Aspiring for a medical seat in Karnataka – as much as across India – and pursuing a dream to be a doctor is a path filled with problems for students and their parents right from the outset. According to the experts, the high cost of medical education in India is a cruel irony. The economics at play behind a medical seat, and the increasing demand for it, provides an in-built mechanism driving thousands of students – like 21-year-old Naveen Shekharappa Gyanagoudar who was killed in an attack by Russian forces in Kharkiv in Ukraine last week – to easier and cheaper routes to achieving their dreams.
They get admission to medical schools in countries like Ukraine, Russia, China or Singapore. And if and when they return, these students face a bleak future -- before starting practice in India, they have to write another examination which is very tough, and even then, they are discriminated against. Besides, the system here discourages students admitted to colleges in Karnataka and India from taking up rural medical service in a country that requires it the most.
There is high demand for medical seats in Karnataka. As per 2021 data for the National Eligibility cum Entrance Test (NEET), the all-India pre-medical entrance test for students aspiring for undergraduate medical (MBBS), dental (BDS) and AYUSH courses in government and private institutions, 1,19,626 students from Karnataka registered for a total of 8,850 medical seats on offer in the state.
Experts say while the competitive spirit prevails in every field, the medical field is heavily influenced by the financial factor. Parents of students who do clear NEET, have to take heavy loans to ensure a seat – more so in a private medical college, where the fees (as per 2021 data) range between Rs 6,28,670 and Rs 20,15,500 per year. The “other” category, or the management seat, costs between Rs 30,12,450 and Rs 60,12,450 per year for a course that goes up to four-and-a-half years. It ranges between Rs 59,850 and Rs 2,04,246 per year for a government seat.
Dr. Dayananda Sagar L, past president of the Karnataka Association of Resident Doctors, says it is not medical education that is expensive in India per se, but management seats. He says the government fixes fees for seats in government medical colleges, government quota seats in private medical colleges and private seats. But, management seats are left to the discretion of private colleges and vary from state to state. “A government college seat may cost around Rs 60,000 per year, while a private merit seat costs around Rs 6 lakh to Rs 8 lakh per year. However, a management seat goes up to Rs 40 lakh per year, which costs around Rs 2 crore for 4.5 years of MBBS,” he says.
Students who do not get a seat through government quota via NEET, and cannot afford management seats in India, go to countries like Ukraine, China, Singapore or Russia, where the entire medical education package costs between Rs 30 lakh and Rs 40 lakh.
Students admitted in Karnataka colleges, whose parents do manage to raise the money – a vast majority through loans from banks or through private money lenders by paying much higher interest – are the luckier ones. But their prime focus on completing their medical course then turns to repaying the huge debts their parents are in. Their only route to repayment is through service in a high-end speciality hospital or by going abroad. Rural medical service is pushed to the back-burner, while private medical colleges continue minting money while laughing all the way to the bank.
Several thousand others seek medical courses in Ukraine, China or Russia, which costs just a fraction of what it does here. And NEET ranking is not considered there either. Also, taking loans from banks for studies abroad is easier than for higher studies in India. A manager of a nationalised bank informed The New Sunday Express that many who seek bank loans for higher studies prefer foreign universities as banks lend money only for the fees, not capitation fees. “We lend only against the college fee receipt. They cannot produce receipts for capitation fees charged by Indian colleges. This is also a reason why they prefer foreign universities,” says the bank manager, who requested anonymity.
NOT ROSY FOR RETURNEES
Having an MD Physician (equivalent to MBBS) degree from universities in a country like Ukraine does not guarantee easy jobs for young Indian students who return to their homeland on completing their course.
Their real challenge is when they pass the foreign degree and return. They have to crack the Foreign Medical Graduation Examination (FMGE), a licensure examination conducted by the National Board of Examination in India, to practice medicine in the country.
Vamshi Varahabhatla, who did his MD Physician from Ukraine, says the FMGE is very tough to crack and only 20 per cent of the candidates manage to clear the exam, which is held twice a year, although there is no limit on the number of attempts.
But those who do their medical in Ukraine have to fight stigma in India. “FMGEs are always considered less knowledgeable by Indian graduates. Only degrees from five English-speaking countries have value here,” says Vamshi.
Further, candidates who have done only MBBS find it very difficult to sustain and have to do MD to earn a handsome salary. A fraction of those who do MBBS in countries like Ukraine go back there to do MD, while others try NEET PG in India.
HIGH COST: HOW IT ADDS UP
Dr. George D’Souza, Dean, St John’s Medical College, explains: “The National Medical Commission has defined norms on how many doctors, junior doctors, nurses, beds for teaching, and equipment are needed to run a medical college. A lot has to be invested into equipment such as CT scan, MRI, endoscopy equipment, ultrasound, etc. These have to be purchased every few years along with buying new technology to train students.”
He says there are only three sources of revenue for medical college hospitals – patients, students and philanthropists. Charging patients is difficult and they do not get as many donors as universities like Harvard and Yale. So, students and their parents bear the brunt.
Dr. KS Ravindranath, former vice-chancellor of Rajiv Gandhi University of Health Sciences, says one solution to make medical education more affordable in India is to encourage more government medical colleges, so that the number of government seats increases. At present, even if students qualify for a seat, many drop out due to their inability to pay for it.
CAMPUS SCENE IN KARNATAKA
43 Private medical colleges
21 Govt medical colleges
64 Total medical colleges
8850 Medical seats
6100 Private college seats
2750 Govt college seats
119626 Students registered for NEET in 2021