I was most interested to learn about the recent Medical Council of India’s decision to enable those physicians who hold postgraduate qualifications from English speaking countries viz the US, the UK, Canada, Australia and New Zealand to function as teachers in medical institutions in India. I do not have the copy of their resolution but if this list is comprehensive, why was the Republic of Ireland left out. Plenty of Indian physicians seek training in Eire (Republic of Ireland) and they would be unfairly placed at a disadvantage. There is a personal reason as well; I myself commenced my medical career in Eire and my first success in a Royal College examination was in Dublin. Besides, Eire does offer training facilities comparable to the other countries on this list.
Those who have perused my columns here and elsewhere would know that I have been a very severe critic of the Medical Council of India for a long time. I have questioned its mode of functioning and publicly blasted it both for its actions as well as inactions. It is an archaic body, which had over period tended to lose confidence of the medical community not just in India but internationally. Some of its officials have, through their deeds, brought comprehensive discredit. Armed with wide discretionary powers under the statute, it has frequently acted in the most arbitrary manner and there has been very often no redressal available for its ravages.
In all fairness, it is not the only medical regulator that has functioned in this disreputable manner. Dr Kernan Manion, a reputed psychiatrist may have a few revelations to make about the way medical regulators through their arbitrariness have left no stone unturned to ruin his flourishing career in the United States. He has decided to take them on in the courts and given the prohibitive rates the attorneys charge; he is conducting a one man battle on his own. The College of Physicians and Surgeons of British Columbia has been pursuing unashamedly racist practices specifically against the Indian physicians. It freely believes that it is well within its rights to erase the Indian physicians without any due process violating every tenet of Universal Declaration of Human Rights and has done so with impunity. It has shown no compunctions disseminating false information and falsifying its records in its dealings with Indian physicians. And the British Columbia statute confers upon them absolute immunity (as they claim) from any legal action. I know a senior attorney has alerted the Indian Minister of External Affairs about this and she has ordered the local Consulate to look into this matter. The sad fact is that even the Canadian Prime Minister has not seen it fit to intervene in this matter. While not as egregious as this, the medical regulators in Australia have also followed deeply unethical and discriminatory practices. The General Medical Council in London is relatively more open but even they have followed practices that are deeply disturbing.
In other words, the Medical Council of India is in good international company with its record of questionable actions. The Rajasthan High Court rescinded one of its erasures a few weeks ago and severely indicted it. The most serious embarrassment was, of course, the arrest of Dr Ketan Desai, who was functioning as the President. He is currently facing a criminal trial for allegedly deeply corrupt actions. Only then did the government swing into action. The MCI is now run by a government appointed committee and the apex court is monitoring its actions. From all available reports, this move has had a positive effect and in this context it would be apposite to wish it well. This recent decision is a positive move for which it deserves to be complimented.
It would be important to understand how this bizarre action i.e. derecognition of the internationally respected British postgraduate qualification came about. When I was a medical student nearly five decades ago, nearly all our teachers had had postgraduate training in the United Kingdom. It was almost customary for anyone aiming for a career in academic medicine to travel to the United Kingdom where they could gain registration with the GMC and start practising without any clearing exams.
In the mid 70s, the GMC became increasingly concerned over the decline of standards in some medical colleges because of lax monitoring by the regulators. The major embarrassment came when the Prince of Wales Medical College in Patna, one of the oldest and most respected medical institutions at one time, was penalized for a year; the graduates of that year were derecognized when it was discovered that one particular candidate was granted 54 grace marks to enable him to pass. The derecognition was rescinded the next year but the reputation of the institute suffered very badly.
The GMC then decided that it was not going to extend automatic registration to Indian medical graduates unless they passed the Temporary Registration Assessment Board exams (which has since become the PLAB exam). Medical graduates from a limited number of countries were exempted from this requirement. India was not one of them.
The MCI president at this time was one Dr B N Sinha of Lucknow. He was known to be an excellent orthopaedic surgeon but was insufferably egotistic and authoritarian and if the number of legal cases against him was any indication, he did not have a single ethical bone in his body! He took this as a personal affront and within a week announced that he was derecognizing all the medical qualifications from the United Kingdom as he claimed the MCI had a reciprocal arrangement with the GMC. That statement itself was mendacious; the MCI chose not to derecognize the medical qualifications from Sheffield and London. It is anybody’s guess why this exception was made and why Sinha chose not to publicize it. Sheffield was never known for its excellence of medical training!
There were other problems that were not sufficiently explained. Firstly, it was wrong to have stated that the UK had derecognized the Indian medical qualifications. All they had done was to curtail the right of automatic registration and this move was not directed only at India. Also, I have a letter from the GMC, which stated very clearly that the reciprocity when it existed was limited to primary medical qualifications; there was no reciprocal arrangement for postgraduate qualifications. Moreover it was open to the MCI to introduce a PLAB like test for the UK graduates if they had wished. The truth was that this was just a case of improper acting out by Sinha as he knew very well that there was no likelihood of any UK postgraduate coming over to India and the only people who were likely to be affected were Indian citizens who were seeking training in the UK. And he could not care less!
The move, of course, did not deter physicians from seeking training in the UK. It did lead to some bizarre situations at times. Dozens of government ministers kept on going to the United Kingdom to seek medical treatment at public expense from those who were deemed unqualified in India! Many Indian physicians returned to India and found employment in the private hospitals, which were only too willing to snap them up. And the most serious embarrassment came about when Nikhil Tandon, a distinguished and senior endocrinologist who had trained in the UK, had to put up a legal battle with the MCI who were refusing to recognize him as a specialist. He was awarded B C Roy Medal, the topmost public honour for physicians in India by the same MCI.
I myself put up a battle against this ruling and despite the very unscrupulous moves by the lawyers of the other side and some absurd machinations by Shridhar Sharma who was opposing me for reasons of his own, a Delhi High Court bench of Justice Mahendra Narain and Justice Ashok Srivastava ruled against the MCI. I had by then lost all interest and returned to the United States.
With the severely declining standards in medical education and disconcerting shortage of medical teachers, I am confident that this would prove to be of overall benefit.
Readers would also know that I am a firm believer in the promotion of postgraduate training in primary healthcare. The MCI has been lamenting for a while that despite the introduction of MD courses in Family Medicine, they cannot find trainers. I know at least a dozen of MRCGP holders who would be most interested in relocating to India; there are sure to be more! This would, of course, address this difficulty.
Above all, I hope this move signals a comprehensive change in the functioning of the MCI!
by Dr Ashoka Jahnavi Prasad
Editor’s Note: The views expressed here are the author’s personal opinion.