India’s Doctor-Population Ratio

 India’s Doctor-Population Ratio: A Closer Look at the Reality Behind the Numbers

India’s healthcare system is often seen as a paradox: while the country grapples with a shortage of doctors in many regions, it also boasts a seemingly impressive number of medical practitioners. According to official figures, as of June 2022, there are over 13 lakh allopathic doctors (MBBS), alongside a significant number of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) practitioners. These numbers suggest that India may already have surpassed the World Health Organization’s (WHO) recommended doctor-population ratio of 1:1,000. However, the true scenario is more complex, and understanding it requires digging deeper into these statistics and examining the factors that shape doctor availability in India.

The Numbers on Paper: 1:834 Ratio

The Ministry of Health and Family Welfare (MoHFW) reports that as of mid-2022, there were 13,08,009 allopathic doctors registered with State Medical Councils and the National Medical Commission (NMC). If we factor in 5.65 lakh AYUSH doctors, the doctor-population ratio in India is 1:834—well above the WHO’s standard of 1:1,000. 

On paper, India has clearly met, and even surpassed, the international benchmark for the number of doctors. This would seem like cause for celebration, suggesting that the country’s healthcare system is well-equipped to meet the needs of its 1.4 billion people.

The 80% Availability Factor

However, the reality is more nuanced. The MoHFW estimates that only 80% of the registered allopathic doctors are actively practicing medicine in India. The remaining 20% have either retired, migrated, stopped practicing, or never engaged in patient care. This means that the actual number of practicing doctors is much lower than the total number of registered practitioners.

If we apply this 80% figure to the total of 13.08 lakh allopathic doctors, the number of practicing doctors reduces to approximately 10.46 lakh. Adding the 5.65 lakh AYUSH doctors into the mix, the effective doctor-population ratio becomes 1:834, which is still above the WHO recommendation—but the actual number of healthcare professionals available for active patient care is far less than the full registration count suggests.

Non-Practicing Doctors: A Silent Contributor to the Ratio

The situation becomes even more complicated when we consider doctors who are registered but do not directly engage in patient care. In every medical college, there are departments such as Anatomy, Physiology, Biochemistry, Pathology, Microbiology, Pharmacology, and Forensic Medicine, which are primarily focused on teaching and research rather than direct clinical practice. Each medical college typically employs 50-75 faculty members in these non-clinical departments, adding up to a total of around 42,500 non-practicing doctors across the country. 

Even if a portion of these doctors engages in private practice outside their teaching hours, they do not contribute to the active healthcare workforce. This brings into question whether they should be considered part of the doctor-population ratio when evaluating healthcare access for the general public.

A Shift to Other Professions

Many doctors, after completing their education, opt to shift to careers outside direct patient care. These can include roles in healthcare administration, pharmaceutical companies, research, business, or even government positions. While these doctors hold medical degrees, they do not contribute to clinical healthcare, further skewing the real doctor-population ratio. There is no official record of how many of these doctors have moved to other professions, but the shift is significant enough to suggest that the number of doctors available for active patient care is lower than official statistics indicate.

The Real Doctor-Population Ratio: More Than Just a Number

In light of these factors, it becomes clear that the real doctor-to-population ratio in India is much more complex than the figure of 1:834 suggests. The number of active practitioners is reduced by several factors—non-practicing doctors, those working in non-clinical fields, and the 20% of registered allopathic doctors who are unavailable for active care.

Furthermore, the distribution of doctors across India is highly uneven. While urban areas may have a surplus of healthcare professionals, rural and underserved regions face acute shortages. The doctor-to-population ratio in these areas could be far worse, exacerbating health disparities. The WHO’s recommendation of 1:1,000 is based on global averages, but for a country as vast and diverse as India, a more localized and nuanced approach is needed.

Conclusion: Addressing the Gaps in India’s Healthcare System

India’s doctor-population ratio is undeniably better than the WHO's standard, but this does not guarantee universal access to quality healthcare. The disparity between registered doctors and those actively practicing medicine, coupled with regional inequalities and the movement of doctors into non-clinical fields, points to a need for a more refined understanding of healthcare availability. 

To truly address the gaps in India’s healthcare system, policymakers must look beyond raw numbers and focus on improving the distribution of doctors, ensuring that the healthcare workforce is adequately trained, incentivized, and supported to provide care where it is most needed. Improving the quality of medical education, expanding rural healthcare infrastructure, and creating policies that encourage doctors to practice in underserved areas will be key to ensuring that India’s healthcare system lives up to the promise suggested by its doctor-population ratio on paper.

Denial of HODship to teachers with medical M.Sc, Ph.D qualifications

Essay: Advocating for Teachers with Medical M.Sc and Ph.D Qualifications as Heads of Departments in Medical Colleges

The ongoing debate over whether teachers with medical M.Sc and Ph.D qualifications should be allowed to become Heads of Departments (HODs) in medical colleges is framed by misconceptions and discriminatory policies. This essay aims to present a well-reasoned argument in favor of such teachers being eligible for HOD positions. It systematically addresses concerns, clarifies myths, and highlights the drawbacks of denying them leadership roles.

I. Understanding the Role of HOD in Medical Colleges

1.1. Administrative Nature of the HOD Role

The primary function of an HOD is administrative rather than clinical. Responsibilities include managing faculty, coordinating teaching schedules, and promoting research and collaboration among departments. These responsibilities are not tied to patient care or clinical duties, making it reasonable to appoint individuals with non-clinical qualifications.

1.2. Experience-Based Leadership

There is no formal training or certification required to become an HOD. Leadership skills are honed through years of academic and administrative experience within the department. Teachers with M.Sc and Ph.D degrees often have long tenures in these roles, equipping them with the same practical administrative skills as their MD counterparts.

II. Academic Equivalence of M.Sc and MD Degrees

2.1. Comparability in Education and Role

Both MD and medical M.Sc programs prepare educators for non-clinical subjects such as Anatomy, Biochemistry, and Physiology and para-clinical subjects such as Pharmacology and Microbiology. The expertise required to teach these subjects does not hinge on clinical qualifications but on academic rigor and pedagogical skills.

2.2. Postgraduate Qualification as the Benchmark

Teaching expertise stems from postgraduate education, not the undergraduate degree. While MD holders may have clinical exposure, the focus of M.Sc and Ph.D training is aligned with academic teaching and research, making these qualifications equally relevant in non-clinical departments.

III. Myths and Misconceptions Debunked

3.1. Myth: M.Sc is for Research, Not Teaching

Fact: Medical M.Sc programs were established specifically to create educators for medical colleges. The curriculum aligns with MD programs, focusing on teaching foundational medical sciences.

3.2. Myth: Lack of Clinical Experience Makes M.Sc Holders Ineligible

Fact: Clinical experience is not required to teach non-clinical subjects. Teachers with medical M.Sc and Ph.D qualifications have deep expertise in their fields and contribute effectively to academic and research programs.

3.3. Myth: M.Sc Courses Are Unstructured

Fact: M.Sc programs follow a structured syllabus, often overlapping with MD courses. Examinations and coursework are conducted by the same faculty, ensuring similar academic standards.

3.4. Myth: MD Is Superior to M.Sc and Ph.D

Fact: Both, M.Sc and Ph.D degrees offer similar specialized academic training. Holding a Ph.D, in fact, reflects higher academic achievement, as it involves advanced research skills beyond what MD programs cover.

IV. Addressing Discrimination and Bias

4.1. Prevalence of Academic Apartheid

The preference for MD holders over M.Sc and Ph.D educators reflects an unfounded bias. This practice undermines academic inclusivity and dismisses the contributions of highly qualified teachers with non-clinical qualifications.

4.2. Global Perspective on Leadership in Medical Education

In Western countries, educators with M.Sc and Ph.D degrees routinely hold leadership positions in medical schools. Denying similar opportunities in India contradicts international standards of academic fairness and meritocracy.

4.3. Structural Discrimination in Policy

The National Medical Commission (NMC) regulations have historically favored MD graduates, often altering guidelines to limit the participation of M.Sc and Ph.D teachers. This systemic bias reflects an unjust monopolization of authority within academic governance.

V. Legal and Ethical Dimensions

5.1. Violation of Equality and Meritocracy

Denying teachers with M.Sc and Ph.D qualifications access to HOD roles constitutes discrimination. Once appointed as professors, these educators should be entitled to all associated responsibilities, including department leadership.

5.2. Judicial Review and Accountability

NMC regulations that restrict leadership roles for M.Sc and Ph.D holders can be challenged under principles of equality. Courts have a duty to ensure fairness and prevent arbitrary discrimination in academic governance.

VI. Benefits of Inclusive Leadership in Medical Colleges

6.1. Enhanced Academic Innovation

Teachers with M.Sc and Ph.D degrees bring unique research perspectives and pedagogical insights, fostering innovation in non-clinical subjects.

6.2. Collaboration and Interdisciplinary Growth

Experienced educators from diverse backgrounds promote collaboration across departments, enriching the academic environment through varied expertise.

VII. Summary: Why Denying HOD Roles to M.Sc and Ph.D Educators Is Harmful

1. Administrative competence is not tied to clinical qualifications; experienced professors, regardless of degree type, are capable of managing departments.

2. Postgraduate qualifications like M.Sc and Ph.D are academically equivalent to MD degrees in non-clinical subjects.

3. Bias against non-clinical educators reflects outdated prejudices, not academic or administrative merit.

4. Global best practices demonstrate that leadership roles are often held by educators with diverse qualifications.

5. Excluding qualified educators undermines institutional diversity and innovation.

6. Systematic changes in policy have unfairly limited opportunities for M.Sc and Ph.D holders, reflecting institutional bias.

7. Legal frameworks support merit-based appointments, and the exclusion of certain educators can be challenged as discriminatory.

8. Collaboration and interdisciplinary growth suffer when educators from diverse backgrounds are denied leadership roles.

9. Academic apartheid reinforces hierarchical mindsets that harm educational progress.

10. Inclusivity in leadership fosters fairness, equity, and better academic outcomes.

Conclusion

It is unjust to deny teachers with medical M.Sc and Ph.D qualifications access to HOD positions. Leadership roles in non-clinical departments demand academic, managerial, and collaborative expertise—qualities that are not the exclusive domain of MD holders. Promoting inclusive academic governance will strengthen medical education and reflect a commitment to fairness and progress. The NMC must recognize the value these educators bring and adopt more inclusive policies for department leadership.

 Denial of examinership: another discriminatory move of the NMC

There are two categories of teachers in India's medical colleges: medical and non-medical. Medical teachers are those with MBBS as the graduate qualification and MD/MS as the postgraduate qualification in a subject specialty. Non-medical teachers are those with B.Sc in life sciences as the graduate qualification and medical M.Sc in non-clinical subject specialty as the postgraduate qualification with or without a Ph.D doctorate. While the non-clinical subjects consisting of Anatomy, Biochemistry, physiology, Pharmacology and Microbiology, which are also considered basic medical sciences, are taught by both medical and non-medical teachers, the clinical subjects such as general medicine, community medicine, forensic medicine, general surgery, orthopedics, obstetrics & gynecology etc are taught exclusively by the medical teachers. This is a general practice in many parts of the world.

Even though the graduate qualifications of both the medical and non-medical teachers are different, the postgraduate qualification is essentially the same. The curriculum and syllabus of MD and medical M.Sc courses in the five non-clinical subjects are similar and students of either course are trained similarly in the one and the same medical college by the same teachers using the same methodology and resources. Medical M.Sc courses follow the same pattern as MD courses with respect to components such as laboratory training, clinical interpretation, seminars, journal clubs, dissertations etc, therefore no qualitative difference exists in the nature of training between the two courses. After successful completion of courses, health universities mostly award postgraduate degrees under the faculty of medicine. Thus, the two classes of postgraduates are similarly placed for teaching roles. It is the knowledge imparted in the subject specialty during the postgraduate course that empowers and enables the teacher to teach that subject, and the knowledge obtained in graduate courses while helpful and supportive, is not essential.

The non-medical teachers in India have been a part of medical education for several decades. Many are working in professorial posts such as Assistant Professor, Associate Professor, and professor in medical colleges. With decades of experience behind them, senior among them also head the department. Some among them have also authored manuals, chapters in textbooks or educative websites. Some have conducted scientific research in their specialty and published scientific papers. Some are also involved in curriculum committees and overseeing the implementation of the syllabus. Despite such long and distinguished service and contribution to medical education, the non-medical teachers now face incessant discrimination imposed by the regulator -the National Medical Commission, which has now barred them from executing their academic role as undergraduate examiners.

The introduction of competency based curriculum in medical education (CBME) is being touted as the reason for this denial. The curriculum has 20% vertical and horizontal integration with other relevant non-clinical and clinical subjects. Since medical M.Sc courses include the compulsory study of Anatomy, Biochemistry, and Physiology irrespective of own subject specialty, the non-medical teachers are competent in integration with the non-clinical subjects. Integration with clinical subjects has always been a part of the medical M.Sc postgraduate course as 'applied aspects', therefore integration is never a hindrance to a non-medical teacher. Besides, all teachers, both medical and non-medical, have undergone mandatory training on the Curriculum Integration Support Program, Basic Course Workshop and AETCOM, thereby equipping all with the necessary knowledge and skills required for teaching the new curriculum. CBME is a repackaged version of the existing knowledge, not a drastically new concept. All the components that were taught earlier will continue to be taught albeit in a slightly different way, but this doesn't call for exclusion of the experienced non-medical teachers from their academic roles of educator and assessor.

Since the introduction of this curriculum, three batches of medical undergraduate students have progressed from non-clinical to clinical specialties. Non-medical teachers have also taught and assessed the students in the new format of curriculum. Barring them now doesn't make any sense. Assessing the student's performance in an exam is an integral component of an educator's academic profession.

Barring non-medical teachers will create the following issues: 1. Artificial shortage of examiners. As many departments already have faculty shortages, conducting both internal and external exams will become difficult and tasking. 2. Involving medical teachers from other colleges whether within the state or outside for every internal and university exam will unnecessarily increase cost as the colleges have to spend on their renumeration and TA/DA costs. 3. Ignoring the senior and experienced teachers will lead to students being assessed by inexperienced junior teachers, which could compromise the standards. 4. Denying the educator the academic role of assessment is a discriminatory and humiliating experience. It will hurt the self-esteem of the faculty and the cordial environment in the department will not be the best.

When the qualifying marks to pass a university exam have been reduced by the NMC to 40%, what difference does it make whether the examiner holds MBBS/MD qualification or medical MSc/PhD? When upholding the quality of medical education is not a priority, rules discriminating against the 'non-medical' teachers stand out as bogus and motivated. Pride and prejudice are the core philosophies of the NMC's undergraduate board in making policies.

 Problems, more problems, and solutions

The so-called non-medical teachers possessing medical M.Sc/Ph.D qualifications who are working in various capacities ranging from Tutors to Professors & HOD are protesting against the unjust norms set by the NMC.

Clarity on the medical M.Sc courses:

The majority of MBBS graduates typically opt for specialization in clinical disciplines, and they consider pursuing postgraduate studies in non-clinical disciplines as a last resort, often after numerous unsuccessful attempts to secure clinical seats. As a result, thousands of postgraduate seats in non-clinical subjects remain vacant each year.

With the establishment of more medical colleges and an increase in MBBS seats within these colleges, the shortage of faculty members has become more pronounced. This shortage is particularly acute in newly established colleges, as well as those situated in remote, hilly, and suburban areas. Due to the scarcity of medically qualified teachers, the education system resorted to appointing non-medical teachers starting in the 1960s. However, historically, the permissible ratio of non-medical teachers was limited to 30% (50% in Biochemistry).

Medical M.Sc courses in the five non-clinical subjects were initially included in Schedule-I of the Indian Medical Council Act. However, as MBBS graduates began to show less interest in these courses and opted for MD programs in the same subjects, the Medical Council of India (MCI) gradually stopped taking interest in these courses. In the late 1980s, MCI stopped granting permission to medical colleges to initiate these courses, and eventually, it completely withdrew its support from them.

At one point, over 100 medical colleges used to offer these courses, but now the number has dwindled to less than 30, including in AIIMS. These courses are primarily conducted within medical colleges, utilizing identical curricula, syllabi, and resources as MD programs. They run concurrently with MD courses, guided by the same teaching methods and faculty. However, regardless of their chosen specialty, all students are required to complete a mandatory one-year study in human anatomy, physiology, and biochemistry, mirroring the curriculum of first-year MBBS students.

All aspects of the M.Sc. course, including university examinations, resemble those of the MD course. Successful candidates are awarded their degrees by the health university under the faculty of medicine. Although there may be differences in the graduate degrees between medical and non-medical teachers, their postgraduate degrees are quite similar. Consequently, aside from clinical practice, both groups of degree holders are well-suited for similar roles and employment opportunities.

It is unfortunate that the regulatory body consistently provides inaccurate information in its affidavit when referring to the medical M.Sc courses. It appears to use misinformation as a political tool to advance its agenda.

Appointment of non-medical teachers:

The practice of appointing non-medical teachers to instruct in non-clinical subjects, which form the foundation of medical sciences, is not exclusive to India. In fact, the percentage of non-medical teachers varies widely in different countries, ranging from 30% to 100%. Only 8-11% of teachers in non-clinical subjects at medical colleges in the United States hold medical qualifications, while the majority are non-medical professionals.

The appointment of non-medical teachers in the non-clinical subjects should be a matter of policy, rather than a temporary measure extended to medical M.Sc postgraduates. The regulations outlined by the World Federation of Medical Education (WFME) emphasize the importance of balanced participation from both medical and non-medical teachers.

The presence of teachers with either set of qualifications brings dynamism to teaching, a fact emphasized by the Board of Governors in supersession of MCI when rejecting a demand to exclude non-medical teachers. Non-medical teachers should be an integral part of medical education to prevent a monopoly of one-degree holders, which can lead to stagnation. Both sets of degree holders can complement each other, rather than compete with each other.

It is incorrect to assume that possessing a specific qualification or lacking it has a direct impact on the quality of teaching. Within both sets of qualifications, there are excellent, mediocre, and subpar teachers. The crucial factor determining a teacher's ability to educate effectively is their postgraduate degree, whether it's a medical M.Sc or MD; the undergraduate degree may have minimal influence. Thus, the quality of teaching ultimately depends on the individual's knowledge, skills, and attitude as a teacher. Medical education should draw benefits from both sets of qualifications, and the selection should prioritize the best candidate, regardless of their specific qualification.

MD in non-clinical subjects:

In many developed countries, medical colleges do not provide MD programs in non-clinical subjects. Typically, these subjects are primarily taught by scientists holding Ph.D. degrees, with only a few doctors who have a keen interest in research. MD programs are primarily offered in clinical subjects. In contrast, India has a significant number of non-clinical doctors, who are included in the count of doctors for calculating the doctor-patient ratio. However, these non-clinical doctors do not engage in patient care or contribute directly to healthcare services. Therefore, offering MD degrees in non-clinical subjects in India is irrational. Instead, these programs be replaced with medical M.Sc courses for MBBS graduates, as was the practice in the past.

Monopoly, dominance, and NMC's abuse of position:

Both the MCI and the present NMC are predominantly composed of medical professionals. In contrast, the General Medical Council in the UK maintains an equal representation of both medical and non-medical individuals. Initially, there was a proposal to limit the composition of medical professionals to 60% in the NMC, but this proposal was thwarted by the medical community, ultimately resulting in the dominance or hegemony of doctors in the NMC.

 Despite divisions among doctors regarding clinical and non-clinical specialties, they consistently unite when their interests are at stake. They tend to prioritize their own interests and often restrict or exclude non-medical individuals from various competitive arenas. This behavior can be seen as an abuse of their dominant position. 

When the NMC solicits public feedback, the majority of the responses come from the medical community, which represents a substantial majority. Conversely, the feedback from non-medical individuals constitutes a small minority and can easily be overshadowed. Consequently, it's important to recognize that all feedback received by the NMC tends to be inherently biased.

Over the years, the NMC has systematically eroded the authority of non-medical teachers and has consistently modified regulations to place them at a disadvantage. These changes in norms are inherently discriminatory and are intended to disenfranchise non-medical teachers. This pattern of denials and restrictions can be attributed to the underlying concepts of pride and prejudice within the medical community.

The pride that doctors take in their qualifications often leads to a prejudice against non-doctors, resulting in a general unwillingness or resistance to extend the same rights or dignity to non-doctors as they afford themselves. This sense of self-supremacy, which is seen as a 'superiority complex', prevents them from treating others with the same level of respect and equality. In essence, this is nothing but 'academic apartheid'. When the regulatory body itself practices discrimination at the highest level, it sets a discouraging precedent, encouraging individuals at the college level to perpetuate discriminatory practices.

Discriminations, and denials of opportunities:

Unjust Ph.D. Requirement: There is an unwarranted insistence on requiring a Ph.D. for the Assistant Professor position, despite the absence of such a mandate by the UGC. The demand for a Ph.D. for entry-level demonstrator roles appears to be a deliberate attempt to undermine the value of a Ph.D. and restrict the appointment of non-medical teachers. Equating postgraduate and doctoral qualifications (MSc+PhD) with an undergraduate degree (MBBS) is both belittling and unfair.

Discrimination Against Medical MSc: Despite the equivalent quality of medical MSc and MD courses, medical MSc is unfairly treated and not recognized as a basic qualification. Medical MSc is intentionally excluded as a postgraduate qualification in the NMC's faculty declaration form, despite there being a substantial number of graduates, ranging from 5000-8000.

Exclusion from Faculty Training programs: Non-medical teachers are systematically and unethically being denied/excluded from faculty training programs like the revised basic course workshop, CISP, and AETCOM.

Denial of Examiner Opportunities: Fundamental roles of a teacher to serve as undergraduate examiners are being denied to non-medical teachers despite possessing decades of teaching experience.

Limited Tenure for Tutors/Demonstrators: The tenure for tutor/demonstrator roles has been restricted to a mere 3 years, seemingly designed to discourage non-medical teachers from continuing in these positions.

Rejection of Feedback and Appeals: Feedback and appeals submitted by non-medical teachers or their associations are persistently rejected as if we don’t exist or our issues don’t matter.

Denial of HODship: Senior professors possessing non-medical qualifications are unfairly denied the opportunity to head departments despite seniority and decades of experience.

In essence, non-medical teachers are subjected to a second-class status, characterized by restricted roles, rights, and privileges. 

Political lobbying and the after-effects:

As the MCI transitioned into the NMC, a group of non-clinical medical professionals made concerted efforts to exert pressure on the NMC in order to exclude non-medical teachers from the medical education system. Their previous attempt to influence the MCI had proven unsuccessful. 

The NMC responded by significantly reducing the allowable percentage of non-medical teachers, lowering it from 50% to 15% in Biochemistry and from 30% to 0% in both Pharmacology and Microbiology. While these changes were initially meant to apply to new medical colleges starting from 2020 onwards, they were, in practice, being applied retrospectively to all colleges.

Existing non-medical teachers, particularly tutors and demonstrators, were facing termination of their contracts or non-renewal, citing the new regulations. Even those with four years of teaching experience and M.Sc qualifications were being denied promotions to the Assistant Professor position. Previous guidelines that required a Ph.D. for the Associate Professor and higher positions were being ignored. Instead, a Ph.D. was being demanded for the Assistant Professor position in MSR 2020 guidelines, a requirement not mandated by the UGC. Taking it a step further, NMC has now mandated a Ph.D. as a requirement for the lowest entry-level non-teaching position of tutor in the MSR 2023 guidelines. This change appears to be aimed at discouraging non-medical candidates from entering the field of medical education. Furthermore, the term of employment for tutors was limited to three years, seemingly to prevent them from getting promoted to higher posts.

Individuals in Pharmacology and Microbiology were among the hardest hit by these changes, as they were effectively barred from applying for teaching positions in any other institution. They faced restrictions on transferring to different colleges or relocating to other cities. In essence, they found themselves trapped within the same college and were at the mercy of the college management. These limitations hindered their opportunities for career advancement and their ability to explore new job prospects. Such restrictions appear to contradict the principles enshrined in Articles 19(1)(e) and 16, which uphold the rights of citizens to move freely between states and seek employment anywhere within India.

It's all about jobs for doctors and filling vacant PG seats:

The persistent vacancy rates of 40-50% in postgraduate (PG) seats within non-clinical specialties are expected to perpetuate the shortage of medical teachers in these fields. Additionally, medical colleges are grappling with revenue losses stemming from these unoccupied PG seats. In certain states, private medical colleges have established agreements with the government, obliging them to allocate a specific percentage of PG seats at reduced fees. Consequently, these institutions allocate non-clinical PG seats to the government quota while retaining the more lucrative clinical seats for themselves. 

Given the lack of interest among MBBS graduates in non-clinical seats, medical colleges are compelled to relinquish the clinical seats, which negatively affects their interests. Thus, there is a pressing need to address the vacancies in non-clinical seats. To address these vacancies, efforts have been made to attract MBBS graduates by offering incentives such as freebies, lowering the qualifying percentile to accommodate lower-scoring MBBS students for PG seats, reducing tuition fees, or even providing the seats free of charge.

Most MBBS graduates aspire to pursue clinical practice, as non-clinical subjects do not provide opportunities for clinical work. Typically, careers in non-clinical fields are centered around teaching in medical colleges. While there is some competition for teaching positions from M.Sc/Ph.D. candidates, this is a relatively minor factor that discourages MBBS graduates from pursuing PG studies in non-clinical subjects.

Despite the numerous vacancies in PG seats, a significant number of MBBS graduates are currently pursuing MD degrees in non-clinical subjects with the hope of securing faculty positions in medical colleges. The association of non-clinical medicos has actively lobbied the NMC to create provisions that would facilitate job opportunities for these individuals.

As a result, the undergraduate board of the NMC made the decision to significantly reduce and eventually stop the appointment of non-medical teachers. This decision serves a dual purpose: firstly, it aims to encourage the occupancy of MD seats in non-clinical subjects, and secondly, it seeks to create job opportunities for medical postgraduates, albeit at the expense of non-medical candidates.

The primary role of the NMC is to establish policies and guidelines that maintain the quality of medical education, rather than engaging in political strategies to occupy PG seats or secure jobs for doctors. By doing so, the NMC appears to be behaving more like an association of doctors focused on advancing their self-interests, rather than fulfilling its role as a regulator.

Role of ministry in ensuring justice:

While the MCI and NMC primarily are bodies 'of the doctors, by the doctors and for the doctors' furthering the interests exclusively of doctors, the union government is entrusted with the responsibility of safeguarding the welfare of all stakeholders. While the regulatory body tends to be self-centered, the policies of the Ministry of Health and Family Welfare (MoHFW) are grounded in reality and uphold principles of universal justice and equality. The NMC Act empowers the government to supersede the NMC on any matter, including policies. Given the inherent bias of the NMC, it is unlikely to ensure a level playing field for non-medical individuals. Therefore, the ministry's intervention is entirely justified. However, it is shocking that the NMC, after initially submitting an affidavit to the Delhi High Court to comply with the ministry's directives, later reversed its stance and exhibited defiance.

Unjustifiable pretexts - myths vs facts:

The rationale employed by the NMC to disqualify non-medical teachers appears to be weak and unsubstantiated. For individuals who have already covered Anatomy, Physiology, and Biochemistry in the first year of their medical M.Sc. program, integrating these subjects for non-medical teachers should pose no significant challenge. In practice, integration with clinical subjects has been ongoing for many years, albeit under the term "applied aspects," even if it was not formally recognized as "integration." Non-medical educators have successfully implemented these integrations since their introduction a few years ago. It's worth noting that while some non-medical teachers may have been excluded from participating in teacher training programs, many have actively participated in critical training sessions, including the revised Basic Course Workshop (rBCW), Curriculum Integration Support Program (CISP), and Attitude, Ethics, and Communication (AETCOM).

The integration component constitutes only a minor portion, approximately 20%, of the overall syllabus. It's crucial to recognize that the fundamental aspects of health and illness, such as the human body, diseases, and diagnostic and treatment methods, remain constant. A shift in curriculum, therefore, does not alter these core principles. The new curriculum cannot be used as an excuse to disqualify teachers who have been teaching for years/decades or prevent them from the academic role of examiner. Furthermore, the early clinical exposure component comprises just 9 hours in each subject. This relatively minimal requirement can easily be fulfilled by medical teachers, who already make up a significant majority, ranging from 70% to 100%, of the faculty.

Non-medical teachers constitute a small minority, with some colleges lacking any non-medical teachers at all. At most, they can make up to 30% of the total faculty strength. The majority of faculty members in these institutions are medical teachers. Hence, the claims of subpar teaching quality cannot be solely attributed to this minority group of teachers.

Proposal to shift non-medical teachers into research:

The NMC's current proposal plans to relocate non-medical teachers, some of whom have served as Professors for several years or even decades, to research positions, ostensibly to create job openings for doctors. However, this plan is illusory, as there simply aren't enough doctors to fill these positions. Forcibly redirecting an individual's career against their wishes is not only unethical but also inhumane. The process of shifting will not happen as envisaged. While permanent government employees may be accommodated into new positions, privately-run institutions are more likely to terminate the employment of non-medical faculties resulting in job loss of thousands. 

It is to reiterate that medical M.Sc courses are historically meant to create teachers for undergraduate teaching, these are no different from MD courses and the false notion that M.Sc courses are meant for research has to be debunked.

In conclusion, what needs to be done?

1. The presence of non-medical teachers should be an integral part of medical education, and colleges should have the freedom to appoint them on merit up to a limit of 30%.

2. All forms of discrimination against non-medical teachers must be abolished.

3. The NMC Act should be amended to ensure that every board, committee, or sub-committee includes 50% non-doctors to ensure fairness and equity.

4. All discriminatory and contested guidelines in the CBME and MSR 2023 should be amended immediately or withdrawn.

5. In order to strengthen and regulate the standards of medical M.Sc courses, a new body 'National Commission for Scientists in Healthcare and Medical Education' must be framed.

It's all about securing jobs and filling empty PG seats under the guise of prescribing quality

The current landscape of medical education in India has been marked by a series of challenges and controversies, particularly concerning the roles and actions of the National Medical Commission (NMC), the Union Government, and the petitioner association, the National M.Sc Medical Teachers’ Association (NMMTA). These issues have raised concerns about the fairness, transparency, and inclusivity of the system, as well as the balance between medical and non-medical professionals.

Roles of the NMC:

The NMC, as the regulator of medical education, holds significant responsibilities. It is empowered to set standards and guidelines, making it essential for them to engage in discussions and gather feedback from stakeholders while framing these standards. Additionally, the NMC is expected to follow prescribed quorum procedures when framing guidelines or adopting resolutions. Moreover, it should operate under the guidance and policies set by the Union Government and adhere to the norms established by international bodies such as the World Federation of Medical Education. The NMC should ideally maintain a bipartisan, fair, transparent, and inclusive approach in its practices and not let policies be dictated by personal or collective pride or prejudices.

Roles of the Union Government:

The Ministry of Health and Family Welfare (MoHFW) plays a pivotal role in setting the overarching policies for medical education and directs the NMC to follow these policies. The Union Government holds the authority to ask the NMC to amend or withdraw issued guidelines as needed.

Roles of the Petitioner Association (NMMTA):

The NMMTA serves as a vital entity in safeguarding the interests of its members, who are dedicated educators and professionals with non-medical backgrounds. They hold medical M.Sc postgraduate degrees in specialized fields such as Anatomy, Biochemistry, Physiology, Pharmacology, and Microbiology, often accompanied by Ph.D. qualifications. The association can file feedback on guidelines or appeals with the NMC or the MoHFW and seek legal remedies.

Current Issues:

One of the key issues that have emerged is the association of non-clinical medicos lobbying with the Medical Council of India (MCI) and later with the NMC to exclude non-medical teachers from the medical education system. Initially, the MCI proposed to amend the guidelines, reducing the permissible percentage for non-medical teachers to 15%. The Ministry of Health intervened, leading to the proposal's abandonment. However, the association continued to lobby with the NMC, which resulted in alterations to the guidelines.

The NMMTA appealed to the NMC, but their appeal was rejected. Subsequently, they filed a second appeal, leading to the Union Ministry directing the NMC to revert to the previous norms. However, the NMC submitted an affidavit agreeing to comply and later defied the ministry's directives.

The reasons behind the NMC's actions are a combination of explicit and implicit factors. Explicitly, the introduction of Competency-Based Medical Education (CBME) with horizontal and vertical integrations, coupled with the perceived availability of sufficient medical teachers, served as reasons for the changes. Implicitly, these actions are seen as an attempt to create job opportunities for medical professionals at the expense of non-medical candidates and to fill the vacant MD seats in non-clinical subjects, which have historically been undersubscribed.

Several thousand non-clinical MD seats in non-clinical subjects remain vacant each year, leading to significant revenue loss for medical colleges. One hypothesis suggests that medical colleges tend to retain pricey clinical seats and offer non-clinical seats to government quotas to fulfill their obligations. However, non-clinical subjects remain unpopular among MBBS graduates, who overwhelmingly prefer clinical practice. Non-clinical subjects are often pursued out of desperation after failing to secure clinical seats, and competition from non-medical candidates adds to the complexity.

Despite the persistent vacancies in PG seats in non-clinical subjects, hundreds of candidates continue to enroll in these courses. As they cannot practice in any clinical specialty, they rely on teaching positions for employment. Consequently, the NMC has taken it upon itself to disqualify non-medical candidates and provide jobs to medical graduates.

The association of non-clinical medicos and the subsequent framing of guidelines by the NMC appear to be primarily motivated by facilitating jobs and filling vacant MD seats, all under the guise of a new curriculum and syllabus. Global norms set by the World Federation of Medical Education (WFME) advocate for a balance between medical and non-medical faculties, yet the NMC seems to be disregarding these norms to favor its own members. The NMC is increasingly resembling an association of doctors, akin to the Indian Medical Association. The original draft of the NMC Act proposed that only 60% of its members would be doctors, but this ratio was changed to grant doctors full control. In contrast, the regulatory body of the United Kingdom includes 50% laypersons, a practice that helps keep a check on doctors' self-interests. It is no secret that doctors may sometimes prioritize their self-interests and attempt to disregard any unethical practice (as discussed in detail in this Times of India article: https://timesofindia.indiatimes.com/blogs/staying-alive/how-docs-have-fought-to-keep-pharma-funding-going/).

The NMC may assert that its decisions align with general feedback received from the public. However, it is essential to note that the medical community, encompassing both clinical and non-clinical professionals, has collectively advocated for the exclusion of non-medical individuals. Given the substantial majority held by medical professionals in this feedback, it is evident that it may be inherently biased. In situations of conflict of interest, doctors tend to prioritize their own interests, indicative of an abuse of the dominant position. 

While the NMC seems to operate as 'of the doctors, by the doctors, and for the doctors,' the Union Government has a broader responsibility to accommodate all stakeholders and protect everyone's interests. Therefore, it is justifiable for the Union Government to direct the NMC to revert to the old guidelines, ensuring a fair and balanced representation of medical and non-medical professionals. It is essential to note that when there is a conflict of interest, doctors often tend to favor themselves. This apparent abuse of dominant position involves changing yardsticks, shifting goalposts, and amending rules to portray one group as eligible and another as ineligible, all to promote self-interests.

In conclusion, the current challenges and controversies surrounding Indian medical education call for a balanced and fair approach that upholds the principles of inclusivity and transparency. The struggle for balance between medical and non-medical professionals is a critical issue that requires careful consideration and a commitment to providing quality education and opportunities for all stakeholders.

Flourishing academic apartheid in Indian medical Academia

In the field of medical education, it is common practice for clinical subjects to be taught exclusively by medical teachers with medical qualifications, while the non-clinical basic medical sciences are taught by both medical and non-medical teachers. As non-clinical doctors are restricted to teaching, they do not contribute to patient healthcare in society. To mitigate this anomaly in many countries, the role of non-clinical teaching is often assigned to non-medical teachers. 

The appointment of non-medical teachers as Heads of Departments (HOD) in medical colleges has been a subject of debate for a long time. However, the allegations that non-medical teachers are not qualified or competent to serve as HODs in medical colleges are baseless and unfounded.

It is important to note that the appointment of non-medical HODs made prior to the notification of TEQ Regulations, 2022, should not be affected in any manner whatsoever. However, this isn't the case as there have been instances where the incumbent HODs with non-medical backgrounds have been removed from their positions and replaced by juniors or someone from the allied departments much to their embarrassment and humiliation.

The Medical Council of India's 1998 Teachers Eligibility and Qualification guidelines state that non-medical individuals may be appointed as HOD in non-clinical departments if there is a shortage of qualified medical teachers available for the position. However, there have been various attempts to change this provision and deny non-medical teachers the opportunity to become HODs.

Despite their different backgrounds, both medical and non-medical teachers perform similar roles in a medical college. The nature of both medical M.Sc and MD degrees are comparable, and both degrees are suitable for academic roles. Therefore, non-medical teachers are not handicapped in any way when it comes to fulfilling academic duties. The role of HOD is to administer the department, which anyone who has worked in the department for at least ten years would be familiar with.

There is no formal training for faculty members on how to become a HOD, and it is not a position that someone is born with the skills to undertake. Instead, individuals learn how to administer a department through interactions with their peers and senior colleagues over several years. As such, anyone who has served as a professor for a significant amount of time is capable of fulfilling the duties of a HOD.

In a department, the highest post is that of a Professor, and HODship is an additional responsibility that a Professor can undertake. If a non-medical person can be appointed as a professor, they cannot be considered unfit for the role of a HOD.

The role of the HOD is not a dictatorial one, and decisions are made in consultation with all members of the department. HODs can seek advice from their peers or superiors when making important decisions, and they can discuss matters with the college dean or management if they are unsure about what course of action to take. The role of HOD is purely administrative, and anyone who holds the position of professor is capable of undertaking it.

Interacting with other non-clinical or clinical departments is not an issue for HODs with non-medical backgrounds. Anyone who is well-versed in their subject area can provide necessary inputs to other departments. While it is true that medical graduates are better equipped to deal with issues related to the health and well-being of patients, the role of a HOD goes beyond that. HODs are responsible for the overall management and administration of the department, including academic programs, research, and collaborations with other departments. A non-medical HOD with experience in management and administration can bring valuable skills to the department.

Non-medical HODs have been working in several medical colleges for many decades without any issues. The success of a HOD comes down to the individual's wisdom, attitude, and behavior, not their background degree. The only underlying issue here is that of prejudice, where doctors who consider themselves superior to non-doctors are unwilling to take orders from a non-medical HOD. This is purely a practice of academic apartheid, and there is no rational basis for denying non-medical teachers the opportunity to become HODs.

The argument that non-medical persons cannot claim parity/equivalence with persons possessing an MD degree is flawed. This is because parity or equivalence is not solely based on qualifications but also on the skills, knowledge, and experience of the individual. A non-medical teacher with relevant experience and expertise can bring a unique perspective to the department and contribute positively to the growth of the institution.

Clinical departments may seek expert opinions from pre-clinical departments for coordination, but it is not necessary that the head of department (HOD) be consulted. Non-medical professors possess similar levels of awareness regarding the latest developments in medicine as their non-clinical medical counterparts. They have also been a part of the department for over a decade, and participate in various meetings, such as journal clubs, CMEs, mortality meetings, and clinicopathological meetings, all of which contribute to their knowledge base. HODs can always consult their peers or colleagues before providing their expert opinions.

The Medical Council of India and the National Medical Commission are both dominated by doctors, who often side with their own interests in cases of conflict. As a result, the rules and regulations surrounding non-medical teachers have been continuously altered to put them at a disadvantage. The people running these bodies often have a pathological hatred towards non-medical teachers, which is akin to the discrimination faced by minority populations in other contexts.  The NMC has demonstrated bias against non-medical personnel, resulting in decisions that are often unfavorable to them. Rules have been revised to put non-medical teachers at a disadvantage. Merely because the NMC holds a statutory position does not guarantee that its decisions are always impartial and just. 

Denying non-medical teachers the opportunity to become HOD is purely discriminatory and has no other rational basis. This is purely an Indian thing, as such discriminatory denials are not practiced in the West. There, the faculties with non-medical backgrounds are routinely made heads of the departments. NMC must shed this apartheid and make medical education more inclusive.

The appointment of a HOD is an administrative position and not a practicing profession. Therefore, the qualifications required for appointment to the position should not be limited to medical qualifications. NMC must restrict itself to prescribing a minimum designation of a Professor for the role of a HOD but it must ultimately be left to the college management to select the deserving person for this role.

Finally, the allegation that the scope of judicial review is limited in matters concerning academic/educational policies is not applicable in this case. The appointment of a HOD is an administrative position, and any appointment that does not adhere to the principles of meritocracy and fair play can be challenged in court.

 Open letter to the NMC over  the non-medical teachers

1. When NMC was formed, it was expected that MCI guidelines regarding teachers would be adopted. In fact, the original draft (Minimum Requirements for Annual MBBS admission regulations, 2020) released on 13-10-2020 for public feedback was an adoption of the MCI guidelines in stating, "In the department of Anatomy, Physiology, Pharmacology, and Microbiology, non-medical teachers may be appointed to the extent of 30% of the total number of posts in the department. However, in the department of Biochemistry, non-medical teachers may be appointed to the extent of 50% of the total number of posts in the department."

Making an unceremonious U-turn, the gazetted guidelines stated, "In the department of Anatomy, Physiology, Biochemistry, non-medical teachers may be appointed to the extent of 15%of the total number of posts in the department subject to non-availability of medical teachers". If a change has to be made, the proposed changes should also have been subjected to public feedback, but the NMC did not seek feedback on this. It is difficult to fathom how thousands of feedback were evaluated in just one week's time. We suspect that this move was pre-planned and the process of seeking feedback was a mere formality.

It is unfortunate that many non-clinical doctors, who see scientists as competitors, hold grudge and ill-will against the latter. Despite being in medical education, the scientists, who are labeled as "non-medical teachers" have never been considered as a part and parcel of the system, instead, they were always perceived as outsiders. With no representation in the MCI, the guidelines were always modified to put the scientists in disadvantageous positions. These non-medical teachers suffer a variety of discriminations and harassments at the workplace due to the prejudiced position of the MCI. It is also no secret that some members of the MCI hold personal dislike against the scientists; some of them have continued to hold positions in the NMC. Their personal prejudices have been allowed to influence the policies, which is terribly wrong and unethical.

It has not escaped our observation that in several litigations MCI had always portrayed the scientists as inefficient and unworthy, albeit many observations were factually incorrect. This is because MCI never considered "non-medical" teachers as valuable assets and part of the system.  MCI always seemed eager to denigrate the scientists at the drop of a hat. Time and again, MCI had opposed in various courts the HODship for the non-medical teachers, implicitly implying the deep malice that it holds towards non-medical teachers. This is evident in the minutes of the meeting (held on 01-08-2011) where MCI had acknowledged "post of head of the department headed by non-medical teachers in pre & para-clinical subjects from the premier medical institutes vis-a-vis PGI, Chandigarh & AIIMS, New Delhi". Despite this, MCI was always reluctant to let scientists head the non-clinical departments. Naturally, such an attitude has percolated down and emboldened individuals and associations of non-clinical doctors. There is hardly an instance where the MCI has upheld or supported the non-medical teachers in any litigation. 

2. Succumbing to the demands of one nefarious organization of non-clinical doctors, MCI in 2018 had proposed to halve and halt the appointment of non-medical teachers. A sub-committee was formed to examine the issue, the findings of which were never publicized. Whatever might be the recommendations, the then board of governors in supersession of the MCI had decided against changing the guidelines. 

3. Reference is made to the minutes of the meeting of the Executive Committee held on 06th January 2020 where it was categorically stated "Non-medical faculty will continue in the Department of Anatomy, Physiology, Biochemistry, Microbiology, and Pharmacology. The existing regulation about maximum 30% non-medical teachers in the Department of Anatomy, Physiology, Microbiology & Pharmacology and 50% in the Department of Biochemistry will also remain unchanged."

Why the U-turn now? What are the reasons and circumstances for such a drastic reversal?

4. Reference is also made to MCI's letter No. MCI-7(10)/2019-Legal/(18354)/183596 dated 21-01-2020 written to All India Pre and Para Clinical Medicos Association which contains the following text, "..a complete phasing out of faculty with M.Sc-PhD from the teaching faculty after 3 years in the pre-medical basic sciences (Anatomy, Physiology, and Biochemistry) would create a closed system. It would preclude the intellectual cross-fertilization which generates dynamism in teaching and research that only advances the growth of the subject but intellectually stimulated the mind of the student, who would then be able to think in innovative ways as to how to understand and practice medicine. Also, there is a great thrust from MCI and other bodies involved in higher education to encourage research. Research does not recognize intellectual boundaries. Many of the advances in science have come from basic sciences. hence, there is a need to maintain this flow of ideas and not completely stop the input of faculty who are not medically qualified int eh pre-clinical subjects. We have to be very clear that higher education (and definitely medical education is classified as higher education), should be to encourage the entry of diverse intellectual streams that feed into the medical sciences. India should not be isolated from the trends in the rest of the world including even the developing world, let alone the developed world, by cutting off the basic roots of medical sciences". 

What happened to this wisdom and chivalry? Thrown out? Just to appease a section of non-clinical doctors who are vociferous in their prejudiced demands to oust the scientists? Are these observations not valid or relevant anymore? 

As already admitted by the MCI, the appointment of non-medical teachers is universal, being practiced both in developed and developing nations. In fact, the percentage of scientist teachers is 50-80% in several colleges in western countries. There is no genuine reason to do away in India now.

5. In the same aforementioned letter it is stated: "on average 50% of more seats in the subjects of MD (Anatomy), MD (Physiology), MD (Biochemistry), MD (Pharmacology) and to the extent of 40% in MD (Microbiology) have gone vacant. Thus there continues to be a paucity of Medical Teachers with MD qualifications in these subjects". 

We wonder what has changed in these 9 months? Has the shortage been magically overcome? Are there sufficient medical teachers available now? It may not be a secret that this shortage continues even now. While medical candidates may be available in metros and big cities, those colleges in suburban, remote, or hilly areas have fewer takers as most medical candidates don't prefer such places. At present, such areas are serviced by non-medical teachers.

6. Sir, we respectfully submit that the following statement of the Adhoc Committee appointed by the Hon’ble Supreme, "compromised teaching faculty will result into the degradation of the standards of medical education as the graduates from such institute will be dealing with lives of human beings without getting adequate training from the medical teachers" is unfounded. To some extent, the same could be attributed to situations where all the faculty members were to be non-medical. Anyhow, MCI had put a ceiling of 30-50%, so such a situation would never arise.

What are the roles of medical teachers constituting the rest of 50% in Biochemistry and 70% in other non-clinical disciplines? Why is the fall in standards attributed only to 30-50% of non-medical teachers whereas the remaining medical teachers absolve themselves of all the responsibilities? Why can't they compensate for what the non-medical teachers lack?

7. Since the non-medical teachers are perceived as outsiders and always under constant scrutiny, they tend to perform better than the non-clinical teachers, who tend to take their positions for granted merely for being a natural part of the system. Mere possession of a certain academic qualification or the lack of is not an indication of quality; it ultimately boils down to individual skill and proficiency. There are good and bad teachers with either qualification; hence qualification alone shouldn't be the yardstick.

8. The new curriculum with early clinical exposure along with horizontal and vertical integration is not an impediment to non-medical teachers. It is wrongly held notion that due to no patient exposure, the non-medical teachers are incapable of handling the new curriculum. All faculty members are expected to undergo compulsory workshops on revised basic medical education, competency-based medical education, and AETCOM. It's an altogether different issue that out of prejudice the non-medical teachers in some colleges are deliberately being denied opportunities to undertake these workshops. While not good as medical teachers, the non-medical teachers with due training, exposure and experience will be able to attain the required expertise. Wherever shortcomings are felt, the same can be overcome by involving or seeking the help of medical teachers. Complete exclusion is not necessary.

9. India needs more doctors to provide healthcare; India needs more specialists. In most Western Countries there are no PG courses in non-clinical specialties. Even if there are, they are mostly MSc courses, not MD (or equivalent) courses. Awarding a Doctor of Medicine (MD) degree in non-clinical courses is an oxymoron. India too must stop (or at least minimize) these courses. Let India produce more clinical specialists, let the non-clinical academics be handled by the medical scientists (as practiced in many countries). Let there be a sound policy on how many non-clinical doctors are required and for what purposes. Thousands of doctors who do nothing but teach are an enormous wastage of professional resources in a country that already has a shortage of doctors. NMC must reduce the number of PG seats in non-clinical subjects and increase seats in clinical subjects. Banning the scientists just because non-clinical PG seats in many medical colleges are going vacant is regressive and counter-productive.

We conclude that medical education must get the best of both qualifications; NMC must create a system so that the best teachers get selected; best in terms of knowledge, skill, and attitude, not merely based on academic qualifications. NMC must reinstate the previous MCI norms; in fact, we suggest completely do away with any prescribed ceilings and let the institutions make their own selections.