India is world-famous for its doctors, and it produces some of the world’s best, from reputable institutions in and out of the country. There are more medical colleges and teaching hospitals in India than anywhere else – 579 to be exact.
But a couple of recent studies and reports have cast serious doubts on the quality and ethics of the country’s vast medical schooling system. The most recent revealed that more than half of those 579 didn’t produce a single peer-reviewed research paper in over a decade (2005-2014), and that almost half of all papers were attributed to just 25 of those institutions.
Producing research papers isn’t a direct indicator of the quality of education at a given institution, or of the health care that might be provided there. But as Samiran Nundy, a Delhi-based senior gastrointestinal surgeon who authored one of the studies, told the Telegraph newspaper, “These findings support long-standing suspicions that for many private colleges in the country, medical education is just a business.”
That is a suspicion that underlies other investigations, too. A four-month-long probe by Reuters found that since 2010, “at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings, including rigging entrance exams or accepting bribes to admit students,” and that “one out of every six of the country’s 398 medical schools has been accused of cheating, according to Indian government records and court filings.”
In a country with the world’s heaviest health burden, and highest rates of death from treatable diseases like diarrhea, tuberculosis and pneumonia, corruption at medical schools is an extremely pressing issue. The Indian Medical Association estimates that nearly half of those practicing medicine in the country do not have any formal training, but that many of those who claim to be qualified may actually not be.
The 2011 court case against a man, Balwant Arora, was one of the earlier indications of the massive levels of fraud. Arora brazenly admitted to issuing more than 50,000 fake medical degrees at around $100 apiece from his home, saying that each of the recipients had “some medical experience” and that he was doing it in service to a country that desperately needs more doctors. He had served four months in jail in 2010 for similar offences.
Private medical colleges have proliferated rapidly in India. When in 1980 there were around 100 public colleges and 11 private, the latter now outnumber the former by 215 to 183. Most are run by businessmen with no medical experience. Last January, the British Medical Journal found that many private medical colleges charged “capitation” fees, which are essentially compulsory donations required for admission. Jeetha D’Silva, who authored that report, wrote, “Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson’s choice – either pay capitation to secure admission at a college or give up on the dream of a medical degree.”
The best public medical colleges have acceptance rates that are minuscule, even compared to Ivy League universities. Those colleges also tend to be the ones that produce the most research papers, as well as handle the most patients, which would seem to eliminate the possible excuse that overwhelming patient burdens prevent private colleges from producing valuable research.
The most productive medical college in India is also its largest public health institution, the All India Institute of Medical Sciences, or AIIMS. In the 10-year period that Samiran Nundy and his colleagues examined, AIIMS published 11,300 research papers. For context, that is about a quarter of what Massachusetts General Hospital produced in the same time frame.