Thread by @docbhooshan

Thread. #NMCBill
There is an optimism is air about National Medical Commission Bill.
Lot of people believe that opening up medical education to private sector will improve number of doctors in circulation and reduce cost of medical education.

Let's see if this is possible.

Presently there are ~550 medical colleges in India producing ~70,000 MBBS doctors every year.
Half of these colleges are government colleges. They charge 0-1,50,000 as fees per yr. (depends on category/caste).
Pvt medical colleges charge 7,50,000 to 18,00,000 per year.

Except bribes, cost of setting up a medical college is -
1. Land and infrastructure
2. Teaching staff salaries
3. Non teaching staff salaries
4. Expense of running a free hospital
5. Running costs

All these are substantial costs and are mandatory per law.

In fact every aspect (including furniture) is guided by present law.

Unless there is substantial amendment in law (what about effect on quality?) , this cost will not come down. On contrary, it will continue to increase at inflationary rate.

Unless government forbids opening of new medical colleges awithin 50km radius of existing colleges, healthcare in underserved parts will not improve.

Poaching of existing teaching faculty will be a huge challenge leading to cost escalation.

Giving over existing district hospitals to private colleges is planned.
Anyone familiar with India must realise that except land, everything in govt hospital is actually a logistical and financial liability.
Unless clean slate is given nobody would want this burden.

Unless initial and running cost is substantially reduced, more colleges and less expensive education is not possible.
Are there any ways that can help?
I venture a few suggestions, all require substantial modifications in laws governing medical education.

1. Class strength be increased to 500-1000 from present cap of 250.
2. Eliminate "class room teaching" and "demonstrations" shift to e-classrooms using MOOC structure. All content to be provided by govt free of cost. Existing elite govt institutes should do this within 6months.

3. Shift patient based learning (hands-on learning) out of college hospitals. Let students learn with real medical practitioners in same city or around. (Such doctors be trained in online classrooms by govt, free of cost).
4. These private doctors should certify skills learning

of medical students.
So, in theory, unless medical education (MBBS only , NOT PG) is radically decentralised, nothing will change.
It should be possible to run a medical college from a 5000sq ft facility that acts as control centre.

Essentially "Uber" model.

In its present plan NMC doesn't look anywhere close to this.

So contrary to govt's expectations,
Seats will not increase substantially, med-ed will NOT become cheaper in near future. Basically no significant change.

Incremental changes , that governments are comfortable with (mainly due to politicians' TOTAL reliance on babus and babus' absolute aim is status quo in different disguises.) will not make any dent.

Total disruption of existing MBBS model, uberisation of MBBS,

using existing govt and large pvt hospitals for PG only can be a game changer.

Has anyone in decision making position got lung capacity (medical term for usable volume (not just girth) of chest) to make this paradigm shift?

Thanks for reading.
#JaiHind