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Dr. Ravindra Bapat Vice-Chancellor Maharashtra University of Health Sciences Nashik ( India)

The Impact of Physician Emigration on Host Country and Health Care System. 1925. 1998. SGSMC. MUHS. Dr. Ravindra Bapat Vice-Chancellor Maharashtra University of Health Sciences Nashik ( India). Policy After Independence. To produce ‘Basic Doctors’ Rural Community

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Dr. Ravindra Bapat Vice-Chancellor Maharashtra University of Health Sciences Nashik ( India)

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  1. The Impact of Physician Emigration on Host Country and Health Care System 1925 1998 SGSMC MUHS Dr. Ravindra Bapat Vice-Chancellor Maharashtra University of Health Sciences Nashik ( India)

  2. Policy After Independence • To produce ‘Basic Doctors’ • Rural Community • Comprehensive Care  Promotive •  Preventive • Curative* •  Rehabilitative “ Basic Springboard to WEST ”

  3. Post Independent Development ? Committees for Upgradation of Health Sciences Education • 1975 : Shrivastava Committee • 1983 : Medical Education Review Committee National Health Policy • 1987 : Prof. J.S. Bajaj Committee • 1988 : Rais Ahmed Committee • 1995 : Dr. A.K. Mukharjee Committee • 2002 : National Health Policy Vision WESTWARDS British Model Continued

  4. Number of Modern Medical Colleges in India Pre-independence Today “ Aims fulfilled ? ”

  5. Outcome of Medical Graduates Expected Present Super Speciality Speciality Basic Doctors Super Speciality Speciality Basic Doctors “ Top Heavy, Bottom Light ”

  6. Can Health Universities Solve the Problem N.T.R. University of Health Sciences, Andhra Pradesh -1986 M.G.R. Health Sciences University, Tamilnadu -1987 Rajiv Gandhi University of Health Sciences, Karnataka -1994 Maharashtra University of Health Sciences, Maharashtra-1998 Baba Farid University of Health Sciences, Punjab - 1998 Politicians handle Finance and Administration ! Mushrooming of Institutions ??? Standards

  7. End Result • Uncontrolled growth can not fulfill AIMS. • Socio-economics & Logistics needs ignored. • Cost-intensive western medicine preferred over promotive, preventive aspects of health “ Shield or Gun is the Choice ”

  8. Doctors in the Five Blocks in Nashik District Percentage Source : Economic and Political Weekly Feb. 3-10, 2001 By Dr. Shyam Ashtekar

  9. Urban Education and Rural Deprivation Rich and Poor both live. Why the living be cost dependent ? Are we Unconcerned ?

  10. Maharashtra : An Illustrative Example Source : 2001 Census India - 1069.06 Million Urban : Rural = 27.78 : 72.22 Maharashtra - 96.75 Million Urban : Rural = 42.40 : 57.60 Germany - 81.84 Million France - 60.36 Million United Kingdom - 59.76 Million Australia - 19.64 Million Health Care Personnel servicing Population Allopathic, Ayurvedic, Homeopathic & Unani

  11. Number of Medical Colleges in Maharashtra Pre-independence Today “ More the Merrier ? ”

  12. Number of Doctors Produced per Year from Maharashtra 5750 + + Medical Dental Ayurved Unani H’pathy Allied No. of Doctors in all faculties = 9860 / Yr

  13. Pride without Prudence • After 1980 – Mushrooming of Medical Colleges • MBBS Graduates – • 80% - P.G. • 10% - Foreign • 8% - Govt. Services • Rural Population Serviced by other pathies. • * Practice Modern Medicine without Training. • * Doctor Population Ratio– WHO - 1 : 3500 • Medical - 1 : 1161 • All Pathies - 1 : 582 “ Primary Health Care in the hands of other Pathies ”

  14. Privatisation of Higher Education in Maharashtra - 1984 DUC : Deemed University Colleges Govt / Semi-Govt : 27 Pvt / Aided : 134 (3+1) “Privatisation of Higher Education is a Policy !”

  15. Suggestions • Moratorium on New Colleges • Strengthen the existing • De-affiliate : less than 50% teachers • Re-designate the teachers • Use of Audio-visual aid • Virtual Classroom

  16. Economics of Medical Education • Economics of Medical Education shall play an important role in providing Parameters A, B & C • Monitoring this shall yield better educational standards • Private Providers cut corners due to economic stringency

  17. Economics of Medical Education • Medical Education differs from other higher education • Managing a Medical College is a viable proposition • Running a free Hospital is economically demanding Medical Students learn on patients Not only on Books & Instruments

  18. Reality or Fracas • Do we have a solution ? • Should we increase Medical Colleges & flood the market ! • Empowerment of knowledge to Non-medical practitioners ? • Aim is to provide proper Health Care in rural India “ Modern medicine is Techno-intensive, cost-intensive with Urban / Semi-urban bias” Clinical Medicine is Declining

  19. Why Migrate ?

  20. Desire to Migrate • For Academic Pursuit • To Acquire Advanced Knowledge • For Economic Prosperity • To Enhance Social Standing Brain Drain or Economic Gain !

  21. Desire to Migrate • For Easy Job Opportunity • Craze for Foreign Land • Due to Socio Political Reasons • Fellowships / Scholarships Brain Drain or Economic Gain !

  22. Migration for Advancement of Knowledge • 1900-60 FRCS / MRCP • 1910-1920 Faculty positions were • given to British Medical Services • Indians Denied Positions • Birth of Seth G.S. Medical College - 1925 • Medical Men Loved to come back home British Degrees Enhanced Professional Standing

  23. Brain Drain or Economic Gain 1960 - 1985 • Exodus to UK / US / CANADA • Left for Higher Education • Didn’t pursue the Goal • Picked what was offered • Changed the Speciality • Settled abroad for Economic gain Knowledge or Money !

  24. Analyze 1960 - 1985 Era • How many achieved academic excellence? • Did they alter their basic post-graduate qualification and • took up other speciality like Radiotherapy, Pathology etc. • They were Post Graduates in Medicine, Surgery , OB & GY, • Pediatrics and Orthopedics • Waste of National Resources for Education and Training * Strengthened the Health Care in Chosen Land Economic Prosperity Blunts Academic Hunger

  25. After 1985 • Flow Diminished~ Demand Dwindling • Reforms in UK / US resulted in declining migration • FMGs from developing countries have to compete • with returning US/UK FMGs educated abroad • Emigration of FMGs from developed countries “The trend is to acquire advanced Technology” Home bound to advanced Urban Centers

  26. Need of Planned Migration • Fellowships of shorter duration • Bilateral short term training programme • Induct fresh Medical Graduates from India to train • in recipient country • Demand in various Medical Disciplines be assessed • Supply to be monitored Manpower Export be Rationalized

  27. Manpower Export • Export potential in order of better opportunity • Nursing – Highest demand • OT/PT – Excellent opportunity • Physicians – depend on need of recipient country Demand & Supply Potential Modern Medical Institutions are flourishing !

  28. Registered Doctors from Maharashtra Medical Council As on 31/3/2004 Doctor Population Ratio WHO - 1: 3500 Medical - 1:1161 All Pathies - 1: 582

  29. Medical Colleges India Total No = 229 South Six States = 142 South = 62% North = 38% 13 38 27 30 20 14

  30. Students Intake Capacity • All over India : 229 Colleges : 24589 • Colleges in Maharashtra, Andhra • Pradesh, Karnataka,Tamil Nadu, • Gujarat & Kerala : 142 Colleges : 16260 66.12 % intake for only 6 States Concentration in South Promotes Migration

  31. Consequences • Surplus in host country • Reverse flow from foreign countries • Congestion in Urban and semi-urban areas • Promotes unhealthy competition, solicitation and • malpractices Market Philosophy is not applicable to Human Professional Product

  32. Migration & Health Care in India • 10% - Modern Medicine Graduates Migrate • No impact on Rural Health Care System (RHCS) • RHCS serviced by other pathies • Primary Health Care System needs to be empowered • with essential knowledge of Modern Medicine Health Care Scenario Unaltered due to Small Fraction Migrating

  33. Global, Focal or Local • “India is a global player” – Manmohan Singh (1991) • 70% population in the rural area - • Martya or Amartya • (Death Prone) (Death do us no Part) • Their economic subsistence is much below the • poverty line. Modern Medicine is Techno-intensive, Cost Intensive Can we serve “Martya” Population ?

  34. The Perils of Globalization of Education The Impact of Globalization • Increasing interest of parents to get their children admitted • to foreign educational institution • Creation of Three different classes of graduates • a) Those educated in foreign Universities • b) Those from costly private domestic institutions • c) Those from economically weaker sections studying • in Government funded institutions • This will only lead to social tensions Unkept Promises Lead to Perilous Situation

  35. Question is service to Humanity A Rural Scene from Ahmednagar District

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