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.

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

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

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

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

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

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

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

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

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

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

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

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

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 the value medical MSc has in medical institutions. There is indeed better prospects outside it.

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

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

Last updated: 14th March, 2017