Saturday, July 9, 2016

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


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 development of Standard Template for 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 opposition 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 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 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 enables 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 provides 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 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 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 Hyderbad 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 the 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 researches. 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, number 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, 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 follow a competitive entrance examination. Therefore, the candidates must have good academic record in both B.Sc and comeptitive 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 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 discipline 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 conduced parallely 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 cases 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 degrees and mere possession of degree doesn't ensure competence. 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 Classificationand 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 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 practicing 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 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 promotes 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, aprreciated 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 dignity of labour and equal working opportunities.

08th July, 2016

Tuesday, December 18, 2007

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

M.Sc (master of science) courses in medical subjects including anatomy, physiology, biochemistry, microbiology and pharmacology are offered by Kasturba Medical College (Manipal and Mangalore). These are the only two colleges in Karnataka that offer these courses. Similar courses are offered by Maharashtra, Kerala, Tamilnadu and Kerala universities too. Every year several students from Karnataka and outside take admission in these two colleges. Not many are aware of its value and utility. The fee structure has been on the rise ever since I took my admission.

I shall concentrate only on M.Sc in medical microbiology only. Even though this is a postgraduate course, it is not considered a PG course by (Medical Council of India (MCI). Typically, any PG course lasts only for two years but medical M.Sc courses are offered 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.

During the two years of 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 student 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. 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. Since Manipal University is a deemed one, answer booklets are evaluated in the same university. 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 doctoral study (PhD). Clearance of UGC CSIR/NET and Gate exams with good results would be added benefit as they would be given preference to those without these exams. Besides, a regular scholarship too would be given. A student can pursue PhD in any institution or university in Karnataka or outside provided it is recognized by MCI. Obtaining a PhD in non-medical universities will not be recognized by MCI. Those not interested in PhD or unable to purse may opt for other studies such as bioinformatics, clinical research, medical transcription, biotechnology, genetics etc. Other less desirable study options includes 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 paraclinical subjects like microbiology by MBBS graduates, the M.Sc degree holders were 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. Some colleges appoint them as tutors or demonstrators and not even as lecturers. Even if a M.Sc degree holder is appointed as lecturer, he/she is entitled to promotion as Assistant professor after three years, which is wrongly and unjustly denied in several institutions. The pay package in private institutions too may vary with the degree, where M.Sc degree holders may be underpaid. MCI does not recommend promoting M.Sc faculty above the post of Asst. Prof. without a medical PhD. In simple words, a M.Sc faculty can not expect any growth in medical college without a PhD. The post graduate course (M.Sc) is not considered as a post-graduate course by MCI at all. The discrimination between M.Sc and MD degree holders is intense and many times unhealthy. In simple words, M.Sc holders have no place in a medical world. A M.Sc degree holder is branded as "non-medico" and is looked down upon in many cases.

To view the list of differences between MSc & MD microbiology, visit www.microrao.com/msc.htm

It makes sense that a person with no teaching experience has no eligibility to be an examiner. What bewilders me is that while MSc's are considered perfectly capable of teaching undergraduates, they are not considered capable of examining them. What extra skill does one need to be an examiner? Only PhD holders are allowed as examiners. I always wonder how a research study on a narrow topic can confer upon an MSc 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.

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 opportunity. 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. Worse, there is no reservation, no rights or no bodies to fight against oppression for MScs.

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 for 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. Some day someone should thank them for their generosity. When the education sector itself is infested with this kind of academic apartheid, we can't expect much change to occur in the society.

Summary:
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 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 a dumb 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.