While the Medical council of India is being purged and hopefully for the better, time has come to revisit how our MBBS doctors are trained for specialties. It may be prudent here to look at some other models to realize that over the years, countries who in 50s and 60s were following the model we still follow, have evolved and changed their systems of imparting post graduate courses.
As I am a surgeon, my discussions will use surgical higher education as a template, which of course can and should be applied to other specialties.
Today, I will list some issues and hope readers will join in to augment this list as well as discus the various issues!
In India, after completing internship, a doctor can be immediately admitted to post graduate training in surgery, which lasts for three years. In the western world, after internship, a doctor joins as a medical officer or what was traditionally called a house job. This is for a minimum of 2 years. During these two years, entrance exams are taken to join advanced training in surgery, which will last for a minimum of 4 years. Only about 10 % of doctors will complete this in 6 years years time. Average will take 8 years.
After being awarded the fellowship (MS in India), senior residency is a must. If one has to go and become a general surgeon, one year of senior residency is essential, though two to three years in preferred. Then only one can become a consultant to practice independently! In India one can immediately start practicing independently after getting the MS. Only who join teaching hospitals have to joining as senior residents for three years, but this is different from state to state and university to university.
Essentially, what is highlighted in the above discussion, is that period of training has a relevance in imparting higher education. There are other issues like who controls this training, the syllabus and the content of training. Standards of examination, research and training are other issues. Criteria for selection is also another issue of contention. All these issues will be discussed in the following blogs.
Sunday, May 30, 2010
Saturday, May 22, 2010
Evidence based medicine
In one of my earlier post, I had discussed the long term repercussions of the various irregularities in the function of the MCI. The visiting or migrating doctor from India to overseas countries has to be credentialed by MCI. The standard of a doctor can be judged by the reputation and stature of the controlling medical body (MCI for us in India) of a particular country.
Now this sad story of MCI is published in Lancet!
Please refer to this article:
Trouble at the Medical Council of India. Chatterjee P.
Now this sad story of MCI is published in Lancet!
Please refer to this article:
Trouble at the Medical Council of India. Chatterjee P.
Friday, May 21, 2010
Non Practising Allowance - Bane of Indian Health System
Indian health services are being either provided by government hospitals (public hospitals) or by the hospitals run by the private sector. In the last 20 years we have seen that there has been massive proliferation in private health services available in the country. Same has been the trend in the medical education sector. Almost 50% of the all the existing medical colleges have come up in the last decade or so. It is presumed that no new government medical college has opened during the same period. Private health services have become popular and wherever possible, an Indian patient prefers to get his/her treatment done in the private sector. This trend has been observed over the last decade or two.
The question to be addressed by people at helm is why has this happened! Health is a state subject, not much funding available for government hospitals, apathy of the politicians and bureaucrats, corruption in purchases of medical equipment and drugs, lack of maintenance and biomedical engineering departments in the hospitals, poor facilities, dirty wards, unhygienic facilities and many more reasons can be attributed to this malady. However, in my opinion, it is introduction of Non Practicing Allowance or what is popularly called NPA is the root cause of this problem.
NPA was introduced in the late 60s to stop government employed doctors from doing private practice within the boundaries of a government hospital. Before its introduction, doctors were allowed private practice in special OPDs in evenings, thus helping them augment their incomes as well providing more income to the government. As time passed, the low total remuneration of a doctor started having affects on maintenance of academic standards for doctors. Continuing medical education in the form of books, journals, attending workshops and conferences is a part and parcel of a doctors life. However to do this cost money. Unable to support these activates with the nominal pays received by doctors and medical teachers resulted in some of these to resort to private practice on the sly. With time this became a norm, thus taking the doctors away from government hospital work. That resulted in a major loss of human resource availability for these hospitals. Non availability of these doctors resulted in lacunae in hospital administration as well fall in clinical standards of delivery of medicine. This also resulted in standards of the attached medical colleges to fall below the acceptable levels.
While this was happening, private sector started proliferating and thus big salaries were offered to senior doctors of various government medical colleges and hospitals. Thus started a migration, which has never stopped. Time to look into this aspect and make government jobs lucrative to stop this brain drain. Once this migration stops, there is hope. Time for the new MCI to look into these aspects.
The question to be addressed by people at helm is why has this happened! Health is a state subject, not much funding available for government hospitals, apathy of the politicians and bureaucrats, corruption in purchases of medical equipment and drugs, lack of maintenance and biomedical engineering departments in the hospitals, poor facilities, dirty wards, unhygienic facilities and many more reasons can be attributed to this malady. However, in my opinion, it is introduction of Non Practicing Allowance or what is popularly called NPA is the root cause of this problem.
NPA was introduced in the late 60s to stop government employed doctors from doing private practice within the boundaries of a government hospital. Before its introduction, doctors were allowed private practice in special OPDs in evenings, thus helping them augment their incomes as well providing more income to the government. As time passed, the low total remuneration of a doctor started having affects on maintenance of academic standards for doctors. Continuing medical education in the form of books, journals, attending workshops and conferences is a part and parcel of a doctors life. However to do this cost money. Unable to support these activates with the nominal pays received by doctors and medical teachers resulted in some of these to resort to private practice on the sly. With time this became a norm, thus taking the doctors away from government hospital work. That resulted in a major loss of human resource availability for these hospitals. Non availability of these doctors resulted in lacunae in hospital administration as well fall in clinical standards of delivery of medicine. This also resulted in standards of the attached medical colleges to fall below the acceptable levels.
While this was happening, private sector started proliferating and thus big salaries were offered to senior doctors of various government medical colleges and hospitals. Thus started a migration, which has never stopped. Time to look into this aspect and make government jobs lucrative to stop this brain drain. Once this migration stops, there is hope. Time for the new MCI to look into these aspects.
Tuesday, May 18, 2010
How should MCI be restructured?
I would like readers to write down their thoughts? Here is an interesting perspective!
http://www.dailytimesindia.com/2010/05/125007.htm
http://www.dailytimesindia.com/2010/05/125007.htm
Monday, May 17, 2010
The Great Challenge
"There are no great people in this world, only great challenges which ordinary people rise to meet." - was quoted by William Frederick Halsy, Jr., a great wartime naval hero. The 6 members chosen to replace MCI administration are just ordinary Indians given a huge responsibility, a great challenge. Today, the whole country is watching them; today people across the world wait to see the outcome; today the work would have begun. It is not an easy task; probably made more difficult by not knowing who is honest and who is not. New teams have to be chosen; inspectors needs to be appointed; support staff needs to be brought in and work has to begin in earnest. Its not only the routine work which faces this team, but the whole constitution as well as regulatory protocols have to be rewritten from scratch. The most challenging task is to restore the credibility of a body, which constitutes the backbone of the medical world of any country. Lets wish them well, lets pray for them, lets support them and lets hope that at least we will have an organization which would be down to earth, honest and transparent. Let these 6 ordinary Indian rise to meet the challenge!
Sunday, May 16, 2010
Medical Council of India should be cleansed, purged but not decimated
Its an eerie feeling to realize that Medical Council of India no longer exists. Its like in being a war and the headquarter is bombed and razed with all the high command gone! This bit is sinking in now that there are certain bodies in the country, which cannot be disbanded! One cannot disband the police commissioners office nor the one can imagine a country without a parliament. Incumbents come and go; removed or expelled. But the organizations remain. This is a piquant situation and a gory reminder of the fact, that not only the leader was corrupt, but the whole organization was. If not, then why has it been disbanded? What is the status of clerks and permanent staff?
The implications of this will be felt for years to come. Purging was required and a correct decision has been taken to let the entire administration go. The sanctity of the Medical Council has to be restored, rather than doing away with the organization. Same 6 member council can look into each and every affair of MCI and get people transferred. new staff can be appointed.
This is a body which is recognized by medical councils of all countries of the world to communicate with regarding issues about doctors who relocate overseas. At this present juncture there is no medical body in India to communicate with! Time to tell the world that new administrators have taken over MCI and order is being restored.
I would love to have views on this topic.
The implications of this will be felt for years to come. Purging was required and a correct decision has been taken to let the entire administration go. The sanctity of the Medical Council has to be restored, rather than doing away with the organization. Same 6 member council can look into each and every affair of MCI and get people transferred. new staff can be appointed.
This is a body which is recognized by medical councils of all countries of the world to communicate with regarding issues about doctors who relocate overseas. At this present juncture there is no medical body in India to communicate with! Time to tell the world that new administrators have taken over MCI and order is being restored.
I would love to have views on this topic.
MCI’s 54-year run ends
Welcome news is that the MCI stands disbanded!. 6 member panel takes over. Hopefully this panel takes the view of many to formulate the new policies of a new board. Lets wish them well!
Inspections By MCI
MCI has published a set of guidelines to set up or maintain a medical college depending upon the number of students taken in each class. To ensure these are maintained, annual inspections are undertaken by MCI for upcoming colleges and an inspection every 5 years for the established colleges. I reckon it is a good system. If at all there should be issues, that should be what is in the guidelines!
However, the conduct of these inspections has come under the scanner, and rightfully so. I will not go into each and every detail of acts of commission or omission during these inspections to ensure that this blog is crisp, I expect readers to put in their comments. My views here are based on conversations I have had with colleagues in institutes which have been inspected over the last decade and could be termed hearsay, but are genuine bits of information I recall!
These inspections are announced at a very short notice and thus do not allow an institute to recall its employees on leave or on academic trips. This results in staff shortage on 'face presentation' and thus disqualify an organization. This rule only applies to a private organization; medical colleges run by the government are exempt from this rule.
The inpectors do not make their own arrangements of lodging and boarding; arrangements have to be made by the college being inpected and lot of these colleges put them in 5 star facilities which in legal parlence is trying to influence the inspectors.
The colleges bring in bogus patients during the inspections, thus filling up beds and falsely showing the hospital to be full. Likewise fictitious medical records are created to show the required average bed occupancy. The only way to pick up this fraud is surprise inspection.
There are other issues which relate to the guidelines and thus would be a subject of another blog. I expect readers to put in their views about these inspections.
However, the conduct of these inspections has come under the scanner, and rightfully so. I will not go into each and every detail of acts of commission or omission during these inspections to ensure that this blog is crisp, I expect readers to put in their comments. My views here are based on conversations I have had with colleagues in institutes which have been inspected over the last decade and could be termed hearsay, but are genuine bits of information I recall!
These inspections are announced at a very short notice and thus do not allow an institute to recall its employees on leave or on academic trips. This results in staff shortage on 'face presentation' and thus disqualify an organization. This rule only applies to a private organization; medical colleges run by the government are exempt from this rule.
The inpectors do not make their own arrangements of lodging and boarding; arrangements have to be made by the college being inpected and lot of these colleges put them in 5 star facilities which in legal parlence is trying to influence the inspectors.
The colleges bring in bogus patients during the inspections, thus filling up beds and falsely showing the hospital to be full. Likewise fictitious medical records are created to show the required average bed occupancy. The only way to pick up this fraud is surprise inspection.
There are other issues which relate to the guidelines and thus would be a subject of another blog. I expect readers to put in their views about these inspections.
Friday, May 14, 2010
Trust Tribune, Chandigarh to carry some good news!
It seems that the Thursday cabinet meeting took a step to re formulate MCI. I hope a composite, modern, effective system of governance is formulated! Your comments on how this system should be are welcome!
http://www.tribuneindia.com/2010/20100514/main2.htm
http://www.tribuneindia.com/2010/20100514/main2.htm
Thursday, May 13, 2010
Tuesday, May 11, 2010
Interesting statistics
In India there are 303 medical colleges teaching MBBS. Out of these, 25 are permitted meaning that these medical colleges are new and getting permission for each year till the first batch of students pass out after 4 and a half year and these colleges become fully recognized. 63 colleges are listed as refused permission or in the process of being permitted, thus indicating there are deficiencies pointed out by the inspection teams.
This indicates that 29 % (88) of medical colleges in India are less than 4 and a half year in the making! There may be another 30% or so which would have come up in the last 10 years; I have not been able to locate a source for this but 30 % seems to be a fair guess.That may indicate that over 50% of the medical colleges in the country may have come up in the last decade.
It is an impressive figure to boast of indicating a robust growth in the medical education of our country. Today, this figure has to be taken with a pinch of salt. Reading in press about the various irregularities in granting permission to new medical colleges in India, it may be that quite a few of these new colleges may be below par in respect to staff, infrastructure, equipment, patient loads in the connected hospitals and the quality of education provided to the students enrolled.
It is prudent to check the antecedents of these colleges, keeping in mind that the current inspection system by MCI may be wanting because of corruption, nepotism and mediocrity. It may be so that a few of these or a majority of these new medical colleges may be adequate and doing a good job.But a recheck is mandatory.
'MCI factory for producing fake doctors' IBN-CNN
It is good to see that there is more activity in the press regarding MCI. Reading the article sends a chill down ones' spine! How could we stoop to such lows!
http://ibnlive.in.com/news/mci-factory-for-producing-fake-doctors/114947-3.html?from=tn
http://ibnlive.in.com/news/mci-factory-for-producing-fake-doctors/114947-3.html?from=tn
Sunday, May 9, 2010
Government to restore credibility of Medical Council of India
This article appeared in various newspapers on 4th of May, 2010. Do note that earlier efforts by the previous Health Minister had been thwarted by the parliamentary committee.
Please read:
http://www.dnaindia.com/india/report_government-to-restore-credibility-of-medical-council-of-india_1378839
Please read:
http://www.dnaindia.com/india/report_government-to-restore-credibility-of-medical-council-of-india_1378839
Who owns MCI?
The Health Minister of India cannot make any change to MCI!
Read on:
http://www.tribuneindia.com/2010/20100506/main5.htm
Read on:
http://www.tribuneindia.com/2010/20100506/main5.htm
Certificate of Good Standing from the MCI- Who Needs it?
This article is so articulate that it should be published in all major newspapers of the country. Please read on:
http://indiaandbharat.blogspot.com/2010/05/certificate-of-good-standing-from-mci.html
http://indiaandbharat.blogspot.com/2010/05/certificate-of-good-standing-from-mci.html
Writing on the Wall
An article in Indian Journal of Medical Ethics:
http://www.ijme.in/cgi-bin/getpdf.cgi
This article makes interesting reading. Concern is that even after publication of such articles in reputed journals, no action is taken. This is ample proof that medical governance has reached it nadir in India!
http://www.ijme.in/cgi-bin/getpdf.cgi
This article makes interesting reading. Concern is that even after publication of such articles in reputed journals, no action is taken. This is ample proof that medical governance has reached it nadir in India!
Medical Council of India: The Rot Within
Note: This post is related to the previous post requesting support for the NCHRH bill that is likely to be proposed in the Indian Parliament this year. Again, I would greatly appreciate any publicity that you can give for this issue. Please link, reblog, tweet, digg, stumble, or share in all the other myriad ways of Web 2.0.
I would be grateful if Indian bloggers and blog aggregators like DesiPundit and Blogbharti publicized this.
TO READ THE ENTIRE BLOG, Please click the following
http://www.catscanman.net/blog/category/medicine/ethics/
MCI
Tolerance is a forte of Indian people. This probably stems from the fact that our society has tolerated conquests by various raiders over centuries and thus have learned to be silent! Its a good quality to possess, but in moderation. I have also tolerated a well known fact all these years while I practiced and taught medicine in a medical college - the corruption in bodies which regulate our medical colleges, hospitals and medical education. The limit to my tolerance stretched and broke, when I read about the extent of corruption in this august body - our Medical Council, with the recent arrest of its president.
What can be my contribution to restore credibility in our regulating bodies? How can I help? I do not have many answers. I have blogged, written to various editors and spent time on the net figuring out what is the reaction of our medical fraternity. I have figured out that alone I cant achieve much. I need to connect and form a community. Thus this Blog!
I want readers to put in their comments as to how 'WE' can do something. I will keep posting links of what has happened as well what have been the various reactions to this scam. Together, we should voice our concern as well as suggest a remedy!
What can be my contribution to restore credibility in our regulating bodies? How can I help? I do not have many answers. I have blogged, written to various editors and spent time on the net figuring out what is the reaction of our medical fraternity. I have figured out that alone I cant achieve much. I need to connect and form a community. Thus this Blog!
I want readers to put in their comments as to how 'WE' can do something. I will keep posting links of what has happened as well what have been the various reactions to this scam. Together, we should voice our concern as well as suggest a remedy!
Subscribe to:
Posts (Atom)