A somebody was once a nobody who wanted to and did.
- John Burroughs
The Union cabinet recently cleared the National Medical Commission (NMC) Bill 2019. One of its salient features is the clause to regulate fee and other charges for 50 per cent of seats in private medical colleges and deemed universities. By this, it seems to contradict the spirit of the draft National Education Policy (NEP), which seeks to accord autonomy to medical colleges on deciding fees. In light of the numerous egregious cases of corruption in medical education and a widespread demand to regulate fees in private colleges on the one hand, and the drive to achieve excellence and equity on the other, it is important to ascertain the correct recipe of regulating and paying for medical education. The government already regulates fees for up to 85 per cent of seats in most private medical colleges. Bringing deemed universities into the fold, which are hardly a tenth of the total number of medical colleges in the country, will make little difference, especially if the ceiling is concurrently brought down to 50 per cent of seats. So, in effect, the NMC Bill actually allows greater latitude to private colleges in fee-setting, as espoused by the NEP. Stringent fee control can be counterproductive.
Medical education is a costly endeavour and expecting any public or private medical college to deliver quality education and research without sufficient financial backing and administrative latitude is fruitless. This is consistent with international experience. While principles like academic autonomy (freedom to set own curriculum) for medical colleges and public disclosure of information to uphold the ‘court of public opinion’ are highly commendable, one wonders about the feasibility and potential efficacy, given our current context where medical colleges are highly deficient in skilled manpower and technical capability, and public opinion is rather disinterested. Thus, as forward- looking as the NEP is, it appears in certain respects to be punching much above its weight. But with greater autonomy and lifting of fee controls at both public and private colleges, the question of affordability of medical education becomes critical.
Costly medical education and student indebtedness after medical school are known to change the trajectory of healthcare services for the worse — by diverting emphasis away from community and primary healthcare into more specialized and costly forms of care, reinforcing the elitist skew in medical education and making some medical specialties unduly more attractive to students than others. These are problems we are already struggling with. Large-scale implementation of such a loans-based solution would be contextually inappropriate for the Indian setting. The solution lies in the traditional prescription of increasing public funding and role in medical education, while not turning away from the progressive regulatory framework suggested by the NEP. Many private medical colleges in India have been little different in spirit from the ‘proprietary’ medical schools that Flexner denounced in his report. While greater autonomy to medical colleges and ‘light but tight’ regulation are crucial, the same must not undermine public role in medical education.