes years to qualify for the examinations, some students have even succumbed to depression and suicide.
Why a Specialist?
The first question that should come to your mind is, why specialize? Why go through this horrendous examination process when you are already a physician and can practice legally?
Now, there is the “because I want to acquire more knowledge and training and expertise” answer, and it is true. However, we cannot ignore the fact that specialization is what the consumer wants. Today, an MBBS graduate in India has very little value because everyone wants the best—they want a specialist.
It pays better, it is a better job, it is a better life, and it is the need of the hour. The Indian population does not suffer from easily manageable communicable diseases like in the 1960s. India is now the world capital of diabetes, it has one of the highest infant mortality rates, automotive and industrial trauma is widespread, and oral cancer is on the rise. What India needs are specialists. And all of this has pushed the Indian medical graduate into a “post-graduation race.”
The Medical Student
All of this comes down to the medical student. We know how this problem affects them and how it manifests as struggle and frustration. But is this it?
No! I think this competition-based education has changed the core of medicine. It has wavered us from the basic reason we became doctors, the only reason we became doctors: the patient.
The average Indian medical graduate spends his or her internship not submerged into laborious clinical work, but instead into sample tests and “multiple choice question books.” Tests and examinations are an integral part of any education, but somewhere in creating the perfect system we have lost the balance.
That is what I think has happened in India. We have lost the balance between the passion and drive of becoming a good doctor versus the protocol and stigma of examinations. In this bid of becoming a specialist, we are forgetting everything “special” about this profession.
A simple answer would be to increase the number of post-graduate positions. This would definitely work, but in reality it is a superficial solution.
We need to ask ourselves why this problem is present in the first place. How have the United States and United Kingdom successfully avoided a situation like this?
In 1943, when India was still a British colony, Dr. Joseph Bhore submitted a report by the “Bhore Committee” to the government with recommendations for establishing the pedestals of health care in India. The report stressed the need for “basic” doctors. In today’s time, the “Vision 2015” report released by the Medical Council of India in 2012 still stressed on the need for “basic” doctors, while—as mentioned above—this is not what we actually need.
While the United States, the United Kingdom and other developed nations have integrated specialist health care into their health schemes, we are still struggling to realize our needs and resources.
I believe the solution is the integration of the decision-making mechanism, namely the government, into the medical community at the highest level, so we can together solve this problem at its root.