Close on the heels of the Union health ministry’s directive to make a year’s rural service mandatory for medical students across the country to tackle the acute shortage of doctors in rural India, comes yet another diktat to resolve the shortage of licensed medical practitioners countrywide. On March 10, the Union government issued a notification under the Indian Medical Council Act, 1956 ‘recognising’ postgraduate medical degrees awarded in Australia, Canada, New Zealand, UK and the US, generally referred to as the ‘English speaking’ countries. However the notification made it clear that only those awarded postgrad degrees in these countries are permitted to practice medicine in India.

Consequent upon this notification, students with undergraduate MBBS degrees from India, who have completed postgraduation in any of the five approved countries, can practice in India without passing the screening test of the Medical Council of India (MCI), the apex body for regulating medical education and approving medical qualifications obtained in India and abroad. This notification has reversed the government’s earlier policy which did not permit Indian medical students with ‘unrecognised’ postgraduate degrees to practice in India. They were obliged to undergo 12 months of  internship in a government hospital and clear a screening test of MCI.

As usual restrictions imposed on postgraduates certified abroad had less to do with safeguarding the public interest than political considerations. Until 1975 postgraduate medical degrees of English speaking countries were more than recognised. But that year the UK cast doubts over postgrad qualifications in India, citing a medical lapse by a postgrad student and stopped recognising degrees of Bihar medical colleges. The late prime minister Indira Gandhi retaliated by de-recognising UK medical degrees. After that spat, MCI mandated that recognition of medical degrees between two countries has to be bilateral. Currently India recognises the medical degrees of Myanmar, Italy, Germany, Ireland, The Netherlands, and Japan, among other countries.

According to medical education sources, the Union health ministry’s volte face has been prompted by the acute shortage of medical specialists in India. According to MCI statistics, the total number of registered allopathic doctors in the country is only 683,582 with one doctor for every 1.63 lakh citizens. In addition, there are more than 6 lakh practitioners of Indian systems of medicine including homoeopathy, ayurveda and unani.

Therefore the decision will encourage foreign qualified postgrads to return to India and practice in any government or private hospital in the country, and also accept teaching positions in medical colleges without the hassle of interning and taking the MCI screening test. Moreover, with the British government having recently imposed new visa restrictions on foreign qualified doctors under the highly skilled migrants programme, Union health minister Anbumani Ramadoss believes that the Indian government’s notification will prompt some of them to return to India. The Union health ministry is awaiting the MCI’s approval of its decision, a mere formality.

Although medical students and practitioners welcome the government’s directive to recognise postgraduate degrees of the five approved countries, they are not impressed by the government’s argument that recognition is being granted to address the shortage of doctors. This is because those holding foreign postgraduate degrees will be exempt from serving in rural areas where there is a dire need for doctors. Moreover, they feel that the government can address the shortage of medical specialists in the country by recognising degrees awarded by the standardised National Board of Examinations (NBA) which conducts postgraduate and higher examinations in various medical disciplines.

“The intense competition for the few postgraduate (MD/MS) seats in medicine makes it very difficult for students to qualify as medical specialists after they complete MBBS. A good alternative is the Diplomate of National Board (DNB) degree (included in the Indian Medical Council Act, 1956) awarded by NBA which is equivalent to the postgraduate (MD/MS) degrees. However though this examination has global recognition, it isn’t accepted in several states including Tamil Nadu, where DNB graduates are not eligible for appointment as specialists in government hospitals,” says Dr. Dinakar Moses, secretary of the Alumni Association of Stanley Medical College, Chennai.

Nevertheless there’s no denying that the Union government’s revocation of the restrictions imposed upon medical postgrads of English speaking countries — born out of political bloody mindedness because medical education standards in these countries are set much higher than in India — has made the climate in India more conducive for those wishing to return after acquiring their postgraduate medical education in foreign countries. However this is hardly enough to solve the huge shortage of medical specialists in the country. This larger problem requires larger solutions, such as augmenting medical education capacity by encouraging private sector and foreign investment in medical education. But such bold initiatives are yet but tiny specks on the radar screens of the Union HRD ministry and MCI.

Hemalatha Raghupathi (Chennai)