“We cannot stop doctors from studying or working abroad – we can provide them with lucrative offers”, these are the words of an official serving on the parliamentary committee. Obviously, doctors are too less in numbers in India. Total number of MBBS seats—53,330 (30,000 NEET) Colleges 426 Total 17,000 PG-NEET seats are available across 350 medical colleges. Candidates appearing 1 lakh (many are repeaters). Registered doctors- 9.29 lakhs (not from live database – many passes away/go abroad) Available in practice – 7.4 lakhs Rati – 1/1974 Ratio recommended by WHO—1/1000 Parliamentary committee report -1/2000 It really breaks one’s heart to see a young student commit suicide after an unsatisfactory result. It happens in all fields and after results of many examinations. Traditionally it is either blamed on parents who pressurise the children to achieve or on immaturity and weakness of personality of the student. None of the education systems is ideal. Students from various backgrounds find it difficult to cope with the social and or family pressure. Everyone’s heart goes out to the grieving parents. Then is there anything more than this about the students committing suicide after NEET? The most important reason why the society should sit back and ponder over the problem is that it is a loss of a coveted human resource that was trained upto graduation in a sector where we severely lack man and brain power. A cursory look at the statistics is enough to tell us how short is the manpower in medical and paramedical fields. The fact that government wants to allow non-modern medicine (AYUSH) graduates and even dentists to work in modern medicine says it all. They can accept such a desperate solution on one hand whereas, on the other, they are not doing anything to avoid loss of precious brains that have already crossed the hurdle of the entrance at 12th and managed to endure a hard course and cleared the final examination. We do not have data about how many specialists are needed in each speciality field, including a number of family physicians. Why do students want to go for post- graduation? There is no good course available to become a respectable family practitioner. Medical knowledge has grown by leaps and bounds. I wonder if it is possible to start family practice without much directed practical training just after MBBS. The practical training during M.B.B.S. is abysmal. It is difficult to go to rural areas due to a severe lack of infrastructure. A doctor in a rural area can practise an only limited range of skills because electricity, water, staff, schools are unpredictable and unavailable. No, don’t blame doctors alone—these are the very reasons why rural population tries to move to the cities; every government official tries for a transfer to cities. And mind you, our definition of a city is a place where water, electricity and schools are available. Actually speaking cities need to be much more than this. And even on these criteria, very few places qualify as cities. With permission being granted to all AYUSH doctors to write modern medicines, practice in the city as a family practitioner will be a nightmare -with a further decline in prospects. Why are post graduate seats so less in number? The government scrapped the honorary system thus reducing the number of teachers. The 1:1 student-teacher ratio is 2:1 now thus leading to deterioration in the quality of teaching. PG seats in private colleges are not affordable. Parents need to take a loan in crores near their retirement in order to sponsor the ward’s education. I don’t think it is fair. The students themselves cannot get education loan as they are not permanently employed. The students who buy seats may feel they have bought the degree. They do not realise the need to work and acquire skills. Technology in medicine has a lead role in saving lives and restoring functionality of individuals. It is impossible to reach top-class healthcare to masses unless we have enough post-graduates. What is the problem with PG-NEET? It is conducted after 1 year internship period which is meant to train young graduates in practical skills. The precious period is wasted in being a bookworm in the prime of their lives. Mind well, we are talking of a 24 or 25-year-old whose non-medical friends have already finished post-graduation and are employed or about to be. Students spend around 2-3 years in the prime of their youth studying for PG-NEET which does little good to add to their knowledge. In fact, these young doctors remain unavailable to work in the field. That is a loss to the society already deprived of doctors. NEET resorts to an extremely theoretical set of questions with random computer generated separate question paper for each student. In short, instead of learning how to give an intra-muscular injection or cardiac massage, the student wastes time in mugging up irrelevant facts of minimal significance like the date on which oral polio vaccine was released for the first time in the world. Mind you, it is not even who, but “when” as if it is a history examination, leave alone asking about the mechanism of action. This is short-coming of MCQ tests. The skills of practical importance are not assessed and are liable to be ignored by students. Everyone has to study during internship thus wasting precious time which should be better utilised in acquiring a set of motor skills. The latter are better learnt earlier. This is because NEET expects you to learn all the 19 subjects in minute details necessary to solve MCQs (requires extremely detailed preparation). And then those who cannot make it to PG become family doctors with a feeling that they have been losers or failures. How can they be good family doctors then? This is the reason for suicide and loss of human resource. How can this be solved? As all boards conduct certification examinations at national or state level, the third M.B.B.S. examination should be nationwide. The same examination should be used for ranking for PG admissions and for licencing to practice as MBBS doctor for students who complete their graduation abroad. This exam should also substitute the NEXT or exit exam proposed at the end of internship ( meant to be licentiate examination before starting general practice and also to assess foreign graduates before they join post MBBS studies or practice. ) What should be the pattern? I understand that such examination cannot be subjective so as to avoid bias. It needs to be in MCQ pattern. It should include only third MBBS clinical subjects because they are the most relevant ones. The examination should be only for theory. But the theory examination can still test the prowess of the student by asking to solve MCQs on given clinical problems. They can be distributed evenly over all third M.B.B.S. subjects. There can be 5-8 questions about decision making and treatment in given cases. This is similar to the concept of JEE advance where questions are never straightforward and are based on an application of principles. Every college should conduct a preliminary practical examination which will decide whether the student is qualified to appear for the above mentioned nation-wide theory examination. The practical marks should not be counted anywhere during PG admission -to eliminate favouritism. A properly crafted PG program should include periodic MCQ exams to refresh knowledge of relevant 1st and 2nd MBBS by the college where the PG course training is offered. These could be state level examinations if deemed practical by medical teachers’ association or universities. If more family physicians are deemed to be required, there should be a well-designed course for minimum two years with rotation through various speciality departments and should include training in handling basic medical and surgical emergencies and life-saving procedures like central line insertion, tracheostomy, minor suturing etc. in relevant departments. They should be trained in psychiatry, sociology and medical economics. In the current scenario of medical advances, a family practice also needs to be a post-graduate speciality a highly respectable and difficult branch to handle. I strongly believe that everyone needs some training after MBBS, NEET should decide only the branch. This will not only revive the long lost glamour of family physician by introducing better quality but also improve quality & remuneration in family practice. The costs of basic care will improve due to better screening. Who knows – it may become a most popular branch. The whole exercise will shift the paradigm of medical entrances in right direction.