Chapter 43: Medicine and Dentistry

Introduction

Among the most sought-after careers by the youth of to-day is medicine and dentistry-the latter to a lesser extent than the former. The number of candidates who appear in the entrance tests in different States is mind boggling. Doctors have a traditionally exalted position in the Indian society. There has been a tremendous knowledge explosion in medical sciences. While newer kinds of diseases are surfacing, so also newer systems of diagnosis and treatment are being found. Newer drugs are being invented both as preventive and curative measures. In earlier days, it was the hospitals and health centres where people used to go for treatment. Now cities and towns, big and small, are dotted with scores of private and corporate hospitals, nursing homes and clinics.

Health and medicine is now a big industry. It is but natural that the young would seek a career in this ever expanding profession. Medicine encompasses besides modern allopathy, both Indian Systems of medicine (Ayurveda, Siddha, and Unani) and Homoeopathy. Then there is what is known as alternative medicine or complementary medicine such as acupuncture and naturopathy and a host of other diagnostic and therapeutic practices and systems which are separate from and in contrast to conventional scientific medicine. This Chapter deals with Medicine and Dentistry, the modern allopathy system of medicine. Chapter 35 deals with Indian Systems of Medicine and Homoeopathy.

Though under the Constitution health is a State subject, Union Government’s intervention is needed to assist States in such areas as broad policy formulation, control and eradication of major diseases, such as malaria, TB and AIDS medical and para-medical education along with regulatory measures and medical research.

Medical and Dental Colleges and Institutions

At the time of Independence there were 19 medical colleges in undivided India (including two in the princely states of Mysore and Hyderabad). The total number of students admitted each year was about 1200. Both the (Calcutta) Medical College and Madras Medical College (now Madras Medical College and Research Institute) were founded in 1835. Other well-known colleges of the pre-Independence days are; Grant Medical College, Mumbai (1846), King George Medical College, Lucknow (1911), Lady Hardinge Medical College, (exclusively for women), Delhi (1916), The first degree awarded was Bachelor of Medicine (MB). There were also 19 medical schools, nine of them being in undivided Bengal and four in Mumbai. These were controlled by the provincial medical faculties.

The education imparted was known as Licentiate Education. The award nomenclature was Licentiate of Medical Faculty (LMF) or Licentiate Medical Practitioner (LMP). In accordance with the recommendations of the then Indian Medical Council made as early as 1942, the medical schools were abolished after 1947. The Licentiates were given opportunities to obtain MBBS degree by undergoing a condensed course. As regards dentistry, at the time of Independence there were only four dental colleges. The first dental college, Calcutta Dental College and Hospital (now Dr. R. Ahmed Dental College and Hospital) was established in 1920 followed by the Nair Hospital Dental College in 1932, in Mumbai.

According to the Annual Report of the Ministry of Health and Family Welfare (1998-99), as on March 31, 1999, there were 162 medical colleges in the country of which 158 (109 government and 49 private) were recognised by the Medical Council of India. The admission capacity is about 17,000 students per year. The list of recognised medical colleges published by the Medical Council of India in national newspapers in June 2000 puts the figure at 166.

Surprisingly, the list includes as many as 19 colleges (including some of the oldest ones and all the seven located in West Bengal) the recognition of which is subject to the final order of the Supreme Court. The list also contains 19 medical colleges, most of them established in recent years which have been permitted to admit students on year to year basis. The largest concentration of medical colleges is in Maharashtra (34). The number of dental colleges is 98, the largest number being located in Karnataka (41). Besides, 12 medical colleges also offer dentistry course. There are two colleges-Lady Hardinge Medical College (Delhi), and Dr.D.Y. Patil Prathistan’s Medical College for Women (Pune) which are exclusively for women candidates.

A new trend in medical education is the establishment of medical universities which take control of the entire medical education in the State covering all systems and types of medical education. Medicine, Dentistry, Ayurveda, Siddha, Unani, Homoeopathy, Yoga and Naturopathy, Pharmacy, Nursing and Allied Medical Sciences (Physiotherapy, Occupational Therapy). There are now six such medical universities- Rajiv Gandhi University of Health Sciences (Karnataka), Tamil Nadu Dr. MGR Medical University, NTR University of Health Sciences (Andhra Pradesh), Baba Farid University of Health Sciences (Faridkot, Punjab), Maharashtra State University of Health Sciences, and Sikkim-Manipal University of Health Medical and Technological Sciences (Gangtok, Sikkim). Besides, there are 11 university-level institutions (including deemed ones) which mainly offer postgraduate courses ( Annexure 1). Some of them also have introduced courses in Allied Health Sciences (See Chapter 17), such as physiotherapy, occupational therapy, medical laboratory technology. Besides, there are a number of institutions affiliated to universities which offer only postgraduate and higher level specialised courses in medicine. ( Annexure 2).

Regulatory Authorities

As stated in Chapter 7 (Regulatory Authorities) the Medical Council of India (MCI) and the Dental Council of India (DCI) are the regulatory authorities in respect of medical and dental education, respectively. The students must take admission only to medical colleges and courses that are approved by the MCI and DCI. There are instances of medical and dental colleges admitting students even if they did not get the recognition of the Councils or granted affiliation by the concerned universities. For example, the Maharaja Agrasen Institute of Medical Research and Education in Agroha (Haryana), which received provisional recognition of the MCI repeatedly failed to fulfil the requirements as specified by it.

The students admitted to the college were accepted as “guest students” by the Medical College in Rohtak. The college finally closed down in early 1999 jeopardising the careers of a large number of students. In Tamil Nadu, Sarvana Dental College & Research Institute started issuing admission advertisements before it was approved by the DCI and was granted affiliation of the university. Tamil Nadu Dr. MGR Medical University through press notes cautioned the students against taking admission into the college. Students who pass MBBS or BDS examinations from colleges which although are affiliated to universities but not recognised by MCI or DCI are not eligible for admissions to postgraduate courses in the 25% seats in medical and dental colleges for which the All India Institute of Medical Sciences conducts the All India Entrance Examination.

Levels of Education

Education in Medical and Dentistry is offered at four levels: (i) first degree-Bachelor of Medicine and Bachelor of Surgery (MBBS), and Bachelor of Dental Surgery (BDS), (ii) postgraduate diplomas in specific areas such as Child Health (DCH), Laryngology and Otology (DLO), Diploma in Gynaecology and Obstetrics (DGO) and postgraduate degree in broad specialities – Doctor of Medicine (MD), Master of Surgery (MS), and Master of Dental Surgery (MDS), (iii) Postgraduate degree (super specialities)-Doctor of Medicine (DM), and Master of Chirurgiae (MCh) also known as post-doctoral degrees, and (iv) research degree M.Phil and PhD. The first part of call in medicine is the first-degree course in Bachelor of Medicine and Bachelor of Surgery (MBBS).

The course of four-and-a-half year duration followed by one-year of internship prepares a candidate to become a general practitioner and the qualification is not considered enough to provide specialist treatment of diseases of complicated nature. The subsequent levels are, therefore, aimed at providing education dealing with broad specialities and super-specialities. In Dentistry, the first degree is Bachelor of Dentistry (BDS) of four-year duration followed by internship for a period of one year.

There are also postdoctoral certificate courses (PDCC) of one-year duration in super-specialities open to holders of MD and MS degrees. Besides, the National Board of Examination (NBE) conducts examinations for the award of Diplomat of the National Board (DNB) as equivalent to postgraduate degrees (MD and MS) and post-doctoral degrees. This has been discussed in a subsequent section. Many medical colleges also offer MSc (Medical Non-clinical) courses.

MBBS and BDS Course

The entry requirement for both MBBS and BDS courses is a pass in 10+2 examination with English, Physics, Chemistry and Biological Science. The candidates must have completed 17 years on December 31 of the year of admission. Most of the States have introduced common entrance tests for selection of candidates. Some tests are common for several professional courses while some are exclusively for medicine. A State-wise list of tests is given in Annexure 3.

Admission to medical and dental courses are generally restricted to candidates domiciled in the concerned States, although according to the Government guidelines, 15% of the payment seats in private medical colleges are required to admit students on all-India basis. The Central Board of Secondary Education (CBSE) conducts the All India Entrance Examination for admission to 15% seats in medical and dental colleges run by the Union and State governments, municipal and other local authorities, except Andhra Pradesh and Jammu and Kashmir. Information about this test has been given in Chapter 9 (Admission Procedures).

Besides, 11 colleges admit students through all-India tests ( Annexure 4). The Ministry of Health and Family Welfare maintains a Central Pool of MBBS and BDS seats by seeking voluntary contribution from a number of States. These seats are allocated to candidates belonging to States and Union Territories which do not have medical and dental colleges, children of defence and paramilitary personnel, children of Indian staff in foreign missions, Tibetan refugees and National Bravery Award Winners.

The Fee Structure: The Supreme Court verdict in 1994 in Unnikrishnan’s case led to the creation of two categories of seats viz., payment and free (or merit) seats, in professional colleges (medical and engineering). At least 50% of the merit seats in every professional college should be filled up by the nominees of the Government or University. The remaining 50% seats (payment seats) should be filled up by those candidates who are prepared to pay higher rate of fee prescribed by the “competent authority”. At present the upper limit for payment and merit seats in private colleges are Rs.1.10 lakh per annum for payment seats and Rs.13,000 per annum for merit seats. This upper limit would be valid for a period of three years from the academic year 1997-98, after which the Ministry of Human Resource Development would review the fee structure.

Higher Level Courses

As already stated, higher level courses in medicine lead to the awards of postgraduate diploma, degree, and in broad specialities (MD/MS), postgraduate degree in super-specialities (DM/MCh) and research degree (M.Phil and PhD). In the case of dentistry, the Master of Dental Science (MDS) is the only available postgraduate degree. The PG Diploma courses are of two years duration. The duration of MD, MS, MDS, DM and MCh courses is three years. Admission to postgraduate courses (MD/MS/MDS) are also based on entrance tests conducted by the colleges and medical universities.

The All India Institute of Medical Sciences also conducts the All India Entrance Examination for admission to 25% seats for postgraduate courses (MD, MS, MDS and PG Diplomas) in medical colleges in India run by the Union and State governments and municipal and other local authorities, (except Andhra Pradesh, Jammu and Kashmir and the All India Institute of Medical Sciences), the Postgraduate Institute of Medical Education and Research, and private medical colleges (See Chapter 9 – Admission Procedures). Annexure 5 gives an illustrative list of branches for which postgraduate courses are offered.

As stated earlier, there are a number of institutions exclusively devoted to postgraduate studies. Institutions like All India Institute of Medical Sciences, Postgraduate Institute of Medical Education and Research (Chandigarh), Sanjay Gandhi Postgraduate Institute of Medical Sciences (Rae Bareli Road, Lucknow) admit students for postgraduate studies as Junior and Senior Residents (House Staff).

The Directorate General of Health Services (Government of India) have introduced a scholarship scheme tenable for two years for students pursuing postgraduate and postdoctoral studies in institutions where residency system has not been introduced. It needs mention that the number of seats available in specialisation courses is extremely limited because of stringent infrastructural requirements specified by the Medical Council of India, e.g. often one-to-one professor-student ratio.

National Board of Examinations (NBE)

The National Board of Examinations, Ansari Nagar, New Delhi-110029 established in 1975 is an autonomous body of the Ministry of Health and Family Welfare. Considering the variation in the level of proficiency and standards of postgraduate and postdoctoral examination in the country, the main purpose of the NBE is to conduct high and uniform standard examinations at the national level. Examinations are held in 33 medical disciplines, 21 broad specialities and 12 super specialities. ( Annexure 6). Successful candidates are awarded Diplomat of the National Board (DNB) in line with the Diplomat of the American Board. The award is recognised as equivalent to postgraduate (MD/MS) in broad specialities) and postdoctoral degrees (DM/MCh) of Indian Universities and is included in the First Schedule of the Indian Medical Council Act, 1956.

NBE accredits hospitals having adequate trained manpower and infrastructural facilities to train candidates for the DNB qualifications. The examinations are generally conducted in two parts-Primary and Final, held twice a year, in January and July. Candidates who have passed the MBBS examination and are undergoing or have completed internship are eligible to take the primary examination. The Primary Examination is common for all the broad specialities (including direct five-year courses in Neuro-surgery, Paediatric Surgery and Plastic Surgery). The Primary Examination (two papers of three-hour duration) is of MBBS standard and is designed to test the basic knowledge of the candidates in respect of the applied dimensions essential for the understanding of the natural history of diseases and their management. It is used as the qualifying parameter for the enrolment for training as specialists in broad specialities.

The Final Examination is aimed at testing the candidate’s professional competence to practise as a specialist. The Final Examination in broad specialities consists of theory and practical examinations. Candidates passing the theoretical examination are permitted to appear in the practical examination. Candidates who have passed the Primary Examination and thereafter completed three years of training are eligible to appear in Final Examination. Candidates who have passed the postgraduate diploma examination and completed one year of training and the holders of MD/MS degrees are eligible to sit for the Final Examination directly. As regards examinations in super-specialities, only candidates possessing postgraduate degrees and having three years of training are eligible to appear. The examination consists of three papers each carrying 100. Qualifying in the theory paper entitles a candidate to appear in the practical examination.

The latest addition to the NBE’s educational programmes is the Post-Doctoral Fellowship examinations in 25 sub-speciality areas ( Annexure 6). The duration of the programmes vary between 12 months to 24 months. The courses, beginning with 2000 AD would be offered by NBE accredited institutions possessing competent faculty, “high-tech” equipment, and which have made outstanding academic contributions to specific specialities. Eligibility requirement is Diplomate of the National Board or equivalent postgraduate degree with two years of practical experience in the relevant specialities and have aptitude for higher specialisation. The award, Fellow, National Board Examinations (Sub-speciality), will be made on the basis of internal assessment, and performance in theory and practical examinations and vice-voce. NBE is reportedly trying to get DNB award recognised in Britain (See also Update).

MSc (Medical Non-clinical) Courses

Many medical colleges offer MSc and PhD degrees in medical non-clinical subjects which are also open to non-medical students. While most of the courses are of two-year duration, some need 3- 3 ½ years of study. Annexure 7 gives a list of universities offering these courses.

Hospital and Health Administration

Although hospital and health administration has been recognised as a postgraduate discipline long time back, it is only recently that this education has emerged as one of the significant career options for both medical and non-medical graduates. The main reason is the establishment of a large number of corporate hospitals in the private health care sector. This sector is a flourishing industry and needs specialists for its efficient management. There are now a number of institutions which offer postgraduate degree and diploma courses both of one-year and two-year duration.

The courses are open to both general and medical degree holders. In some institutions, preference is given to degree holders in medicine. The MD and Diplomat (of NBE) courses in Hospital Administration, however, is open only to medical graduates. Annexure 8 gives a list of institutions which offer courses in hospital administration along with the nomenclature of their awards.

Public Health

Although a large number of medical colleges offer post-MBBS diploma course in public health (DPH) of two-year duration, and MD in Social and Preventive Medicine, the Government of India had established the All India Institute of Hygiene & Public Health (110 Chittaranjan Avenue, Calcutta-700073) for conducting research and training in the subject. It offers as many as 11 courses relating to hygiene and public health areas. Most of the courses are open to MBBS degree holders, while non-medical candidates are also admitted in some courses. Appendix 9 gives a brief account of the programmes.

Sree Chitra Tirunal Institute for Medical Science & Technology (Thiruvananthapuram 695011), also offers Master of Public Health (MPH) course of 1 1/2 – year duration open to graduates in medicine, veterinary science, engineering and postgraduate degree holders in social sciences.

Career Opportunities

Most of MBBS degree holders begin their careers either as private practitioners or taking up jobs. Many prefer to continue higher studies. As is well-known, job opportunities for MBBS degree holders are available in different types of organisations and establishments. A brief account of them follows:

(a)  Defence Service (graduates of the Armed Forces Medical College, Pune);

(b)  Railways, Indian Ordnance Factories Health Service, Central Government Health Service, and Municipal Corporation of Delhi (recruitment through the Combined Medical Services Examination conducted by the UPSE),

(c)  hospitals run by many Municipal Corporations;

(d)  Health Services of State Governments (for working in hospitals, clinics and primary health centres)

(e)  hospitals in large industrial establishments, both in the public and private sectors,

(f)  increasing number of corporate hospitals (including speciality hospitals).

By and large, the government hospitals do not permit private practices, but doctors are paid an additional non-practising allowance (NPA). However, mere MBBS degree is not enough for career progression either as private practitioner or in service. In this age of specialisation it is absolutely essential that in course of time one should acquire higher qualifications in various broad specialities, super-specialities and sub-specialities described earlier.

Acquisition of such qualifications open up opportunities in teaching and research institutions, employment as specialists or as visiting consultants in hospitals. Besides, as private practioners, they can have their own clinics. Another option is the research career. The Indian Council of Medical Research (ICMR) in the Ministry of Health and Family Welfare has a chain of 36 research institutions, Regional Research Centres,, and Centres for Advanced Research (See Annexure 10).

Those who are interested in social service rather than money would find a stint in rural area quite rewarding. This of course would also provide opportunity to get into postgraduate course.

Update

National Board of Examination (NBE): NBE has now decided to conduct from 2001,Diplomate of the National Board (DNB) examination in Dentistry in four specialty areas, viz., Othodontics, Prosthodontics, Oral Surgery, and Conservation Dentistry. The Examination would be held in two parts - Primary and Final. Candidates Who possess MDS degree in these areas are entitled to take the examination. The awards would be included in the respective schedule of the Indian Dentistry Act, 1948 (Act 16 of 1948).

The NBE has also introduced two-year post-doctoral fellowship programmes in 14 sub-specialties viz., Critical Care Medicine Trauma Care, High Pregnancy and Parent logy, Vitreo-Retinal Diseases, Pediatric Ophthalmology, Pediatrics Orthopedics, Pediatric Cardiology, Cardiac Anesthesia, Interventional Cardiology, Reproductive Medicine, Minimum Access Surgery,Peripheral Vascular Surgery, Hand Surgery, and Spine Surgery, Eligibility requirement is DNB award or MD/MS/DM/MCH degree in relevant specialties. The candidates will undergo training in designated teaching hospitals accredited by the NBE.

Medical Council of India (MCI): The MCI had notified in the Gazette of India (Part III Section 4) dated October 7, 2000 new regulations relating to opening of a new or a higher course of study on training and increase of admission capacity in any course of study and training.