Dr. Sanjay Kumar Bhasin
Producing quality graduate (MBBS) and postgraduate (MD/MS, MCh /DM) doctors is the sole responsibility of medical colleges in addition to doing research and providing referral healthcare. Unfortunately in last two decades, the medical institutions have been relegated to the positions of healthcare delivery centers rather than becoming Institutions of Excellence for Medical Education. Due to unnecessary referral from Sub-district and District Hospitals, the medical teachers remain busy in providing healthcare and in the event academics and research work suffers a lot. The present condition of medical education in GMCs in whole country as well as J and K is an eye opener, where proper infrastructure and equipment to cope up with fast growing new technologies in the field of medicine is lacking. The research and academics falls prey to non-availability of new and quality gadgets/equipments and journals and also the forced primary and even basic secondary level patient care that can be dealt by Sub-district and District hospitals. Ironically we view faculty strength of GMCs with patient care that actually is not the case; the sanctioning of faculty in each department has to be as per yearly intake capacity of MBBS students. GMC Jammu has sanctioned intake capacity of 150-MBBS student, whereas its present faculty strength in almost all departments can cater to even 250-MBBS students. For example in surgery department one Professor, five Associate Professors and six Lecturers/ Assistant Professors are required, whereas GMC Jammu at present is having five Professors, three Associate Professors, seven Assistant Professor and nine lecturers working the department.
The deteriorating government health and medical education sector is indirectly a boon for corporate health sector in India as the same has grown tremendously. Corporate health sector has taken over large chunk of quality health care and is charging exuberant rates beyond the reach of people from poor socioeconomic back grounds. Now it is eyeing to take away government run medical education also in a planned manner. Overcrowding coupled with absence of adequate manpower; equipments and infrastructure at district and sub district hospitals, as well as medical colleges make doctors handicapped in providing quality services to the patients. As sub district and district hospitals san infrastructure and equipment, both politicians and bureaucrats try to thrust treatment part on the medical colleges that leads to compromise with the research & teaching activities. There is no second thought that medical education in India is on downhill course and sooner the policy makers realise and decide that research and teaching should be the focus in medical institutions and not primarily the patient care better it is for all. Government must focus on strengthening sub-district and district hospitals for patient care and medical colleges for referral care and teaching as well as research. For running medical institutions smoothly three things of paramount importance are Money, Material and Manpower. None of these should go surplus nor remain deficit. Money is needed for making building, purchasing equipments/ machinery/ gadgets, pay/ perks of doctors and for maintenance of the system subsequently. Unfortunately the focus of money utilisation is on building infrastructure and purchasing machinery for varied reasons and in the absence of maintenance funds, the subsequent work suffers as is seen in SSH, Jammu. A definite policy needs to be devised and money utilisation should be prioritised. Recruitment of manpower including teaching faculty should start at the beginning and it’s the strength has to be viewed vis a vis yearly intake capacity of MBBS students. Now for smooth functioning of the new GMCs whose inaugural stone has already been in place, the people at the helm of affairs must formulate policy well in advance so that no hindrances occurs at the time first batch of MBBS starts. Following issues needs to be considered on priority:
1. Medical Education Vis a Vis Health Care: The primary goal of all medical colleges is teaching and research work as has been discussed above. The patients in these institutes are needed for tertiary care and for research purposes. Over a period of time, all state as well as central government has not realised it in a proper way and teaching medical institutions are flooded with patients for even primary and basic secondary level of health care that can easily be provided in a good Sub-district and District hospital. This has led to compromise with the research and teaching activities. Sooner the policy makers realise and decide that research and teaching should be the focused area in medical institutions and not primarily the patient care better it is for all. Referral to medical colleges for minor and moderate ailments needs to be curtailed/stopped.
2. Qualified Faculty and Emoluments: Engagement of best teaching faculty for upcoming medical colleges should be the priority. Experience of already established AIIMS like institutions at Patna, Bhopal, Raipur, Bubneshwar is an eye opener where the authorities have failed to recruit teaching faculty as well as paramedical manpower. All these institutions are having severe manpower deficit including faculty in spite of the better pay/perks being offered to them. At contemporary posts there is huge gape of pay/perks between corporate hospitals and government run institutions. If government is serious about functioning these new GMCs, it must start recruitment process at least basic para clinical and non clinical specialties like Anatomy, Physiology, Biochemistry, and they should be deputed to GMC, Jammu till the new colleges are not operational. Buildings alone and good equipments cannot make an institute. Every time a medical college or AIIMS like Institution is build, the thrust of policy makers is on erecting buildings and purchasing equipments. So the basic problem of highly qualified Human resources especially teaching faculty and paramedics need to be sorted out even before making buildings and purchasing equipments.
3. Medical Equipments: purchase of new and good quality medical equipment to cope up with the growing trends in medical science has always remained a great problem for already established GMCs. Even repair of the equipments needing very small amounts is a great problem in government run institutions. This not only hampers patient care but also a big block in research and academic activities. Long and tedious purchase processes needs to be simplified and given in the honest hands to tackle this very important aspect of healthcare delivery system. The purchase of machinery and equipments should be in the last leg of establishment of these GMCs once build work has finished and medical manpower is in place. If these costly equipments/ machines are purchased at the beginning, they will gather dust/rust and by the time they are put in use new variants reaches market and older ones becomes obsolete.
4. Autonomy to the Medical Institutions: For smooth running of medical institutions, they should be given greater autonomy in the sense that there should not be unnecessary political and bureaucratic interference and influences. A high powered College Council or Institution Council needs to be established with medical persons of highest integrity and qualities as members of the council including Dean/ Principals of all medical institutions and all HoDs. The annual budgets should be kept at the disposal of the council with a well placed accounts and planning department whose head should preferably be an HoD of major specialty. Head of medical institution should preferably be from major specialties and the process of his selection should be streamlined and unbiased.