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None of the five states in South India will be able to open new medical colleges or add more MBBS seats in existing institutions if the guidelines framed by the National Medical Commission (NMC) for undergraduate courses come into force from the next academic year.
The new guidelines published in the extraordinary gazette of the Union Government dated August 16, 2023, not only cap the number of MBBS seats in existing medical colleges, both government and private, but introduce the ratio of 100 MBBS seats for l0 lakh population in the states.
“Applications for establishing new undergraduate medical education colleges shall be allowed only for 50, I00, l50 seats, provided that medical college shall follow the ratio of 100 MBBS seats for l0 lakh population in that state,” the guidelines added. This means all the Southern states and the tiny Union Territory of Puducherry have already surpassed the mark (100 MBBS seats per 10 lakh population) set by the NMC.
While Tamil Nadu has 11,600 seats for a projected population of 7.64 crore as of 2021 according to data provided in Parliament, Karnataka has 11,695 seats (6.68 crore), Andhra Pradesh has 6,435 seats (5.27 crore), Kerala has 4,655 seats (3.54 crore), and Telangana has 8,540 seats (3.77 crore).
According to the new guidelines, Tamil Nadu should only have around 7,600 seats, Karnataka (6,700), Andhra Pradesh (5,300), Kerala (3,500), and Telangana (3,700). The doctor-population ratio of 1:1,000 is also high in all the southern states when compared to the national average of 1:854.
The guidelines will not just deal a body blow to plans by Tamil Nadu and Karnataka to have at least one medical college in each district but are also being viewed as infringing on the state’s rights to provide healthcare and education to its citizens.
Karnataka Medical Education Minister, Dr Sharan Prakash Patil, said the state government will not accept the guidelines and write to the Centre in this regard.
"This is a regressive order and not in the interest of the state or the students. We will definitely raise our concerns. This is clear discrimination against Southern states. And how can they restrict the students' interest to study medicine?” he asked and blamed the Centre for punishing the South for “non-performance” of the North.
The argument that is being placed in favour of the new guidelines is that the number of medical seats should be proportionate to the state’s population as any excess number will only lead to unemployment.
The new guidelines also triggered a massive debate on social media with many seeking to know why the Union Government is trying to penalize the performing states.
“First tax rich states and transfer to poor states. Now prevent them from investing further in human development? Is the Government of India determined to drag everyone to the level of the bigoted least common denominator?” economist Rathin Roy said in a post on X, formerly Twitter, platform.
Senior vascular surgeon Dr J Amalorpavanathan is of the view that since medical education is closely tied to public health, the state governments should be allowed to decide on the number of doctors they want to produce according to their needs.
“Each state must have a plan of its own on producing doctors. The plan based on the needs of the state should be done in a scientific method. It is the responsibility of the state to provide healthcare and the NMC has no right to dictate terms to elected governments. Let states decide what is good or bad for them,” Dr Amalorpavanathan told DH.
NMC is just a regulatory body of officials, and they should not be allowed to usurp the rights of an elected state government, he added.
Education activist Prince Gajendra Babu rejects the argument, saying the NMC should allow more government-run medical colleges as the tuition fee there is very nominal when compared to that of private medical colleges running into lakhs.
“If you really want to close medical colleges, close those in the private sector. If a particular state wants to produce more doctors by opening medical colleges at its own expense, all that the regulatory body should look at is whether rules are being followed. Not to cap the number of seats. What is the guarantee that a student who passes out from TN will only work here? Why can’t he go to any other state?” Babu asked.
Twenty-two districts in Karnataka have government medical colleges and the government plans to open new ones, including in Kanakapura, the home constituency of Deputy Chief Minister D K Shivakumar.
Tamil Nadu has 38 government colleges, and it plans to open six more in the state, Kerala wants to open one each in Kasargod and Wayanad, and Andhra Pradesh plans to add 2,737 seats by opening 17 new government colleges. All these plans will come to naught with the new NMC regulations.
However, states like Kerala have a different advantage with the new guidelines paving the way for starting PG courses even without MBBS seats.
“The state will be able to start PG courses at Wayanad and Kasargod. Having more PG doctors will also be beneficial,” Kerala University of Health Sciences (KUHS) Vice Chancellor Mohanan Kunnummal told DH.
(With inputs from Rashmi Belur in Bengaluru, Arjun Raghunath in Thiruvananthapuram, and S N V Sudhir in Hyderabad)