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Com. Rajat writes…
The National Medical Commission (NMC) recently announced that the National Exit Test (NExT) is going to be conducted in May 2024 for the 2020 MBBS batch. It will be a licensing exam for medical students to start practising or appear for postgraduate courses. This indicates that the MCQ-based exit exam will gradually become the main qualifying exam for MBBS students, undervaluing the importance of practical and ward-based experience needed currently before becoming practicing doctors.
At present, practical experience serving in wards is an important component of the MBBS course and criteria for appearing for MD. This is an important component for ensuring MBBS qualified doctors are of a minimum standard and have had hands-on experience before entering service. However, as we have seen with JEE, NEET and CUET UG, such high-pressure exit exams eventually devalue core academic subjects as they become the sole criterion for further studies or professional careers.
Asking students to focus on tactically cracking exit exams without coaching now tends to unimaginable. It ultimately disrupts the ethical responsibility of a doctor towards society by making medical degrees a ticket to getting returns on the investment made in high coaching and medical fees.
Since India became a signatory of the World Trade Organisation’s GATTS agreement to marketize education and healthcare in 1994, there has been aggressive privatization in healthcare and government medical institutions. The Medical Commission of India’s Vision Document published in 2011, the draft National Health Policy 2015 and the National Medical Commission Act, 2019 were important milestones in this attack on public medical education and healthcare as a whole. The fall in Indian medical education standards that began as a result, first, behind closed doors under the UPA regime, is now being flaunted with pride by the current BJP dispensation.
Over the last decade, the introduction of centralized, multiple choice questions-based entrances has opened the door to multi-crore coaching cartels catering to middle class aspirations for these entrance exams. These have also opened the backdoor for the mushrooming of private medical institutions (established in the name of ‘trusts’) by giving them parity with government institutes in common entrances.
Centralised MCQ-based entrance in medical (NEET) was brought in saying that it will standardize the quality of doctors and eliminate corruption in admissions. However, we have seen that ‘management quotas’ and ‘donation’ system for medical seats continues unchecked. There could not be a greater blow to ‘merit’ than privatization. Suicides of Anitha and Pratibha–medical aspirants from rural, non-English boards and backward castes–are symptoms of this broken system. The creation of the NMC in 2019 curtailed the professional autonomy of doctors and centralized decision-making as its members are wholly-nominated by the ruling Union government. Previously, the Medical Council of India (MCI) had members elected among the medical fraternity.
We have also been witnessing how corporate health care set up glittering centering around metropolitan populations. These private institutions require professional, English-speaking doctors from the rich (and predominantly upper castes) to treat the rich who can afford to ‘buy’ health as commodity. On the other hand, the glorified status of the Fortises and Medantas (now innaugurated by the Prime Minister himself) weakens the idea that it is the Government’s responsibility to provide free health care to common people.
The student movement and the wider medical fraternity must unite with toiling sections of our country to build a robust public healthcare and medical education system. We must demand the immediate rollback of NeXT which is the most recent attack on our slogan: ‘Healthcare for all!’
Rajat is a student of BA (Economics) at Hansraj College, University of Delhi.
