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.