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.

Open letter to NITI Aayog regarding medical scientists

Open letter to NITI Aayog calling for intervention over policy directions regarding medical scientists

In the 1950s, there were very few teachers in medical colleges to teach the non-clinical subjects of the MBBS curriculum, as most MBBS graduates would pursue postgraduation in the clinical disciplines. To overcome this shortage, the Health Survey and Planning Committee, 1961 (well known as the Mudaliar Committee) under the Ministry of Health and Family Welfare (MoHFW) recommended offering M.Sc courses in the five non-clinical disciplines to the life-science graduates (B.Sc). These courses were conducted by the medical colleges with due recognition by the Medical Council of India (MCI) based on the same curriculum and syllabus as those of MD courses in these disciplines. The degrees are now awarded by the health universities under the 'Faculty of Medicine'. These scientist teachers are known as "non-medical" teachers in order to distinguish them from medical teachers, who possess basic MBBS qualification. At one point, around 100 medical colleges used to run Medical M.Sc postgraduate courses, which has now shrunk to around 35 colleges. It is estimated that around 3-4 thousand students are currently enrolled in these courses. Scientists with Medical M.Sc qualifications, like their counterparts with MD qualifications, have three main career options:
1. as non-clinical teachers in medical/dental colleges,
2. consultants in diagnostic laboratories,
3. scientists in research institutions or industries. 

Having similar educational qualifications and career opportunities, both the degree holders compete for the same jobs. Over the last few years, a section of non-clinical doctors (MBBS graduates with MD in non-clinical subjects) and their associations have lobbied hard with the government to exclude the scientists from the teaching and diagnostic roles. The first axe on the scientists fell in 2014 when the health ministry, through the guidelines under the Clinical Establishment Act, disentitled the entire scientist community from any participation in the diagnostic laboratories despite being granted eligibility by the National Accreditation Board for Testing and Calibration Laboratories (NABL). Both the Directorate General of Health Services (DGHS) and the MCI connived to pressurize the NABL to drop the eligibility of scientists. However, the MoHFW realized its folly and eventually restored the eligibility of scientists as consultants in diagnostic laboratories.

In 2018, again yielding to the lobbying from the community of "non-clinical" doctors, MCI proposed to halve and halt the appointment of "non-medical" teachers in medical colleges. Under the MCI guidelines, there are provisions to appoint scientists up to 30% (50% in Biochemistry) of faculty strength in the five non-clinical disciplines. Following a nation-wide protest by the scientists' community, this proposal was shelved, only to resurface once the National Medical Commission (NMC) replaced the MCI. Under the recent NMC guidelines published through a gazetted notification, the appointment of "non-medical" teachers have been reduced from 30% to 15% in the subjects of Anatomy and Physiology; from 50% to 15% in Biochemistry, and from 30% to 0% in Pharmacology and Microbiology. In a FAQ document released by the NMC, the new guidelines would take effect under three conditions:

1. All new medical colleges that start MBBS admission (2021-22 batch)

2. All old colleges that seek to enhance student admission

3. All new appointments in medical colleges, whether new or old

These guidelines have been like a bolt from the sky that has sounded a death knell to the scientists. These guidelines ensure that thousands of students who are currently pursuing medical M.Sc courses would be deprived of teaching jobs. "Non-medical" teachers who are currently employed in one medical college will have to remain in the same job until they resign, forced to resign or are ultimately fired; once out of a job they have all doors closed everywhere. Being on a sticky wicket, such faculties would be at the mercy of the employers and have to put up with a variety of harassments and give up hopes of any promotions or salary hikes. If a certain institution goes for MBBS seat enhancement, the new rules kick in and the "non-medical" teachers automatically become disqualified or excessive in numbers; which will lead to their sacking. All of these are inhuman scenarios and violation of basic human rights. Scientists, who had pursued these courses never bargained for such an unforeseen situation.

NMC is wrong in its decision for various reasons. Unlike what is projected, there aren't sufficient medical teachers available to fill the void; vacancies are still real. In fact, many MD postgraduate seats in the non-clinical disciplines are going vacant as there are few takers. The prejudiced position of the NMC is arbitrarily depriving the medical students of qualified teachers. Possession of a certain qualification isn't a guarantee of competency and its absence doesn't indicate incompetency. It is a fallacy to assume that the quality of medical education can be improved by purging the scientists. In fact, 21% of teachers (including clinical disciplines) in the US medical colleges are scientists. In the top 10 global medical colleges, scientists account for 70-80% of teachers in the non-clinical disciplines. There are good and poor teachers with either degree. Instead of relying purely on the nomenclature of the academic qualifications, stress must be on the skill and competencies of the teachers. Let the medical education get the best of both; let teachers be selected purely on merit. 

Besides teaching, the "non-medical" teachers are also involved in clinical diagnostic laboratories and research. The "non-medical" teachers are at the forefront of COVID testing in most medical colleges. They are solely or jointly managing these labs in many cases. India's healthcare must not be deprived of quality services that are offered by competent scientists just to please a section of medical professionals. That would be bad policy. Medical education should not be deprived of "non-medical" teachers with Ph.D. qualifications, who can engage in research and guide postgraduates and Ph.D. scholars.  India must utilize the human resource that is available to her. Policies must be made according to the prevalent education system and societal needs. 

Given the poor patient-doctor ratio, India needs more doctors engaged in direct healthcare. Currently, thousands of "non-clinical" doctors are engaged in academics without directly contributing to direct healthcare. In many western countries, there are no postgraduate courses for the doctors in the non-clinical disciplines; in such countries, doctors attend to patients whereas academics and research are mainly handled by scientists. This is a policy that India too must consider.

Finally, it is also to bring to your kind notice that ever since the MCI abandoned the medical M.Sc courses, these courses suffer from variations in curriculum across the universities and haven't been upgraded in a long time. A scientific council to regulate these courses and register the scientists offering professional services in the diagnostic laboratories is warranted. At the same time, given the dwindling job opportunities, the government must put a policy in place regarding the utility of Medical M.Sc courses. By having no representation in the erstwhile MCI and the current NMC, it becomes convenient for the regulatory body dominated by the doctors, to put competing scientists in disadvantageous positions. Our concerns have consistently been ignored both by the Education and Health ministries. The "policy paralysis" regarding the medical M.Sc courses and the biomedical scientists has to end. 

The purpose of this letter is to induce a concern among the top minds of NITI Aayog so as to formulate a futuristic policy taking into account the welfare of this minority community of scientists and their services to the nation.