Friday, June 16, 2017

medical M.Sc postgraduates aren't taking doctors jobs

No, medical M.Sc postgraduates aren't taking doctor's jobs!

In a shocking article published by the Times of India on June 16th, Jaipur edition, the blame for PG seats remaining vacant in the pre- and para-clinical subjects are squarely laid on the medical M.Sc postgraduates. The article is available here:

Here is an open letter to the editor of Times of India on this matter.

It is unfortunate that this article is not well-researched and is biased against M.Sc degree holders. Medical M.Sc degree was made acceptable at a time when there were few doctors with MD degree in the pre- and para-clinical subjects. It is true that now there are plenty of MD degree holders in these subjects. The reason they are not fetching jobs are many; here are some points that will help in getting a clear picture.

1. MCI has reduced the teacher-student ratio, thereby decreasing the number of teachers required in medical colleges. This has led to decrease in the job-opportunities.

2. The retirement age of teachers in medical colleges has been raised to 70 years, which too contributes to the lack of vacancies.

3. Medical M.Sc persons can be appointed only to the extent of 30% in a department, the rest 70% are MD degree holders. It is incorrect to state that "..but medical colleges are applying the rule as compulsory". In most medical colleges, non-medical faculties are much lesser than 30%. Throughout India, the percentage of non-medical teachers in these subjects is only around 13%. In fact, MCI has asked medical colleges to give MD holders the first preference for academic jobs.

4. The reason why most doctors opt for MD in pathology is not that MSc in the subject is not available, but the fact it is in high demand in diagnostic laboratory sector.

5. The statement "lateral entry in medical colleges for jobs" is inaccurate because appointments are made as per MCI guidelines only. As qualified PG degree holders, even medical M.Sc persons are entitled to a job they deserve as per their education in medical colleges and MCI's teachers' eligibility guidelines.

6. The situation is similar with medical M.Sc postgraduates. Since they have obtained PG degree in the faculty of medicine, they are not equipped to work outside the healthcare system. Since MD holders are also doctors, they can always practice because of their professional degrees but medical M.Sc postgraduates have nowhere else to go. In many of the job advertisements posted recently, medical colleges have unfairly preferred only MBBS/MD holders for academic jobs. 

7. In many western countries, pre- and para-clinical subjects are mostly taught by non-medical persons. In most of the top 10 medical colleges in the world, 50-60% of the faculties in these subjects are non-doctors. In their countries, doctors are expected to assist in healthcare rather than teaching. The primary role of doctors is to treat patients, the presence of non-doctors in the medical education is good for the society as it spares doctors required for healthcare given that patient to doctor ratio in our country is dismal.

As a responsible media, TOI is expected to make a thorough research and get a clear picture before publishing. It would be prudent that TOI makes a well-researched and a balanced article on the same.

Saturday, May 13, 2017

letter to health ministry over CEA guidelines on diagnostic laboratories

The following is the letter in response to the gazette notification of the Ministry of Health and Family Welfare on draft rules regarding diagnostic laboratory under the Clinical Establishment Act, 2010.
The draft can be downloaded here:

Under Secretary (Medical Services),
Ministry of Health and Family Welfare,
Room No. 508, D Wing,
Nirman Bhavan,
New Delhi – 110011

Dear Sir,

Subject: Objections to the Clinical Establishments (Central Government) Amendment Rules, 2017 published in the Gazette notification dated 5th May, 2017

It gives us great pain to write to the health ministry yet again. In 2014, the National Council for Clinical Establishments sought suggestions & objections from the stakeholders on the guidelines for the diagnostic laboratory. Since then we have been protesting against the unjust exclusion of medical M.Sc degree holders under the human resource guidelines. All our protests and pleas have been completely ignored.

Umpteen number of representations have been made so far. Letters have been written to the Union health minister, Ministers of state & Secretary of MoHFW, as well as to the Chairman and members of the National Council for Clinical Establishments on this issue. Signature campaign protest was made, grievances were filed with online portal and protest event with procession and dharna was held in Delhi. Despite all these efforts, it is extremely distressing to observe total neglect of medical M.Sc degree by the concerned. It is really a sad state of affairs. Such a neglect of a qualified medical M.Sc degree is unprecedented.

It appears that the ministry of health is determined to denigrate this degree and unjustly deny the degree-holders of any role in the diagnostic laboratory. It is now clear to us that this exclusion is planned and deliberate. It is not that the health ministry is unaware of the nature of medical M.Sc courses or the roles these degree holders have been playing for several decades. We are convinced that this is a systematic attack on the medical M.Sc degree. Therefore, no amount of further objections would serve any real purpose.

However, for the sake of record, NMMTA officially objects to the exclusion of medical M.Sc degree (with or without Ph.D.) under the section IV (Human Resource).  Like MD course in Microbiology or Biochemistry, medical M.Sc courses are held in medical colleges using the same syllabus & curriculum. We are pretty sure that policy makers in the council are well aware of this fact, but want to turn a blind eye towards it. Therefore, we formally request the council to make amends in the guidelines to accommodate medical M.Sc degree (without insisting for Ph.D.) for all the three categories of the laboratories. 

We reiterate that service in the diagnostic laboratory is NOT the practice of medicine; it has already been proven in two courts of USA. Therefore, one does not need to be a doctor to certify diagnostic reports. The job of a Microbiologist or a Biochemist in the laboratory is to ensure correctness of the test report, ensure quality control and offer only a minimal interpretation. The ultimate responsibility of interpretations lies with the doctor who ordered the test on the patient. 

Before you discount medical M.Sc degree, we wish to bring to your notice yet again of the decision taken by the members of the Adhoc Committee appointed by the Hon’ble Supreme Court and of the Executive Committee of the Medical Council of India, the following decision of the Ethics Committee on January 2005: “M.Sc. (Medical Biochemistry) with or without Ph.D is entitled to independently or solely sign a medical Biochemistry report in a clinical laboratory”. Is the ministry questioning the wisdom or authority of the Supreme Court's Adhoc Committee on this matter? It must also be brought to your notice that NABL, the body that sets standards and accredits laboratories has recognized medical M.Sc as authorized signatories in its document 112. The qualifications are framed by technical experts from all the disciplines possessing the necessary technical competence/expertise and knowledge on accreditation requirements. Does the ministry intend to question the competence of the experts in determining the eligibility?

Doctors with Diploma in Clinical Pathology, who are posted for a small duration in Biochemistry or Microbiology departments hardly attend or learn anything serious at the PG level. Trusting them to deal with the interpretation of bacterial cultures would be a grave mistake. Also, persons with MBBS and Ph.D. are queerly deemed eligible to interpret certain tests that require understanding at a postgraduate level. It would be foolhardy to assume that the knowledge to interpret diagnostic tests would be acquired by undertaking a research-based Ph.D. This is especially true with bacterial cultures, which requires a PG-level understanding of the pathogenesis, which an MBBS+Ph.D is completely unaware of. This clearly shows a dritharashtra-like blind bias towards the medical degree and a contempt towards non-MBBS degrees.

It is disgusting to note the inclusion of Ph.D among the qualifications acceptable for laboratory technicians. Ph.D is one of the highest degrees in India and does the ministry seriously expect such degree holders to work in the laboratory as technicians? Is this an intentional mischief or an act of ignorance? The section 15 of IMC Act, 1956 does not mention anything about diagnostic laboratories. The ministry must not deliberately misinterpret the clause to extend it to diagnostic services.

Have the policy makers given any thought to what will become of those qualified medical M.Sc persons who are already in diagnostic laboratories for years and decades? This policy change will not only lead to career disruption of medical M.Sc degree holders working in diagnostic laboratories but also severely affect them socially, financially and psychologically. How can the government nullify with a stroke of the rule, what these people have learned in the medical college and experience gained over the years? Did these people spend three-years in medical college, lakhs of rupees on education, got trained and skilled like their MD counterparts only to be disqualified later? The government permits these courses to be run and then prevents the degree holders from practicing the skills they acquired. Is this how governments work? Every act of madness has a method, and the method adopted here seems to destroy the legacy and utility of medical M.Sc courses. This systematic destruction of medical M.Sc must stop.

The policy-makers must familiarize themselves with the relevant degrees being conducted in India and set policies in accordance with the available skilled workforce. Prejudiced, biased and myopic policies do more harm in the long-term. Although the Clinical Establishment Act or its guidelines is currently not applicable to all the states or teaching institutions, it is currently being misused and abused to prevent teaching faculties with medical M.Sc degree from working in laboratories attached to the teaching hospitals. 

Currently, there are thousands of diagnostic laboratories of all sizes across India. Are there enough doctors to cater to all these diagnostic laboratories? Implementation of these guidelines will only force the laboratories to hire part-time consultants who would offer their services to several laboratories at a time. They will end up only signing the reports but doing little else.  Who would benefit from such faulty rules? The government must factor in another fallout of this rule. Doctors naturally demand more remuneration than what the laboratory owners currently offer to non-doctors for the same work. This will add on the expenses of the laboratory, which will be conveniently passed on to the patients, thereby increasing the cost of healthcare. Is this a justifiable government policy?

Honorable Rajya Sabhha MP Shri CP Narayan raised this issue (UNSTARRED QUESTION NO 1771) on August 2016 with the MoHFW, but the ministry did not give a convincing reply. The ministry has consistently ignored multiple memoranda, grievances, letters, references and evidences from accreditation boards, as well as international standards. The partisan attitude of the ministry has been glaringly exposed. It must be borne in mind that any discipline of science can progress only when there is participation from people from diverse backgrounds; monopoly only leads to stagnation, fall in standards and rise in malpractices.

Instead of protecting the interests of biomedical scientists, this government is harming it. This government is treading on the misconception that degree alone confers competence. Mere possession or absence of a specific degree alone doesn’t guarantee quality or competence. In the developed countries more importance is given to training and certification, but we are still stuck with degrees. The government is behaving in a partisan way by promoting one degree at the cost of another. Govt must create a healthy atmosphere where all qualified degree holders complement each other instead of competing and serve the healthcare needs of the nation.

Ministry of health and family welfare is at a threshold of making a fine policy on CEA; to set it right or to make a mess is left to the policy makers. We can only hope that wisdom and benevolence prevails.

Warm regards,

National M.Sc Medical Teachers' Association (NMMTA)

Tuesday, October 4, 2016

NMMTA: the National M.Sc Medical Teachers' Association

"Birds of the same feather flock together", it is only natural and appropriate for people having things in common to come together. People from the same academic background too come together and form associations of persons. There are several associations representing diverse academic fields.

In India, Medical M.Sc courses are generally conducted by medical institutions. This 2-3 year postgraduate course is conducted in the subjects of Anatomy, Biochemistry, Physiology, Microbiology and Pharmacology and awarded under the faculty of medicine by the universities. Several medical colleges or institutions recognized by the MCI offer medical M.Sc courses. This course, which was initially included in the first schedule of Indian Medical Council Act 1956, was regulated by the MCI until the late 1980s. MCI used to give permission for medical colleges to run these courses. Mysteriously, this process was discontinued. There are no councils in India which regulate medical M.Sc courses or register persons with these degrees.

Until now there has been no national-level association of persons representing medical M.Sc degree holders graduating from medical colleges. There is no documentation or database of numbers of persons with the medical M.Sc degree in India. Therefore, a need for national-level association was felt.

NMMTA, the National M.Sc Medical Teachers' Association, is a national organization of persons with the medical M.Sc postgraduate degree in India. It was established in 2013 as an association of persons registered under the Societies Registration Act, 1860. It came into being on 14th August 2013 following registration by the Registrar of Societies, District East, Government of NCT of Delhi. Its headquarters is based in Delhi. 

The association was created with the intention of bringing together all persons with medical M.Sc degree in the subjects of Anatomy, Physiology, Biochemistry, Pharmacology and Microbiology that are conducted in medical institutions and awarded under the faculty of medicine. 

There are currently 619 members from 23 states across India, including student and honorary members. The number of persons enrolling into NMMTA is on the rise. The administration of the association is handled by the executive committee, which comprises of President, Vice-President, Secretary, Treasurer,  zonal Joint-secretaries and other members. The association conducts its executive committee and General Body meetings periodically and submits the activity to The Registrar of Societies, Delhi along with the audited financial report. 

Aims of this association include:

to bring medical scientists from different departments under one body
to promote medical science by interdisciplinary exchanges
to explore research and job possibilities for members
to co-ordinate recent developments in medical science with scientific exchanges from universities, colleges and healthcare industries
to represent the academic and employment-related issues of members
to bring out scientific publications

Public activity:

On 20th March, 2017, NMMTA held a protest event at Jantar Mantar, Delhi against the unjust exclusion of medical M.Sc biomedical scientists in the human resource guidelines for diagnostic laboratories under the Clinical Establishment Act. The event consisted of dharna, procession, submission of memorandum to the health minister and culminated with a press conference. This event has been covered by over 50 online news portals and several newspapers.

Reference: Membership process
Frequently asked questions: FAQ

Saturday, July 9, 2016

Are medical M.Sc's no longer wanted in India's clinical laboratory services?

08th July, 2016

Guidelines on minimum Human Resource requirement in the Standards for Medical (Clinical) Laboratory 026 of the Clinical Establishment Act

1. Clinical Establishment Act (CEA)
The Clinical Establishment Act (2010) guidelines have been specified on the minimum standards of facilities and services for regulation of all clinical establishments in the country. The Act has taken effect in the four states namely, Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim, and all Union Territories except the NCT of Delhi since 2012. The Act has been formulated following series of meetings by the sub-committee for the development of Standard Template for the development of Minimum Standards under National Council for Clinical Establishments. 

2. Discriminatory guidelines of CEA
However, many feel that those formulating the guidelines on the prescription for human resource in medical laboratories have erred in the draft -Standard for Medical (Clinical) Laboratory, Standard No. CEA/Laboratory- 026. This error is causing serious resentment among those who are already in employment and fear job loss when the Act would be implemented in their states. While formulating the guidelines the committee had sought public opinion in March 2014. Despite several vehement oppositions to the existing norms, the policy makers went ahead with their discriminatory approach.

3. Interpretations of laboratory results
A clinical diagnostic laboratory has several divisions or specialties such as pathology, microbiology, biochemistry, genetics, molecular biology etc. These allied or para-clinical subjects are meant to assist physicians in diagnosis through laboratory tests. This requires a thorough understanding of the disease process, sample collection, and testing procedure. It does not require patient interaction as samples are often collected in hospitals and sent to laboratories. The samples are processed and tested by the laboratory technicians. Based on the knowledge, the signatory (such as microbiologist/biochemist/pathologist), validates the results, assesses the importance of results and signs it, sometimes with a comment. Many of the tests under Biochemistry are performed by semi- or fully-automated sophisticated instruments with in-built quality controls. In such cases, the role of biochemists is only to validate the results obtained. The interpretation, if any, issued by the laboratory is only preliminary and it is ultimately for the physician to interpret the laboratory result depending on the patient’s condition. In case of doubt, the clinician has the right to take a second opinion or repeat the test with a different laboratory or testing methodology. No competent clinician would ever blindly trust a laboratory report without applying mind. To squarely blame the laboratory report indicates own shortcomings.

4. Qualifications for signatories in laboratories
There is no denial of the fact that in the field of clinical diagnostic laboratory services, doctors with suitable postgraduate degree in the subjects of Biochemistry and Microbiology are suitable to sign laboratory reports. However, there is another competent degree that many are completely unaware of- the lesser-known postgraduate degree called medical M.Sc degree. This is a 2-31/2 year postgraduate degree, which is awarded under the faculty of medicine by the health universities across India. It is conducted by the same medical colleges that also conduct MD degrees using the same hospital, laboratory and teaching faculties. Like their peers studying MD degree, these students are also taught about the causative agents (etiology), disease process (pathogenesis), specimen collection, performance of relevant diagnostic tests, quality assurance and interpretation of laboratory tests.  The course involves exposure to clinical specimens, its processing in the laboratory and elaborate discussions on its interpretation. The course and curriculum of both these degrees are mostly similar. Upon passing, persons with medical M.Sc degree can competently undertake the professional role in diagnostic laboratories and they have been doing it competently since the inception of this course. Similar courses are conducted in UK too, where clinical diagnostics is a career prospect.

5. Accreditation of laboratories for good quality
All over the world, accreditation bodies such as International Laboratory Accreditation Cooperation (ILAC), Asia Pacific Laboratory Accreditation Cooperation (APLAC) or Clinical Laboratory Improvement Amendments (CLIA) follow the guidelines specified in ISO 15189 with regards to medical testing laboratories. India’s own accreditation body, the National Accreditation Board for Testing and Calibration Laboratories (NABL) is an autonomous body under the aegis of Department of Science & Technology, too follows ISO guidelines. The ISO document does not specify qualifications. Technical requirements 5.1.2 of the ISO document states the following:

The qualifications shall reflect the appropriate education, training, experience and demonstrated skills needed, and to be appropriate to the tasks performed. The personnel making judgments with reference to examinations shall have the applicable theoretical and practical background and experience.” This means that each country shall specify its own guidelines for framing qualifications as long as they receive appropriate education, training, experience and skill. This is where both NABL and CEA have erred.

Further, the clause 5.1.6 of ISO 15189 states that all laboratory personnel including signatories must undergo periodic competency assessment. Both NABL-112 and CEA-026 conveniently ignore this guideline. Perhaps the professionals recommended by these two bodies are assumed to be competent for life, who need no assessment.

6. Existing education system in India and qualified workforce
The policy makers in India must identify the prevalent education system in India that provides the requisite knowledge and skill. There are only two courses that enable persons to function as signatories in the department of Biochemistry and Microbiology- the MD degree (doctors) and medical M.Sc degree (non-doctors). DNB after MBBS too are qualified but their numbers in India are scarce. Diploma in Clinical Pathology (DCP) is basically a diploma in pathology with superficial exposure to Biochemistry or Microbiology. Therefore, only MD and medical M.Sc are the two major postgraudate courses in India that provide the education to understand the disease process and to employ suitable diagnostic tests. While the former is a celebrated course, the latter is largely an obscured and an unknown entity. Not only medical M.Sc courses in India are misunderstood but are also viciously maligned thereby discrediting all the doctors who teach, medical colleges that conduct these courses and the universities that award these degrees. Those who feel threatened that their jobs in laboratories are being taken away by the 'less-qualified' persons, level a variety of allegations including 'lack of clinical experience' to justify their tirade

7. Guidelines of NABL for medical laboratories
In order to accreditate clinical diagnostic laboratories, NABL has specified its own guidelines keeping in mind the local education system and the available workforce. Rightfully, persons with medical M.Sc (as well as non-medical M.Sc) were prescribed as an acceptable qualification for the role of signatories in clinical diagnostic laboratories as early as 2007. Incidentally, Dr. A.S Kanagasabapathy, the chairman of the first technical committee which formulated the guidelines for medical laboratories was not a medical doctor. Another premier government body, the Indian Council of Medical Research (ICMR) had approved the NABL guidelines for qualifications in its 2008 document on ‘Good Clinical Laboratory Practice (GCLP)’. Even in its most recent document, No. 112, the NABL (2016) has considered medical M.Sc (with or without Ph.D) as qualified signatories. Despite the existing norms, the policy makers of the Clinical Establishment Act decided not to consider medical M.Sc qualified to be signatories. The CEA document 026 states, “The person signing and interpreting the report shall be registered with Medical Council of India / State Medical Council”, thereby closing the doors on qualified medical M.Sc persons for this role. This stubborn decision appears to stem from personal bias and prejudice. No guideline should ever be based on presumptions or misconceptions.

8. Controversy with NABL guidelines
Although NABL has specified M.Sc as a signatory in its recent document No. 112, its intentions are not honest. It too plans for complete denial of any role to medical M.Sc persons unless they possess Ph.D and five year post-Ph.D experience.  Several representations of protests were made against the proposal. A group of 16 private diagnostic laboratories and hospitals met on 5th January 2014 at Hyderabad to discuss the proposed changes in NABL-112 guidelines. This group recommended continuation of M.Sc persons as signatories. NABL, ignored these suggestions and proposed qualifications bereft of M.Sc degree.

NABL has sought consent on its new proposal from Medical Council of India (MCI), which is a statutory body for establishing uniform and high standards of medical education in India. It also grants recognition of medical qualifications, gives accreditation to medical institutions, grants registration to medical practitioners, and monitors medical practice in India. It does not have any mandate to prescribe qualifications for persons working in clinical diagnostic laboratories. MCI has admitted that Medical M.Sc course is beyond its purview, atlhough medical M.Sc course is still included in the First Schedule of the Indian Medical Council Act, 1956. By quietly "discontinuing" the practice of recognition and registration of medical M.Sc degrees, MCI has ensured that the holders of this degree are not registered in MCI or state medical councils. By making it compulsory that only those registered with the medical councils can be signatories of laboratory reports, the CEA guidelines has tactfully ensured that all non-doctors are kept out of the system. If this is not degree-based-discrimination, what else is it?

The Executive committee of the MCI had sought clarification from its own Ethics Committee if persons with medical M.Sc could sign biochemistry reports. In reply, the following has been stated in the minutes of the meeting of the Ethics Committee of MCI held on 3rd& 4th January, 2005:
M.Sc. (Medical Biochemistry) with or without Ph.D is entitled to independently or solely sign a medical Biochemistry report in a clinical laboratory.”
In the subsequent meeting of the Executive Committee Meeting of the MCI held on 31st January 2005, the recommendation of the Ethics Committee was approved. Paradoxically, when some individuals questioned the MCI via the RTI Act, MCI replied otherwise thus contradicting its own approval. This demonstrates MCI’s prejudiced attitude towards M.Sc degree.

The standing committee of the parliament on health and family welfare’s report (No. 92) presented on 8th March 2016 in both the houses of parliament has stated that MCI has failed to address the needs of the health system in the country.  Often, it has been felt that MCI, which is entirely composed of doctors, has always been hostile in its outlook to medical M.Sc persons. The government has decided to scrap MCI and replace it with the Medical Education Commission. If MCI provides assent to the NABL’s proposal, which denies roles for medical M.Sc persons, it must be nullified. It is natural to suspect if both NABL and MCI are colluding to stonewall opportunities to medical M.Sc persons in order to protect the employment interests of own profession. Collusion among health service providers in India is an open-secret. 

9. Role of Ph.D qualification in routine tests
In its proposal to MCI [Annexure II (b) page 103], NABL seeks Ph.D and five year post-Ph.D experience to be authorized signatory. One must appreciate the ground reality in this aspect. In several western countries Ph.D programs are routine among all institutions, as they receive generous grants for research. In India, research is only a namesake and undertaking Ph.D is a herculean task. There are few health universities, which offer Ph.D programmes and there are even fewer qualified guides. The number of Ph.D seats is totally disproportionate to the number of medical M.Sc postgraduates. 

Most of the Ph.D courses are now being offered by private deemed-to-be universities, who don’t provide any financial assistance or scholarship to Ph.D scholars. Therefore, numbers of Ph.D holders are very less. Further, many medical M.Sc persons who are working in private medical colleges don’t get deputed for Ph.D with leave and salary by the employer. Hence, the only option available is to undertake Ph.D in apart-time mode. Ultimately, Ph.D is awarded by the University only after being satisfied with the quality of the research done and the ability of the scholar to defend the thesis in a public defense. Those undertaking Ph.D on a part-time mode spend two additional years on research. The research is supervised by the guide and the co-guide and the candidate has to submit progress report every 6 months to the university. Part-time Ph.D should not be confused with ‘distance’ or ‘correspondence’ education. It really doesn’t matter if the Ph.D is done full-time or part-time; part-time only means that the Ph.D scholar is externally registered. It is only the narrow-minded policy makers who come out with frivolous criteria with the sole intention of making it harder for medical M.Sc persons to work in diagnostic laboratories. Further insistence of five-year post-Ph.D experience is another ploy to prevent non-doctors from getting into the system.

The purpose of Ph.D is to advance knowledge, not merely apply existing knowledge. One must also appreciate the fact that Ph.D is an extensive research conducted on a narrow area of science. It neither confers knowledge nor skill in interpreting routine diagnostic tests. Therefore, the insistence of Ph.D is another ploy to keep medical M.Sc persons out of diagnostics. The policy makers who frame rules are either oblivious to the existing education scenario in India or deliberately being partisan to promote own professional ilk. Mere copying guidelines of the developed western countries for our country is inappropriate. What is suitable for the West may not be applicable to our country.

10. Medical M.Sc persons are not laboratory technicians
Several institutes conduct para-medical courses in Medical Laboratory Technology (MLT). These courses are offered as diploma, bachelor or master’s degree. These courses enable persons to ‘process clinical specimens’ and to ‘operate equipment’. These support staff are considered as laboratory technicians in the laboratories. In the Clinical Establishment Act, the policy makers have erroneously placed medical M.Sc persons as technicians in Annexure 4, column II. Since plenty of efforts were made in 2014 to inform the policy makers about the existence and relevance of medical M.Sc courses, it is improbable to dismiss it as an act of oversight. In the 6th meeting of the National Council for Clinical Establishments, the following was stated:

It was informed that as recommended by National Council during earlier meetings, the attempts by allied health professionals like medical technologists, MSc in medical microbiology, MSc. in medical biochemistry etc. to work as independent practitioners were not agreed to”.  

Thorough searches of first to fifth minutes of the meeting documents fails to reveal any such information. Thus, one may suspect that denying the rights to medical M.Sc persons as signatories was purely intentional. 

11. Are medical M.Sc persons really inefficient as alleged?
Medical M.Sc course is open to those who have Bachelor's degree (B.Sc) in life sciences. In most universities, the admission to these courses follows a competitive entrance examination. Therefore, the candidates must have a good academic record in both B.Sc and competitive examination. Medical M.Sc courses in the subjects Anatomy, Physiology, Biochemistry, Pharmacology and Microbiology are more popular. Generally, M.Sc courses are of two-years; the listless UGC too mentions medical M.Sc as a two-year course. However, barring few exceptions, most universities offer medical M.Sc as a three-year course. This is because, irrespective of the chosen discipline, all medical M.Sc students undergo compulsory one year of education in human Anatomy, Physiology and Biochemistry just as the MBBS students in the first year do. This is to make the students learn the structure and function of the human body; it is this year that makes medical M.Sc course truly 'medical'. After the students successfully pass the first year, they pursue their respective disciplines such as Biochemistry or Microbiology. In these two years, they undergo training just as their peer undergo MD degree. In the same department, medical M.Sc and MD courses are conducted parallelly along similar syllabus and curriculum by the same teaching faculty using the same laboratory and hospital facilities. Like MD students, these students also participate in journal and seminar presentations and write dissertations. The examination is conducted just as it is conducted for MD students. Although the underlying graduate degrees in either case are different, the postgraduate degrees are similar in many ways. Doctors with MD degrees have the rights to hold high esteem of their degrees but have no right to belittle and malign medical M.Sc degrees. There are capable and incapable people with either degree and mere possession of a degree doesn't ensure competency. What really matters is the dedication and hard work of the individual to excel in the field of study.

12. Qualifications in other countries
Even other countries such as Nepal (Nepal Health Professional Council Act), Sri Lanka (Sri Lanka AccreditationBoard for Conformity Assessment) or USA (College of American Pathologists) include persons with M.Sc degree as signatories or consultants in clinical diagnostic laboratories. As per the Guideline of Professional Classification and Registration for Health Practitioners of Saudi Arabia, persons with M.Sc degree can be appointed as specialists and senior specialists. Therefore, the same can be considered here as well. Some countries insist on additional Ph.D qualifications for non-doctors, but their system of education and research is qualitatively different from ours, hence not applicable to India and must not be enforced here.

13. Is medical M.Sc now an unwanted degree?
There are hundreds of trained and qualified persons with medical M.Sc in India, who are already working in clinical diagnostic laboratories; some of them for several years. India must utilize such large pool of human resource. Why else is government permitting medical M.Sc courses if they are deemed unemployable? This issue appeared in the daily The Hindu on 4th July. Those following this news inside and outside the country will perceive India's medical academia as an intolerant society that wishes to establish a monopoly by booting out non-doctors in the guise of guidelines. Does India want to send this message? Why did the policy makers overlook the existing NABL guidelines or the international systems? Was demoting persons with medical M.Sc based on rational findings or was it to promote one particular profession? When the policy making is left to one profession, there is always a risk of promoting and safeguarding own profession. Government policies must be bipartisan and inclusive, but it is not so in this case. 

When the products of own education system are considered unwanted and discriminated, it only adds to the existing curse of brain drain. Why should youngsters spend 2-31/2 years and lakhs of rupees only to be told later that they are unworthy of practising what they learnt in their own course? In medical colleges, the medical M.Sc course fee may be as high as two-to-three lakh rupees. Should they be investing so much of their parent’s money and own efforts only to be told later that they are only worthy of being laboratory technicians? No other degree has been maligned and demeaned as much as medical M.Sc in both medical education and clinical diagnostics and the government has done nothing to uphold its value. When MDs in these departments were in short supply, medical M.Sc's were used for teaching in medical colleges and signing reports in medical laboratories. Now that MDs are in good supply, rules are being altered to portray M.Sc’s as ineligible and fit to be excluded from the system. This is not just injustice, it is exploitation. India appears to be a difficult place for scientists as the policies, guidelines and working culture are big impediments.

14. Response of Anil Kumar, Additional Deputy Director-General, DGHS
In the news item that appeared in the daily The Hindu on 4th July, Anil Kumar representing the Directorate General of Health Services opined, "...they are not exposed to patients. They have only theoretical knowledge and no practical experience in clinical practise". It is rather appalling that policy makers seated at Delhi are totally disconnected and unaware of the the curriculum and syllabus of medical M.Sc course. Clinical investigation is the core component of this degree and a crucial part of the university practical examination. Either there is a genuine lack of awareness among policy makers or deliberate attempts are being made to project it falsely. In the news report, he further adds, "...they have been doing it illegally, as there were no regulations in the past". This statement is baseless for two reasons. Firstly, the Clinical Establishment Act is not mandatory for all states to follow. As on 21st March 2016, it is applicable only in ten states and 6 union territories (except Delhi). Therefore, the guidelines of this act are legal in only those states and union territories. The news report states that among these states and UTs, they are being implemented only in Rajasthan and Jharkhand. Secondly, to say that there were no regulations in the past is also false as 13 states have their own acts.

15. Council for registration of degrees
All doctors are registered with the state unit of Indian Medical Council. Medical M.Sc persons, who work as teachers in medical colleges and also offer professional services in clinical diagnostic laboratories are not registered by any council or professional body. In the absence of any registration, there is absolutely no data on the number of medical M.Sc persons in India. Since private deemed-universities do not come under the ambit of RTI Act, they don’t divulge data on medical M.Sc courses. This anomaly too must be corrected. Medical M.Sc course is unique that it does not fit either with para-medical council or allied health professional council. Hence, a separate council may be made for registration of medical M.Sc persons or authorize some national association of M.Sc degree holders to register them. 

16. Importance should be on competence, not degree
In majority of countries, the stress is always on training and competence. Unfortunately, in India the degree is above competence. Once a specified professional degree is acquired by the candidate, competence is automatically assumed and taken for granted. This explains why no periodic competency assessment of signatories is specified in NABL or CEA guidelines. This fallacy must be corrected. Like other countries, India too must rely on our existing education system and workforce and give more importance to training than the nomenclature of the degree. Irrespective of their degrees, all persons, whether MD or medical M.Sc must undergo prescribed training programme before becoming authorized signatories. All signatories must undergo periodic competency assessments.

17. Actions required
The government must address this issue without ignoring the genuine concerns of the aggrieved. After all, laws are believed to bring in equality and justice. It is, therefore, imperative that the guideline needs to be corrected and the mistake must be amended. The attitudes of 'holier than thou' and 'my degree is superior to yours' has no place in modern India. Monopoly and academic-inbreeding promote mediocrity and stagnation. Like any branch of science, medical science too should be open to contributions from diverse backgrounds. If needed, a commission may be formed to examine the utility and importance of medical M.Sc in medical education, healthcare and research. Persons with medical M.Sc degree are already discriminated in a variety of ways in medical colleges and if this anomaly is not corrected the discrimination will only worsen. If an aberration can be recognized and solved by the government, the aggrieved will not have to take the painful process of seeking legal remedy. The roles of medical scientists with medical M.Sc degree must be recognized, appreciated and upheld by the government giving the dignity it rightfully deserves. The lawmakers must strive to eliminate the degree-based discrimination (academic apartheid), end monopoly of one profession and ensure the dignity of labour and equal working opportunities.

Update (13-08-2017, 08-03-2017):

1. Honorable MP (Rajya Sabha) Shri. C.P Naryanan had raised a few questions "UNSTARRED QUESTION NO 1771" on the issue of denial of recognition to medical M.Sc degree. The ministry in its reply to the questions raised by the honorable member on 2nd August, 2016 stated the following, “NCEA/Laboratory 026 Standard has not been approved by the National Council for Clinical Establishments and it was used as an input for finalizing standards of laboratories by the National council.” In the unnamed document on diagnostic laboratory available at CEA website, there is no mention of medical M.Sc degree in any role under the section IV Human resource.

2. Several individuals had filed the grievance with Centralized Public Grievance Redress and Monitoring System that since M.Sc and Ph.D qualification holders are designated as authorized signatories for clinical lab reports by NABL, CEA guidelines should do the same. Instead of taking up the issue sympathetically and on merit, the MoHFW (vide a letter from Mr. Amit Biswas, Under-Secretary, MoHFW, dated 26/12/2016) has 'almost questioned' NABL on doing so and sought its reply. In that letter MoHFW stated, "Attention is invited to clause (b) of sub-section (2) of section 15 of IMC Act, 1956 which interalia provides no person other than a doctor having qualification recognized by Medical Council of India and registered with Medical Council of India/State Medical Council(s) is allowed to practice modern system of medicine or surgery or sign a clinical laboratory report." However, the said clause & sub-section of the said section 15 of IMC Act mentions the following, "shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law t be signed or authenticated by a duly qualified medical practitioner". There is no mention of diagnostic report in the clause; is the ministry deliberately misinterpreting and misguiding the clause to extend the interpretation to diagnostic laboratory report? In the same letter, the Mr. Amit Biswas mentioned  'practice of medicine' citing the aforementioned rule. One can only wonder how the officer took the liberty of interpreting 'laboratory practice' as a 'practice of medicine'.

Further, attention is drawn to the following sentences in this legal document: "Laboratory testing has never been, and is not now, the practice of medicine. Clinical laboratories provide relevant information as a tool for the physician to use, but laboratory tests themselves are not the practice of medicine. It is the act of the physician in diagnosing and treating the patient by using all available information and tools at his disposal that is the practice of medicine."

In its reply to MoHFW, NABL has clarified that the eligibility guidelines for laboratory signatory is pending approval by MCI and that its guidelines would be suitably modified as per MCI's reply. The executive committee of MCI, in a meeting held on 31-01-2005 and attended by the members of the Adhoc Committee appointed by the Hon'ble Supreme Court approved the following, "M.Sc. (Medical Biochemistry) with or without Ph.D is entitled to independently or solely sign a medical Biochemistry report in a clinical laboratory". Since MCI has already approved this in 2005, will it backtrack on it now? Will that not be a contempt of the SC appointed Adhoc committee's approval?

3. National Medical M.Sc Teachers' Association (NMMTA) has filed a writ petition in the honourable Karnataka High Court on 26/07/2016 against the guidelines of the CEA.

Update 20-03-2017
The National M.Sc Medical Teachers' Association (NMMTA) held a protest event at Jantar Mantar, Delhi on 20th March, 2017 against the discriminatory attitude and policies of the MoHFW. The dharna and procession were followed up with the submission of a memorandum to the health minister and a press conference. The details of the event and media coverage is available here:

Update: 12-05-2017
On 5th May, 2017 the Ministry of Health and Family Welfare published a draft of rules with respect to diagnostic laboratories under the Clinical Establishment Act and sought public suggestions or objections within 45 days. The draft is available here:

Despite all the opposition since it first asked for a similar feedback in 2014, medical M.Sc degree has still been left out for the roles of Technical Head of Laboratory or  Specialist or Signatories for all the three categories of laboratories. This clearly indicates that the government has NO intention of doing justice to biomedical scientists and that the notice is just a mandatory procedure.

By publishing in the gazette, the government wants to legitimize the discriminatory rules, all this when the case against it on this issue is ongoing in the court.

Tuesday, December 18, 2007

What is the scope of MSc in medical microbiology in India?

Medical M.Sc (Master of Science) courses in medical subjects including Anatomy, Physiology, Biochemistry, Microbiology and Pharmacology are offered by several medical colleges across India under the faculty of Medicine. There are few non-medical institutions, which offer this degree under the faculty of science. The number of institutions offering these courses have declined over the recent years. Not many are aware of its value and utility. The fee structure has been on the rise ever since I took my admission in 1993.

I shall concentrate only on M.Sc in medical microbiology only. Even though this is a postgraduate (PG) course, some people have difficulty in accepting it so. Typically, any PG course lasts only for two years but medical M.Sc courses are offered in many medical colleges for three years. The first year is dedicated entirely to learning medical subjects like Anatomy, Physiology and Biochemistry just the way first year MBBS students do. The only difference lies in Anatomy where brain and limbs are not included in the syllabus. After the student clears the first year, he/she can then proceed to the subject of specialty, which lasts for two years. 

Update: Medical M.Sc course were originally included in the first schedule of the Indian Medical Council Act, 1956. Medical colleges (up to 1980s) used to seek permission from the Medical Council of India (MCI) for starting medical M.Sc courses. Mysteriously, MCI has washed its hands off from these courses, with no trace of any such decision (in gazette or by law). UGC, however recognizes medical M.Sc as a two-year course. Kasturba Medical College (Manipal University), which used to offer medical M.Sc as a three-year course has cut it down to two-year course thereby taking away the 'medical' component of the first year in basic medical sciences.

During the two-years of the second part of the study, the student has to take up 2-3 internal assessment examination and undertake a dissertation. The course, curriculum and system of examination are exactly similar to that of MD a course. The only difference between M.Sc and MD course is the duration, MD students get three years to study the same portion. During the course, the student has to present subject and culture seminars besides undertaking a research work leading to submission of dissertation. In some colleges dissertation may not be compulsory. In few other colleges, research methodology and teaching skills are also taught to the students. At the end of two years, a final examination would be held, consisting of theory and practical examination. Practical examination is held for three days and the examiner panel consisting of internal as well as external examiners. The pattern of examination is same that of MD examination. The successful candidate is then awarded a Masters degree in Medical Microbiology and a certificate is given to this effect at convocation.

The options these students have next is limited. Unreserved candidates securing 60% or above and reserved candidates with 55% can pursue higher education by undertaking a doctoral study (Ph.D). Clearance of UGC CSIR/NET and Gate exams with good results would be added benefit as they would be given preference in universities. A regular scholarship too would be given. A student can pursue Ph.D in any institution or university of choice as long as it is recognized by UGC. MCI doesn't involve itself in this process. A Ph.D obtained from non-medical (health) universities will not be recognized by MCI for teaching jobs. Those not interested in Ph.D or unable to purse may opt for other studies such as bioinformatics, clinical research, medical transcription, biotechnology, genetics etc. Other less desirable study options include computer courses. Students not interested in further studies can find employment in diagnostic laboratories, call centers, pharmaceutical companies or biotech companies. If you are lucky you could land a technician job at any hospital in Gulf. Or worse, one can join a medical college as a teacher.

Scope of M.Sc students joining in medical colleges as faculty: In simple words, there is no scope at all. There was a time when there were no takers for pre- and para-clinical subjects like microbiology by MBBS graduates, the M.Sc degree holders were then in demand. Now almost every college has full admission to MD microbiology. Each year 20-30 MD students pass out of medical colleges from Karnataka alone and the number of M.Sc students from both the colleges too is almost same. With so many MD degree holders around, the scope for M.Sc degree holders is scarce. Many institutions are not appointing M.Sc degree holders these days. They are appointed to the non-teaching posts of tutors or demonstrators. After three years, these candidates are elgible to be promoted as Assistant Professors (even without Ph.D), which is wrongly and unjustly denied in several institutions. MCI's approach in this regard has been inconsistent and confusing. It has recognized medical M.Sc persons (without Ph.D) with three years of expereince as tutors/demonstrators as assistant professors but insists on Ph.D in its website. In the general body meeting of MCI, it was adopted that Ph.D should not be made compulsory for the post of Assistant Professor but the same has not appeared yet in the gazette. In simple words, a M.Sc faculty can not expect any growth in medical college without a Ph.D. The pay package in private institutions too may vary with the degree, where M.Sc degree holders may be underpaid.  The discrimination between M.Sc and MD degree holders is intense and many times unhealthy. A M.Sc degree holder is branded as "non-medico" and is looked down upon in many cases.

It makes sense that a person with no teaching experience has no eligibility to be an examiner. While MSc's are considered perfectly capable of teaching undergraduates, they are not considered capable of examining students. What extra skill does one need to be an examiner? Only Ph.D holders are allowed to be examiners. How does a research study on a narrow topic can confer upon an M.Sc teacher a "skill" to become an examiner? The reasons for not letting MSc's become examiners are more than what meets the eye. It is simply a denial of opportunity in order to consider themselves (MDs) superior to MSc's.

Clinical diagnostics is an integral part of medical M.Sc in Microbiology. Like MDs, the students are taught about the etiology, disease pathogenesis, and its laboratory diagnosis (including specimen collection & transport, principle & procedure of diagnostic tests and interpretation). After the degree is obtained one can practice in clinical diagnostic microbiology as a consultant. People opposed to this degree have launched campaign and lobbying to prevent medical M.Sc from practicing diagnostic microbiology. NABL, which recognizes medical M.Sc (with or without Ph.D) as signatory for diagnostic laboratories, is under pressure to withdraw this recognition. Ministry of Health & Family Welfare has brought out an act (Clinical Establishment Act), whose guidelines (although not applicable all over India) has unjustly denied any role for medical M.Sc degree holders in diagnostic laboratories. This essentially means that medical M.Sc graduates are not allowed to practice what they have learned.

How does one become bigger than the other? There are two ways to do this; a) outgrow and outperform the others, b) don't let others perform/grow by denying them opportunities. It is obvious that the second one is felt more appropriate. People want "differences" and how do you create differences? By denial of all opportunities and benefits.

Government has a policy of upliftment of backwards by promoting them via reservations. But what is happening in the medical education is quite the opposite. When the need of the hour is to unite and serve the education with a common goal, the system ends up creating differences. The differences are not only highlighted but every attempt is made to keep the difference not only intact but also to widen it. While the motto should have been to "live and let live", the scenario is quite unlike that. 

There is no denial that the two these two groups are not the same. A demand for equality is also uncalled for. Both these come from different backgrounds and different UG degree. Hence, the concept of superiority of MDs over MSc's is bound to occur. There is no point challenging their superiority or demanding equal status. But it is disheartening to see the denial of opportunities just to make these differences obvious. Agreed that the graduate degrees of both these groups are different but the post graduate degrees are qualitatively the same. When the nature of work is based on the PG degree and not UG degree, why should there be discrimination? The discrimination (if any) should be on merits and not based on UG degree. This is exactly similar to the caste based discrimination, race based discrimination that exists in the society. We now have a new “degree based discrimination”, what I call "academic apartheid". When rights are demanded, MSc's are often told bluntly that they already have been given more than what they deserve.  When the education sector itself is infested with this kind of academic apartheid, we can't expect much change to occur in the society.

Do not pursue M.Sc in any medical subjects and if you must undertake M.Sc course, then; pursue higher studies, do a PhD and never join a medical college as teaching faculty.

Caution: No degree is good or bad. It is up to the individual what one can achieve with it. The purpose of putting up this article is to highlight the ground reality of the value medical MSc has in medical institutions. There is indeed better prospects outside it.

Please don't post questions seeking guidance as they will not be entertained anymore.

If you still want to join this course, you are either stupid or a very enterprising individual. Make your choice carefully! If you have read this far, I suggest you read the comments at the bottom of this page.

Last updated: 14th March, 2017