Disquiet In Medical Schools

With authorities opening a section of graduate and half of the postgraduate medical education berths to an All India Quota, most of the medical college students came out on roads in protest. Scheduled to be applicable from 2022, Khalid Bashir Gura met the students to understand the challenges and opportunities of the decision

In September 2020, Dr Ahmad, a resident of Kupwara, appeared in DM gastroenterology examinations. He scored 61 and the cut-off was 60. Dejected, the recently married Ahmad with ailing and aged parents to take care of, choose one of the medical institutions in north India far his studies. He wanted to stay closer to home.

Now, he says, he is bearing the brunt of the All India Quota (AIQ) and the absence of a legal bond in Kashmir.

In 2017 Sher-e-Kashmir Institute of Medical Sciences (SKIMS) adopted the National Eligibility and Entrance Test (NEET) for admissions of DM and MCh courses, which opened avenues for non-Jammu and Kashmir candidates to study at the deemed university.

Had this system been not in place, Ahmad believes he might have been serving Kashmir. Outside Jammu and Kashmir, doctors pursuing super-specialist degrees have to sign a bond that after completion of his degree, he has to serve the area of his study for a particular time. So Ahmad is still serving the state of his study outside Jammu and Kashmir. He can opt-out but pay a huge penalty.

Ahmad rues as his wife had to leave her teaching profession to join her husband. The newlywed couple could not bear separation because of the degree and ensuing legal bond. Now, Ahmad is worried about his aged parents.

Similarly, Dr Suhail pursuing DM in cardiology in a south Indian state cursed his degree as he has to live far away far from home. His mother had a massive cardiac arrest and by the time he reached home, his mother was buried.

Protesting Medicos

Last fortnight, students from almost all medical schools across Jammu and Kashmir were on roads protesting against the proposed pooling of MBBS and postgraduate seats in the All-India Quota (AIQ) via the NEET. The medical seats in Jammu and Kashmir colleges, which were restricted to local students till recently, will now be opened to applicants from mainland India.

Medical College Students Protest Against All India Quota In Srinagar on October 5, 2021. KL Image: Bilal Bahadur

However, according to some doctors’s the dilution in the process had started earlier in 2017 when SKIMS opened avenues to national level competition.

What provoked the protests was an official pronouncement of the Medical Counselling Committee (MCC) backed by the Union Ministry of Health and Family Welfare. The order contained two fresh provisions.

As the order reiterated the requisition of 50 per cent ‘all India quota’ in seats across all states, it said, “this year Jammu and Kashmir is likely to participate in All India Quota counselling subject to confirmation from competent state authorities.” Also, a 100 per cent quota in ‘Deemed Universities’ has also been set, which in Jammu and Kashmir translates into the allocation of all such seats at SKIMS, a premier tertiary care facility, to a national level competition. Besides, Jammu and Kashmir, which has nearly 1000 seats in government colleges, will pool 15 per cent of its MBBS seats in the all-India quota.

According to the doctors Kashmir Life spoke to, the opening up of seats to AIQ will mean the patient care will suffer in the future as Kashmir’s health care sector will be deprived of super-specialists.

The protesting medicos said that one would rarely see any super-specialist especially native in tertiary care hospitals as has happened since 2017 in many departments at SKIMS. It will also impact patient care, they alleged.

An intern at SMHS hospital, Dr Tajamul Islam, said they see a bleak future.

1000 Berths

Apart from students who study in off-shore universities, there are seven government institutions supposed to churn out around 1000 MBBS graduates every year. They compete amongst each other for a few hundred PG NEET seats. Until this year, Jammu and Kashmir students had to compete within the state quota. But after the binning of special status, the extension of central laws changed this system forever.

As per the prevailing system, around 537 seats for PG NEET, were reserved for local candidates. Now, according to Dr Islam, this AIQ quota will result in a minuscule share for natives, especially in the open merit category. Jammu and Kashmir has 543 postgraduate seats for MD/MS and it has to surrender 271 seats in AIQ and the competition will no longer be amongst a few hundred regional aspirants but lakhs of students who complete MBBS programmes across the country every year.

The new system will be in vogue from next year. This will help Dr Islam to appear in the exam next year.

Students, Islam said are apprehensive of pursuing medical careers. “Maharashtra has 4922, Karnataka 5379, Delhi 2715, Gujarat 2127, Tamil Nadu 4255, Kerala 1587 seats for speciality courses like MD-MS, DNB seats,” Islam said as even after pooling an ample number of seats are left in their respective quota. Jammu and Kashmir has fewer berths already.

The healthcare sector which is already overburdened according to the doctor may witness further deterioration. The doctor-patient ratio may further worsen. Currently, it is 1: 3800 in contravention to WHO requirement of one doctor for 1000 people.

This, according to him will result in a net loss of almost 70 per cent PG berths to natives.

The aspirants not able to secure a berth for post-graduation, however, can opt for private institutions but that will cost a fortune thus making health care more expensive.

Aspiring candidates said the decision will create a crisis at the super speciality level. “Where will we go?” one aspirant asked. This will eventually trigger a brain drain.

Since the government has increased the number of MBBS seats across Jammu and Kashmir and most of them will not get jobs for lack of masters. This according to Dr Aatif Hassan Sanaie, President of Resident Doctor’s Association (RDA) said will create unemployed doctors like BDS doctors and other saturated fields.

“It is PG’s which run the engine of health care,” Dr Sanaie said. “And in the absence of legal bond, the healthcare facilities will be further burdened.”

Sanaie said the health sector is not hugely dependent on graduates and the pooling of 15 per cent seats to AIQ will not impact as it is a minuscule number that can be compensated.

 Fair Standard

Jammu and Kashmir is perhaps the only place in India where the females have half of the total berths reserved at the undergraduate level. Now the seats have gone up from 500 in 2018-19 to 1100 in 2020-21. This was supposed to improve health care but new riders are expected to play differently.

The surplus at the graduate level will face a crisis at the post-graduate level where the opportunities of further studies are curtailed. Patient care apart, this can impact the faculty status of all the new colleges, which have just started. A huge section of female candidates are traditionally unwilling to move out, owing to marriage soon after graduation.

“It is not possible for girl students to stay away from family for so long in different cultural and climatic settings,” Mehak, currently studying at SKIMS medical college said, insisting the government must ensure a maximum number of seats outside AIQ.

Noha, pursuing MBBS abroad said for lack of opportunities and resources, she may have to fly off-shore again for PG.

Shagufta Sadiq, an MBBS student at GMC said she would happily go for post-graduation at AIIMS or PGI but not to an institution governed by a bond system.

Digital Divide

Competition apart, the students of all streams including medical, are facing infrastructure issues. Unlike other places, the internet is part of the security setup, at least when there are issues linking to law and order.

“If there was uniformity in a situation no one would have objected but the Kashmir scenario is different,” Ahmad said. “I wanted to qualify for Membership of the Royal Colleges of Physicians (MRCP) of the United Kingdom and simultaneously prepare for DM but the internet outages upended my dream,” Ahmad said he knew he had the potential of making to it but it would require a lot of online mentoring. “I dropped the idea simply because of the internet,” he said.

Ahmad admits that the pooling of seats into AIQ will also open opportunities for people to the best medical institutions across India.

The situation is usually playing with the careers in Kashmir. Dr Islam, for instance, is already a year behind his contemporaries outside because he completed his MBBS in six years and not five. What drags degrees besides occasional natural disruptions is the political turmoil.

“In 2016 academic calendar was disrupted by the killing of Burhan Wani,” Dr Islam said. “The reading down of Article 370 was followed by communication blackout which hampered education across Kashmir.”

Dr Sanaie said the internet is indispensable for modern medicine. “Unlike other places, we tap and capitalize on limitations and do self-study, which is complemented by some online platforms for PG NEET exams,” Dr Sanaie said.  “As the internet is uncertain, the amount at times paid to these portals is lost.” During the first wave of Covid-19, the internet remained snapped.

According to another PG first-year doctor, Dr Haziqa, who completed her MBBS at GMC Srinagar, the doctors in Kashmir have to prepare during an internship for PG NEET exams as they already lag behind by a year. “In comparison to us, aspirants outside Kashmir get a one-year breather to prepare,” she said.

Dr Junaid Yousuf, a medical officer from the 2014 MBBS batch, appeared in this year’s NEET PG exam. “We had an exam in January but it got postponed because of Covid-19 till April. But it was again postponed to September,” he said.

Capable to Compete

A general impression created by the medico protests was that the Kashmiri students are unwilling to sit in competitions and are keen to retain the “reservations”. The students insist it is untrue.

Dr Mohsin Raj Mantoo is pursuing his DM in Cardiology at AIIMS Delhi. After graduating from GMC Srinagar, he added many feathers to his cap by topping all three super-specialist exams of NEET, PGI and AIIMS. He also sees the positive side of the decision as it will open the number of opportunities outside Jammu and Kashmir in the countrywide pool of seats.

The protesting students rue the absence of the level playing field that is basic to any competition.

No Legal Bond

Unlike most states across the country, Jammu and Kashmir lack the mandatory legal bond system that ensures “retention” of doctors once they graduate or complete this post-graduation. Native doctor’s said Kashmir will become a preferred destination given the climate, quality institutions, and perks and no requirement of staying back after completing the degree. The absence of this bond set-up has helped hundreds of Kashmiri doctors to work off-shore.

Under the system in vogue, if the doctors flout the bond, they will have to pay a huge penalty – somewhere between Rs 10 lakh to Rs two crore. In Uttar Pradesh, for instance, a student will have to sign a 10-year work bond if he chooses to do PG in any of its institutions.

Impact on Patient Care

Speaking in absolute anonymity, a doctor said in 2020 two doctor’s, one each from Kerela and Delhi, got admitted for Diplomate in National Board (DNB) exams (equivalent to MD-MS). When Covid-19 raged and doctors in Kashmir were at the forefront of fighting the pandemic, the two doctors allegedly managed to skip from the duty by getting some intervention at some level.

There are language barriers playing a major role in recording history and diagnosis. “Most of the patients from far Kashmir periphery are in a position to explain problems in the mother tongue, which may not be the case if the healer is from a different linguistic group,” the doctor said.

Dr Ahmad, for instance, dropped Christian Medical College in Vellore because of a language barrier.

 Not every state in India is supportive of NEET. Tamil Nadu is calling for its scrapping because it is “discriminatory” and helps “privileged sections”. NEET was introduced in 2013, not done in 2014 but was formally implemented by the Supreme Court from 2016-17.

Response

Prof AG Ahangar, Director SKIMS, said that he accompanied the delegation of students that met LG Manoj Sinha. “The LG took cognizance of these reports and apprehensions,” Dr Ahangar said. “He has assured me and students he will take up it with concerned authorities in Delhi to help students out.”

While giving a year-long breather, LG said students from Jammu and Kashmir will be in an “advantageous position” with access to 5000 MD and MS berths by participating in AIQ.

Currently, there are 1000 MBBS berths and by contributing 150 of these seats, aspirants will become eligible for 4568 seats in AIQ.

Vivek Bhardwaj, Additional Chief Secretary to Jammu and Kashmir Government said that faith has to prevail over fear. “AIQ will give better opportunities and open a new world for students,” he said. Following protests, the government has given a breather to students by deferring it to next year.

This was after the entire political class supported the protesting students. Congress’s GA Mir termed the order as “encroachment” aimed at “harming local professionals.

Considering it as a fallout of reading down of Article 370, Yousuf Tarigami said this is unacceptable.  Peoples’ Conference said the

MCC will have to either reconsider this decision or the number of seats allocated under the quota will have to be compensated through a reverse quota in all Indian colleges for Jammu and Kashmir students. “Nowhere in the country is there a 50 per cent reservation for female students. We are putting a lot of students in disadvantageous positions,” the p[arty spokesman said.

Stunned, NC spokesperson Ifra Jan said people in Jammu and Kashmir have ceased to be stakeholders in the decisions impacting their lives. “The importance of Jammu and Kashmir people as stakeholders in taking such decisions through popularly elected governments cannot be undermined or replaced by an un-elected incumbent administration at the helm of affairs,” she said.

“Only 172 seats will be reserved for domiciled aspirants of Jammu and Kashmir implying that 70 per cent reservation will be written off with 30 per cent of seats only earmarked for destitute UT,” Mohit Bhan, a PDP spokesperson said. “We don’t want the AIQ system to be furthered to Jammu and Kashmir. It will drastically impair and affect medical students in specific and health infrastructure.”

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