Increase in MBBS seats in JIPMER - Reality and feasibility : LUSENET : JIPMER Net : One Thread

Since KAN suggested that we start a new line on increase in MBBS seats I thought I might start the discussion and get the input of JIPMERites. Have the seats been increased or decreased in the past in JIPMER? Yes there have been; In 1978 - only 30 odds students were taken into JIPMER, while the now famous "double batch" was accumulated over 2 years 1979-1980 ( total of 130 students). During the initial acclimatisation period; "ragging" as they used to call it then, we were asked " thera kya hoga saamba?"

However let us think about the pros and cons of increasing seats in JIPMER.

What are the advantages of a big batch?

You get lots of competition.

You get to know a lot of good guys and gals.( probability theory) and those who survive are really good ( theory of natural selection)

You may be able to use it as a pretext to recruit new staff, equipment,subsequently new hostels have to be built to house in the extra students and you may get more funds from the Central Government.

The economy of the UT - might improve ,More med students will be eating out and going to Ratna and use the 3 wheelers. However I am told that since our days students have a lot more expendable cash and own their own mobikes, scooter etc. Now that there are more doctors the rvenue generated may be more( remember most of the patients may not be paying)- debatable topic.

Fringe benefits - we may have a better team in Hockey, football, athletics and cultural program may increase.

Medical schools are very expensive to be built new, maybe enlargement of the current existing good ones may save the Govt. a bunch of money.


Can be a disaster if proper arrangement are not made to house this additional group ( as happened to few of us in the double batch) dissection room,physio lab, PSM, patient distribution, path lab and pharm lab, etc

PG seats may need to be increased / doubled to accomodate this increase ( though this is not binding),

You may need more Senior and junior residents to teach this additional increase in students size. I know how sometimes we were sent off as there was no one "free" to teach us. However there were some divine human beings " Bhatta, Deshmukh, RPS Andy Basu, Purnendu Roy ,etc. who took extra classes in the evenings. God bless your souls.

The mess needs to be increased in size too.

With the growing population maybe we need a lot of additional doctors. These are few of the thoughts , I am sure we can find several more.

Amit Ghosh

-- Anonymous, April 05, 1999


I think that there are multiple issues to evaluate when changing the number of MBBS seats is being considered.

First, what is the rationale? Does India/Pondicherry need more doctors? Do more people want to become doctors?

Second, would increasing the number of seats achieve these goals?

Third, what is the cost to the government, to JIPMER, to individuals, and to society in general when the number of seats is increased? [cost defined as direct and indirect costs e.g. hiring of more faculty, building more hostels, obtaining more lab equipment etc]

In response to the first and second questions, it is my impression that what India has always needed is a stronger and smarter political will to improve the existing infrastructure (clean water, sanitation, roads, housing, less pollution etc) rather than more doctors. If anything, more nursing and paramedical personnel are required. Life expectancy and quality of life measures are not likely to improve with more doctors but may improve with improvements in public health and other preventive measures. On the other hand, more doctors are definitely required to perform basic scientific research on problems more prevalent in India. (Unfortunately, the MBBS is not basic research-oriented but almost totally clinical oriented- only those who do PG in physio/biochem etc do basic research which are usually not disease-targeted). Completing the answer, I again do not think the number of seats should be increased just because more people want to be a doctor. Sure- everyone wants to be a doctor or engineer- what would happen if everyone got their wish? People have to realize (get career counselling in school) that there are many other things one can aspire to be- a business entrepreneur, an astrophysicist, an architect, a physiotherapist, an audiologist etc. The answer to the third question requires a formal feasibility survey to be carried out by JIPMER administration, if they think the issue is so important that one is indeed required. I think that an increase in class size to more than 70 or 75 would make classes rather impersonal as lecturers would not be able to give personal attention (beyond a critical limit of about 70, individuals may blend into a homogeneous crowd).

-- Anonymous, April 07, 1999

Ambal makes some excellent points. The staff ought to come up with what their threshold of acceptance it. However the decisions to join either a medical school maybe more complicated. A complicated set of decision making goes on in the + 12 phase of ones life about where one wants to go. Given the economic uncertainity of professions like music, mathematics, politicals science, playing basketball many families decide that a strong foundation of good education would probably end up in a stable ' economic future' ( from personal experience I must say i am happy I am a doctor and not a technician, without any offense to the profession , I just like the economics of the former better). While problems more global in nature safe water supply, good roads remain of consumate importance, good education seem to equally important. Medical schools with large number of students MAMC, LHMC, Calcutta Medical College ( over 100 students) have produced very bright graduates who are doing very well when tested in national competitions ( PGI, AIIMS, All India Entrance), which indicate that increase in the number of students will not affect the quality of atudent as long as they are appropriately selected into the medical school. Our double batch did very well despite the intial attitude of " thera ka hoga kalia/samba" of few of our seniors. Students who are intersted and unable to get in , have several second choices in their lives.Some of the more fortunately ones end up in privately owed medical schools. From my experience despite the initial desire not very one is interested in becoming a doctor or engineer, but those who very seriously are should atleast be given a chance. One has to weigh the reality and feasibilty of JIPMER increasing its seat. There should be a debate in the JSA, JDA, staff and the management. Of course we will put our 2 cents worth, being an alumuni. Cheers.

-- Anonymous, April 07, 1999

The success of any industry is judged by the quality and quantity of the products it churns out and any increase of these indicate growth. Therefore PLANNING to increase the seats is a step in the right direction.

The ideal way to bring about this change is to send in a team to assess the available infrastructure and bring forth the changes required to meet the challenge of the increased seats without affecting the standard. This may mean more space, manpower, funding and much more. Is the center prepared to do this?

I don't think so.

The likely events of occurrence is that the seats will be increased with some piddly / attempted changes in the infrastructure. The staff will have to struggle with the meagre resources and this is bound to strain the staff-student relationship. The initial results are bound to be reasonable for I am quite confident that JIPMER will rise to any occasion. But in the long term, it is bound to lead to de- recognition scandals and JIPMER will be looked at in poor light.

JIPMER definitely has the potential to take in more students. It is truly a great institute. I would like to see changes without any affect on its pride and glory.

-- Anonymous, April 08, 1999

As is typical of JIPMER alumni, we are actually getting a serious debate on whether more seats would be beneficial or not.

Pardon me for being cynical. One of the things I have learned about my own country after living elsewhere (initially mentally, later physically) is that education is big business.

If JIPMER has more seats, local politicians would like to control a few seats for the following purposes:

a) A single medical college seat can be "sold" for a large sum of money - like 25 Lakhs ($60,000) in case anyone has forgotten.

b)Some seats are given as favours - because a "doctor" means great prestige in India - more than we can imagine from our narrow academic experience.

If JIPMER doesn't get more seats - you can be sure that another medical college will pop up in Pondy sooner or later.

Incidentally I know a young man in Bangalore (and I know his father too) who got a seat in Ramaiah Medical College Bangalore for 20 Lakhs. When people are offering such sums of money, who cares whether India or Pondy needs more doctors or not.

-- Anonymous, April 09, 1999

I agree with Sastry, about the trading of medical seats for favors and other things. The important thing is that do you need another medical college in Pondy. JIPMER could do well with the cash flow. I am told that manipal has been able to hire a lot of star faculty and has one of the best libraries in the country. So academics aside the economics of having seat " donation " types could be a bad idea. Even in US the rich and famous i.e., Tiger Woods gets admission into Stanford one of the toughest ivy league colleges where even the best brains have been struggling to get in. Why does it happen? Academic excellence is but only one criteria for a medical school's prominence. The other thing is " I know you are good , but do you have good connections." Even if we were to produce star students if they are not exposed to the " real" thing and the way medicine works in the country maybe we are not training them to be self sufficient. I thought we were trained more to be an idealist than practical to the existing situation at times. But then this is only my view.

-- Anonymous, April 09, 1999

Its interesting that Ghosh should mention Manipal. Manipal was the "mother" of all "donation" medical colleges, located in Karnataka - a state in which privat "donation" medical colleges are a dime a dozen.

When I joined JIPMER in 1972, none of us had a very good impression of the college in manipal because of its penchant for offereing medical seats for money. But over the decades, manipal has acquired respectability, and now ranks among the top five or so - but for every manipal, there are a dozen really worthless colleges, with plenty of rich students, but no staff and no patients.

I can, at reasonably short notice get a teaching assignment for one or two days a week at some of the colleges outside bangalore - so desperate are they for staff - never mind patients.

The joke about Bangalore is that if you have one spare room you can start a nursing college, if you have two, a pharmacy college, with three rooms you can start a dental college and with four, a medical college. This is not as far from the truth as one may think.

The idea of making big money out of education is spreading, and Pondy is sure to catch up, whther it needs another college or not. After all, they will say, its not for Pondy people alone - its for "all India" students and for NRIs.

-- Anonymous, April 09, 1999

Great to read the views of the students of a "prestigeous" medical college -- the views of those who are proud of their alma mater and are indeed privileged to be so. At the risk of starting a riot -- let me make a few observations. Chastize me if you please.

(1) How many of us sincerely believe that we would have been any worse as doctors had we graduated from any other medical college -- especially one which took "donations" for admission ?

(2) When I went to Bombay after completing my MD(Med.) at JIPMER I was working along with a lot of doctors who had done MD(Med.) from Universities in Maharashtra. Unfortunately MD(Med.) from any Univ. in Maharashtra was not at that time MCI recognised. That did not deter the interviewers for DM courses there from telling me that local students will get the first go at the seats. So much for being a JIPMERite.

(3) Talking of success in the profession -- I seem to read about the great achievements of about 4-5 Jipmerites from each batch. Is the average Jipmerite really that successful --- or do we have blinders on our eyes ? What is "success" anyway ?

So (and this is my opinion) what if some funds came in through the donation route ? Over the years (maybe a decade or two or three)-- with proper administrative decisions -- the med. school could then blossom into a center of academic excellence. Maybe staying a DGHS funded college has stifled the growth of Jipmer !

And what about "research grants" and the like. Oh ... that by itself is a whole new ball game.

-- Anonymous, April 09, 1999

Ashish makes some excellent points on how there is no real difference in the way JIPMErites are looked at in India, by most other graduates. Initially there is a very short awe but soon the whole thing fizzles to - " I have more contacts than you and may get the DM seat." i wonder if there are going to be financial incentives for admissions into MBBS why not JIPMER? even among the ones who cpould pay there is a merit list and the best ones( you could easily have some king of point system), or ones with exceptional talents , the Tiger Woods kind to get in. I dont think there is any objective data that if the number of students were to go up from 50 to 100 the performance in exams and others areas would go down from 100 to 50! Getting interested people i.e., executives, politicians ( why not, dont they promise better health and education), physicians etc into the committee and trying to make a workable solution may help in this issue.What do you think?

-- Anonymous, April 09, 1999

Deshmukh has come up with some interesting questions.

I think that most of us who joined JIPMER would have done well in any other college. Although at least some of us (including myself) tend to be a bit uppity about a JIPMER background, the fact remains that there are some very good people coming out of all medical colleges. But its a question of percentages per batch.

The rules in India do require that at least a proportion of students in "donation" colleges should be bright.(I'll say what I mean by "bright" in another message if someone wants.) The problem comes with the rest of the seats, - the chaff if you will, that are reserved for the really high paying influential types. These are the people who fund a lot of the medical colleges infrastructure, but in addition, they also fund the individual sponsors and supporters of the private medical college - and this is where the corruption and decline comes in. Merit and capability take a definite back seat and everything, from staff appointment to exam passes requires an exchange of money, and possibly other riders such as caste and community.

If the situation were as simple as "donate, get a seat, get a good education and leave" then there would be fewer questions raised.

The comparison of the success JIPMER graduate vs other college graduate is difficult to make as is the definition of success. There are very very few JIPMER graduates around. From the 40 batches from 1956 to 1996 we get approximately 3200 alumni (@60 per batch). This number is miniscule compared to the numbers coming out of other colleges - especially the older reputable and established ones such as Calcutta and MMC. When I last read some figures about this (about a decade ago) India was producing 13000 medical graduates a year. A safe all India assumption of 7000 graduates a year from 1956 to 1996 would put JIPMER graduates as about 1% of all doctors in India, and none among those who joined med college before 1956.

As I have pointed out elsewhere JIPMER graduates do find it difficult to settle in practice in India (IMHO) and their main escape route is to go abroad.

There is no problem in having "donation seats" in JIPMER. IMHO this would merely decrease the percentage of "bright" students, but increase the percentage of students who would go on to become hospital builders and decision makers. Just my thoughts.

-- Anonymous, April 09, 1999

First a question to Deshmukh, "would you have been able to get admission into JIPMER if the seats were offered for money?"

I am sure most of us would not be JIPMERites.

Capitation is as bad as reservation. It is superselective.

Again there is no worry about capitation students, as when they graduate from JIPMER they will be incapable of practicing anyway! They will soon learn to seek other institutions.

-- Anonymous, April 10, 1999

It is difficult to give a straight answer to Chandu's question asked of me. Suffice to say -- "Where there is a will, there is a way". Maybe I would not have been a JIPMERITE -- but does that translate to my not becoming a doctor ? Maybe if I had done my premed in Delhi I could have tried for a med school there. (Remember we had our school leaving after Std 11 and then had to do premed in Delhi/Bombay etc.)

But that is beside the point. The point I was trying to make is that life outside JIPMER is so competitive that just being a JIPMERITE is usually not enough. I suppose the "double batch" is lucky in a way that they learned this early enough. Ghosh -- were you guys taught any lesser because of your larger number ?

Raising the number of seats per se should not be a problem. Maybe autonony would be a pre-requisite for that, so as to avoid MCI guidelines etc. Dinker / KAN --- What does the faculty think of that ?

And Chandu -- Does one become a bad student just because he is able to pay for his education ? You should look at the college fees in the US -- nearly everyone seems to be on education loans.

-- Anonymous, April 11, 1999

I agree with Asish that just becuase we were in the double batch , we were not taught ant less. Am I less smart because I was in the double batch? Hell no, I was dumb even prior to joining JIPMER. I also agree that just by paying money for admission doesnot make you an automatic doctor. You should not however have oaid money to pass the MBBS. If that happens then we ought to see where we are wrong and whom to blame. Seats are reserved in different colleges under different names/quota's , but my experience has been that there is also lot of cpmpetition for these seats bringing the best from everywhere. I think there is no harm in increasing the seats, provided the ground work is solidly performed and the criteria's for selection is known to all. Realistically thinking a dying or sick person doesnt give a squat if you are from AIIMS or JIPMER or from Manipal if you are not able to help him. There may be more than a name to succeed in life. JIPMER by percentage produces many more stars maybe but as Sastry points out we lose them most to a foriegn country. Maybe more benefit would be done if other's students , sponsored from State, donation etc. would serve the country better by staying back home.

-- Anonymous, April 11, 1999

I agree,agree, agree,that money need not necessarily mean bad doctors. But it is a question of affordability. It weeds out many genuine aspirants. It is like having a private treatment. Do we treat non-private patients badly???!!!

With no insult to anyone, atleast during my time, private seats were sought by those who could not get into other colleges by merit and also by those who wanted to make a business out of medicine. Again generally, 'plenty' of money and good academics do not marry well as there is no need for that in most situations. It is simply translated into more money. Do we need to encourage this?

Increasing seats should benefit the public at large. This can be done with increased government funding. All we need is, to do an Oliver Twist, many times over. We have learned from the past that if we compromise with the government, we lose.

-- Anonymous, April 12, 1999

Chandu is dead right about the true relationship of money and seats in Indian colleges. It is a sort of "black market" in which the person who cannot get the first set of seats on merit tries to get a seat on the basis of state or caste, and when all else fails, money will buy the seat.

Admittedly, given a number of people with loads of money for donation, only the ones with the best academic record will usually (but not always) get in.

However, many people whose academic record is good, and often better that the donation category students, do not get in because they cannot afford to pay the money. So, essentially, the best don't get in, though those who do get in will be claiming that they were the best five years later.

The system says, even if you have brains, you'd better have money. The more money you have, the less the brain power you are required to display.

-- Anonymous, April 12, 1999

I think a lot of ex JIPMERites will probably go through a fit if admissions in JIPMER were to be made by capitation. This would be against the code which the founder fathers envisioned for JIPMER. However, were they really rigid in their original planning, when they decided that only 60 odd students would be enrolled? Maybe they were, and wanted to keep it that way.

Imagine if other elite institute's AIIMS, CMC were to also decide to increase their seats will the respectability or craze of getting into these places be any less!

I am told the the craze of IIT was so much that they built a new IIT in Assam ( am I right ?!) to accomodate more students. Ofcourse the students have their heirarchy of selection as we all did during our times. I think the main problem in increasing the seats is not in just quantity and how do we handle the increased load of smart kids, but how do we assure that the quality remains equally good. I guess having a fairness of selection could ensure this point. I don't think a lot of alumuni would really appreciate if the increased seats were all to be alloted based on some 'ill defined criteria' - like the minister's quota.

As I donot see any discussion from the current JIPMER faculty I get the feeling that maybe the increased seat issue is not currently being pursued actively in JIPMER, or is it?

-- Anonymous, April 12, 1999

Looking back at KAN's letter, it is clear that the faculty is not in favour of any increase in the number of seats. Can the board know what the 'official' reasons mentioned are?

From the review of the letters am I right in saying that the alumni would favour a practical increase in seats only if matched by appropiate changes in infrastructure and that we are opposed to any move to commercialise medicine in JIPMER? Also, autonomy is a non- viable option due to major financial and political implication ?

If the faculty is agreeable, can I suggest that someone write, on our behalf, to the institute or to the government expressing our concerns. Would that be reasonable?

-- Anonymous, April 13, 1999

"Looking back at KAN's letter, it is clear that the faculty is not in favour of any increase in the number of seats. Can the board know what the 'official' reasons mentioned are? "

I don't know any "official reasons" and I'm not a member of the staff at JIPMER, but it is not difficult to guess what is going on.

Some local politicians are clamouring for extra seats which they can control. It will suit them and benefit them either financially or in terms of influence or votes.

Getting students in would be the first step. The next step would be pressure on JIPMER staff to pass certain students, and this would include financial incentives to a minority of staff who might be amenable. Anyone opposed to such pressure would be hounded out by physical threats or transfers ar other unpleasant actions.

I doubt if any JIPMER staff would dare to speak this out openly on the net, and I cannot blame them. They are just doing a good job - as they have done for decades. The crisis and threat JIPMER faces is now from local politicians and some of their cronies within JIPMER.

-- Anonymous, April 13, 1999

Kudos to Sastry as he tries to explain the motives of increasing the seats. It would be absolutely devastating if the motives of increasing the seats were to satisfy the " academic" needs of spoilt offsprings of some of the highly influential , lot of money, big political clout kind of people, whose aim in life is to get their kids someway in a reputable med school so that they can brage in a party - " My son / daughter/ significant other is a genius he/she is in JIPMER?" We stand behind the faculty in full strength in their effort to stop this exploitation. JIPMERites have for long been a very strange group. Most of them are really cool , you could at any time find them wearing some really cool dress ( used to be lungi during my times- we used to call it L/2, as it was usually divided in half in the middle) talking about cricket or others, but the same person could rattle away 25 causes of diarrhea when faced in battle situations like tests. A calm appearance of JIPMERites may be mistaken by the uninformed about the real firmness of purpose which these individuals possess. Trying to change this equilibrium with a set of individuals dubiously selected could set of a serious Brownian movement of unrest. We stand behind the excellent staff in their decision as we know it will be in the proper interest of JIPMER.

-- Anonymous, April 13, 1999

Amit Ghosh says:

"We stand behind the excellent staff in their decision as we know it will be in the proper interest of JIPMER."

Chandu says: "If the faculty is agreeable, can I suggest that someone write, on our behalf, to the institute or to the government expressing our concerns. Would that be reasonable? "

Both are dead right, and I think those of us who are concerned should do whatever we can to influence opinion. Few of us are in "influential" positions, but we know or are related to people who can make a difference.

May I urge that we spread the word around so that we can ultimately make that difference?

-- Anonymous, April 13, 1999

Thought process of a JIPMERite -- (differing opinions welcome)

Pre Clinical Years -- Great ... I am now in a medical college. Should try to settle in. How great it would be to transfer to a college in my state ! After all I would be close to home and maybe I could work out some good contacts for my practice.

Para Clinical Years -- Hard luck .. the transfer option did not work out. Anyway I have settled down here -- "Home away from home"(maybe with a few romantic attachments etc.) Must keep my sights on a PG seat.

Clinical Years -- Ah ... the slog years. Well -- at least I have selected my PG choice. Hope it works out.

Internship -- I'm a DOC now. Must get a PG somewhere. Luck there are a few All India quota seats which I can try for. It would be great if I could get an institution where I could do superspecialisation.

Post - graduate years -- Thank God I got the subject of my choice ( or -- thank God I got a PG seat). Next step -- possibly off shore bound.

Why is it that we keep reading about lack of research opporunities and lack of super specialization academics in Jipmer in the same breath that we read about why the financial base of the institute should not be broadened. I think it is foolhardy to continue to depend on the DGHS for funds when we have seen over the years that they are preferentially given to AIIMS Delhi and PGIMER Chandigarh.

What would the Institute lose if we had say 150 seats -- 50 % paying seats and 50% merit seats. That way the paying student would be subsidizing the merit student. Once in the pool then the forces of competiton will take over and the better student will progress faster. It will of course depend on the integrity of the faculty to see that merit is rewarded.

BTW -- do we have any MNAMS slots for medical / surgical specialities nowadays at JIPMER ? These could at least offer some solace for the lack of DM seats.

-- Anonymous, April 14, 1999

I am not sure if Deshmukh is just opposing to non-increasing of the seats or wants a re-discussion on the whole issue?

Half the seats for money and the other half for merit? Not a good idea at all. It will be difficult to bring them together on the same platform. Predictably, a 'Berlin Wall' is bound to develop. JIPMER is esssentially a bunch of ordinary, largely middle class, people and the arrogant affluent heads have never been allowed to rear. And as Shastri rightly explained, money will be changing hands in such ridiculous ways that the so called better-halfs cannot but drop their chins and watch. Deshmukh, can't you see it destroying the unique harmony, oneness and simplicity that is characteristic of JIPMER, and I'm sure you don't want that? Again you know the now international reputation of Indian bureaucracy and politicians.

-- Anonymous, April 14, 1999

What is the "ideal" number of students per batch in a hypothetical "ideal" medical college?

Does the staff-student number ratio have any bearing on the quality of teaching?

Does anyone have any insight into this from experience in other Med Schools in India and the US.

One thing I always felt about JIPMER (but have no proof) is that the undergraduate quality is very good, and this indirectly raises the PG standard by putting preeure on them (eg. student knows Harrison by heart and gives a hard time to a PG with a hangover)

I know from the experiences of some of my friends that when they do an MD in a place with DM their training and experience in some fields - eg cardiology may suffer. There may be some plus points in not having DM/MCh seats.

Comments please

-- Anonymous, April 14, 1999

The staff to student ratio does matter in determining the effectiveness for your education at an undergraduate level. MCI can decognise an institution if the quality of education is below par. JIPMER students have been selected by rigorous tests and ususally a top class, so even with variable levels of teaching they might do well, but does that equate to the fact- " since you are good lets us compromise on staffing quality!" Small group hand on teaching are far more effective tahn didactic lectures which often are boring. I can still recall several of the back seats were reserved for a good afternoon nap during these sessions. Regardless of the notes one ahs to read the books anyway. How often have we found the small group clinic exercises most useful. Being the site coordinator for medical students I have found that students in Minneapolis adore small group teaching. I can do the acid base/fluid electrolyte lectures and keep all of them awake! A work shop in Evidence Based Medicine which I attended in London reinforced the same principle. A lot of us were talking and tackling difficult issues in a period of weeks, where prior to the small group sessions we had great difficulty in perception.So the faculty/student ratio is very important. What we are all arguing is about the right balance of criteria's for admission without really jeopardising the spirit of JIPMER.Quality control is of utmost importance, as long as we can maintain that, increase in seats would probably not hurt JIPMER.I unfortunate thing which comes about in an Institute with multiple admission criteria's is the labelling effect of different quota's which create uncalled for reactions in students. Would capitation add fuel to this growing discontent? What do you think Ashish?

-- Anonymous, April 14, 1999

Yes, it is true. Numbers do matter and the ratio is all the more important. But somehow because of the high population in India, the ratio of students to staff has to be high and the quality nevertheless assessed. I do remember a discussion I have had,long ago, with a friend from another college. He clearly thought that JIPMER's high standards were due the small intake of students. I did not disagree then, but definitely there are other reasons too.

Again with the introduction of the time-bound promotions, every department is found to be flooded with professors. The professor/student ratio must be the highest ever :-)

Ratios are not uniformly important. They do not matter in the lecture theatres, as those who want to sleep will do so anyway. Lecturing to small groups in India is out of question. It however does matter for practicals and clincals. But rescheduling the practical/clinical rotas should not be very difficult. It may however mean that the staff may have to cover the same topic several times- can be a bore, but it is what teaching is all about. I am sure that the JIPMER staff will find a way around this. They have always done.

Shastri's point about DM is well taken but there is another side of the coin. Having a superspeciality in the hospital automatically calls for improvement in facilities and widens treatment options and therefore offers better exposure, which in itself can go a long way. How many times have we read about a treatment in a book but been unable to follow?

-- Anonymous, April 14, 1999

It is true that if the medical school has DM course the MD are probably better trained. They may not end up doing as many cardiology procedures but the exposure to several different diagnostic and therapeutic modalities is really mind boggling. One of the excellent things which happen in these institutes is that the student get to learn from individuals who are so called " gold standards" in training DM's etc, thereby very complex issues are often made realitively simple because of repetition and application. Though not a context of current discussion " time -bound promotion", though are very satistactory to several staff may still require intense internal reevaluation at the level of the Head of department to maintain a high level of proficiency. Some institutes have different criterias i.e, publication, student teaching, clinical activity and productivity as some of the criteria's for staff efficiency.

-- Anonymous, April 14, 1999

Sorry if I rekindled the discussion during "closing statements". I somehow feel that in our affection for and enthusiasm about our alma mater we are not being objective in our assesment of the situation.

Jipmer is a closed homely society -- basically with people of "middle class" origins -- and as long as we are there we strive to maintain the status quo. After having been away from Jipmer since the first week of April 1987 (12 years now) I am beginning to reasses what that tranquility has done to our psyche.

Amit -- I agree that stratification of the students based on admission criteria could be detrimental to interpersonal relationships. The thought originated from a step taken in a few colleges in India so as to allow donation seats while at the same time not compromising on the number of "merit" seats. There must be better ways of doing it.

MD - in today's day and age - has lost its stature in many of the cities of India. There are really too many DMs around for any MD to feel comfortable and required. What with all the Ayurvedics, Unanis, Homeopaths, compounders etc referring cases direct to the DMs !

Are we fighting the move towards autonomy or towards a seat-increase just because it will cause an upheavel in the situation we have learned to adore. Maybe we will all be happy if the whole issue was just postponed to another generation. That I think is just one way of avoiding the question.

-- Anonymous, April 14, 1999

Maybe I am being naive here, but why should there be an increase in the number of medical students in Jipmer? India already produces far too many doctors of variably dubious quality, so much so that even essentially average ones from places like Jipmer run the risk of being mistaken for geniuses. The government should reduce the number of publicly funded medical seats and cut down on the expenditure of training medics. The money is beter spent training more paramedics, nurses and midwives, improving their salary and career structure and retaining, rather than creating, more doctors.

-- Anonymous, April 15, 1999

Way to go .... Rajneesh.

That is exactly what is hapenning in the US now with Physician Assistants, Nurse Practitoners and a host of Technicians (handling various machines which they cary around from hospital to hospital to be used as needed - presently I fall into this category). Three cheers for CLINICAL MEDICINE.

Unfortunately (?) the government does not have the teeth to reduce public funding of medical education -- and let me remind you that there are really very few Central Government funded medical colleges around. Most of the rest are privately (which means what ?) funded and are effectively outside MCI control and regulation as even though the degrees of such doctors are not nationally recognised they are allowed to practice and compete for higher (?) education within their state.

We have had out good times at JIPMER .. we are happy about them. What we are discussing is the necessity or otherwise of changes to keep up with the times.

-- Anonymous, April 15, 1999

Good question! But first of all, do we have a paramedical system in India? Ambulance services are run from hospitals and the members of the mobile team are selected from the available doctors and nurses. Improvement of this paramedical system will automatically call for more changes including improved roads, well-controlled traffic, better hospital support and ofcourse more doctors and nurses. A whole new world that India can ill afford. There is a definite need for more trained nurses and in-hospital staff. But if the government can only make dubiously qualified or at the most average doctors, it is difficult to be confident that public money will be well spent in training the nurses and other categorial staff either. I think in India, private institutes are largely responsible for the dubious quality of doctors (mostly due to insufficient clinical exposure and narrowed interests). These institutes came up in the first place, because of the increase in demand for doctors. Reducing public-funded medical education would only encourage more of such institutes and will therefore affect quality further. Increasing the seats of reputed colleges will help in quality check.

If you ask me, hospitals all over India need a thorough and rigorous assessment by a dedicated team and more importantly a sincere quality control(a real Herculean task) by the state and money spend on it will be money truly well spend. The rest of the problems of numbers and brain drain will automatically sort itself.

If the idea is to save public money, is there an argument for reducing the duration of undergraduate training period? Do we have to spend >5 undergraduate yrs when postgraduate training is available?

-- Anonymous, April 15, 1999

I agree with Chandu. We cannot automatically tranfer the information of what is happenening in the West to India. Apart from problem of transportation, just imagine we are discussing the quality of doctors being produced then imagine the quality of the hospital aides?! I do think that we still need the 4 yrs of training. The internship year can be scrapped if students are allowed to take in calls from 3 and 4th yr. I must admit that a 3 rd yr student in US probably may have more maturity in handling cases though may lag behind in rattling out 25 causes of clubbing. However this calls for a global change in the way medicine is taught and evaluated and maybe the right system in India. I have realised Ashish's sentiments that in JIPMER we have remained idealist ( probably for a good cause), but you step out of Pondy and things look different. The students in JIPMER seem to be nested and protected from the ' other way to practice medicine' which is prevalent and does that decide our future decision to stay back? I probably doesnot.There is a need for change.

-- Anonymous, April 15, 1999

We must qualify 'change'. Increasing the number of seats should produce only statistical change and nothing else. We however need to be sure that it will not have a long-lasting effect on the quality of the graduates produced. IMHO, there is no need for any radical changes, for, these may not have the desired impact. JIPMER graduates are arguably not the best, but I think they are suitably prepared to take on the world unlike most others. Besides being unfit for private practice ( which I think is not entirely true ),they seem to smoothly fit into most hospitals in and out of India. This seems to be because we have the theoretical back-up knowledge which can quite easily be translated into effective practice in suitable situations. Ofcourse not everyone performs / achieves alike and it would be unfair to blame the Alma Mater for it. Again it is everyone's prerogative to chose to stay back or go abroad and JIPMER provides that. Should we change that?

-- Anonymous, April 17, 1999

The decision to stay back in India is ofcourse every individuals decision. However for an average middle class person moving out of the country is bound by several reasons. As in my case it was many for personal reasons both in the form of' professional satisfaction and economic reasons. I had got a DM in Nephrology from PGI Chandigarh and having been blessed with middle class poverty from my parents was making a messy 7500 rupees as an Assistant professor in PGI. Fortunately my wife was a staff too and our combined salary was decent enough that we could maintain a Priya scooter and a Luna moped and stay in a rented house.There was also the big hurdle of professional stagnation. I am sure for most of us these were the same reasons. Love and loyalty to ones' country is a necessity, but you need fodder to sustain your family and self.Does the CGHS or Government realise this. Also a lot of JIPMERites want to teach and be in academics. I was told of the story of a very senior prof in surgery who had to wait till retirement to build his own house! Is this the way we reenumerate our mentors and teachers. I am told that the poor Professor had a MI during this process, during to increased strain.There has always been a subtle critism of people who are abroad and who should probably not worry about India and JIPMER. You know that sentiment is not right. There are reasons why every one makes a career choice , but still for every JIPMERite there is that one spot left for JIPMER which always brings happy memories. Change is good, it needs to be organisational, professional and also in personal attitude.

-- Anonymous, April 17, 1999

I may be wrong here, but I get the feeling that the education system in India is somewhat like seed dispersal in which enormous numbers of seeds are thrown into the wind in the knowledge that a few will take root. Large numbers of graduates are churned out making India a country with the third largest pool of "trained manpower" in the world. Undoubtedly many have to go abroad to make a decent living, but some do stay here, and others may return.

I am not at all sure the process can be called "brain drain". It is dynamic, and constantly in flux, with people going out and coming in all the time. Those who do go out are a sort of resource, that is tapped on a regular basis. Perhaps the system does work, albeit in a strange and uncontrolled manner.

Just my thoughts.

-- Anonymous, April 18, 1999

Does India really need more doctors? If you factor in the population, the size of our patient population, probably we do. However as Ashish pointed out earlier a lot of the problems could be managed by a properly trained individual who could practise within the boundaries of his knowledge and limitations. There are still several places in Bengal were a well respected individual is the expert in the management of several conditions.

However with the growing knowledge base and TV customers (patients) are more picky and ready to pay big price to see a " foriegn trained doctor" or " Real cardiologist not just an MD" (personal experience during residency). So we really are at a lose of generalise whether there should be mushrooming of more medical schools or the existing ones make a 10% increase. In US where there is graduate funding lots of residency programs have cut their seats by 25% to avoid " physician surplus", as a lot of physicians trained in US donot leave US, however can we apply the same knowledge to India where over 50% physicians trained in the big 10 medical colleges leave India probably for good ( Check out the list of JIPMERites abroad in Shyam's site, also CMC, St Johns PGI and AIIMS not to mention a lot of others. Just my observation.

It would be very valid if if had information of how many graduate and how many of these candidates are in India after 3 to 5 yrs.Are they leaving for higher education, economic reasons, stagnation, lack of jobs or do they feel that they just donot fit in? What are we really doing to get these people to come back?

-- Anonymous, April 18, 1999

I think the problems regarding getting doctors to work all over India result from:

1) No law can stop doctors from working anywhere they want in India. 2) No law can prevent them from emigrating if they wish.

I cannot foresee any change in this because it would impinge on fundamental, constitutionally guaranteed rights.

Most doctors who go abroad and return tend to return and work in the big cities and towns serving less than 20% of the population - and in the big cities the doctor-patient ratio is very high - as high as that in developed countries.

The smaller towns and villages, where medical services are available at all, are covered by the "ordinary" MDs. I think that one of the problems we face (unwittingly) as Jipmerites is the perceived need to keep competing to get a higher and higher education - MBBS, MD, DM and perhaps a PhD on the way like some. The value of a "mere" MD goes unrecognised.

The vast majority of patients in India who have access to medical care are being cared for by MBBS or MD or DNB level people. I got some first hand experience of this (as flak) when I wrote (and had published as an "editorial" in the JIMA) an article in which I argued that the General Surgeon is a dying breed. There was a lot of feedback, and the letters from the rural surgeons of India were a revelation to me. General Surgeons and Physicians and MBBS level doctors seem to be carrying the greatest burden with regard to the provision of medical care in India.

This is not to say that those who become super-specialists have no role - but their role is necessarily restricted to geographical areas in which infrastructure for their work is available - which in plainspeak means big cities. The same can be said of those who return from abroad. And it is not as though there isn't anyone coming back from abroad, The pressure in the cities is intense with the best of the locals competing with those who are freshly "foreign returned" for jobs, placements and patients.

I think the "powers that be" have taken the attitude that if you increase the number of medical graduates by allowing private investment in new medical colleges in peripheral areas with a quota for local people, there is a greater chance that local graduates will ultimately opt to work in these medically underprivileged areas. If these multiple colleges lead to an excess of doctors, the effect of this excess can only be beneficial to the population - though detrimental to the doctors themselves. In any case the "excess" is not a problem for a medical college or the country as a whole given the current demographic situation.

I quote from the 1995 edition of Park (P&SM - not Park & Park - for one Park is dead)

The overall health care worker(doctor or nurse):population ratio in India is better that the recommended 1:3500 to 1:5000, but there is gross maldistribution with the ratio being 1:13,000 to 15,000 in Karnataka and Kerala which are relatively well developed states.

The hospital beds per population ratio in India varies from 1:286 in Pondicherry to 1:2483 in MP.

The conclusion from such statistics is simple. India needs more doctors and nurses. The problem is getting them to be where they are needed most. As doctors, most of us use every iota of our intellectual capacity to get away from those god-forsaken areas of India where doctors are needed most, but where no middle class, city bred, bright graduate in his/her right senses would want to go. Can't blame them. If you graduate in Information Technology you can start earning $60,000 a year at age 22 - unlike the Rs 1000 or so a month that house surgeons earn at that age.

-- Anonymous, April 19, 1999

I like the seed dispersable theory of Shastri. It nicely describes the educational system of India. However the seeds need to be good, well selected and well-trained to bear fruit.

I would like to discuss the options taken by JIPMER graduates?

From experience, I can only think of three ways they go: 1. apply for postgraduation (MD/MS) 2. apply for postdoctoral degree (DM/Mch) 3. sit for overseas exams

But what are the possible outcomes? 1. get postgrad degree 2. get postdoctoral degree 3. go abroad for training. 4. failures

what are the options for 1 and 2? 1. join as senior residency and patiently go up the ladder 2. join as senior residency and leave after completing 3 yrs as a security in case fancying a teaching job later. 3. join a nursing home as a consultant 4. start own practice 5. sit for overseas exams for "higher training"

What are the options for No.4 ( those who fail to get a PG/PD/overseas exams ) 1. join state / UPSC service 2. join a nursing home as medical officer 3. start general practice in home town / village.

What happens to overseas trainees? (I can tell you what happens in the UK) 1. join as SHO 2. if lucky get into type 1 rotation SpR, leading to CCST, and eligiblity for consultant post. 3. get into type 2 rotation as visiting registrar, no chance of becoming a consultant. But can become a staff grade (permanent middle grade post). 4. return home with degree and money. Options being to join nursing home in big cities, or to start own practice in cities / towns(unfit to go to villages). Some return to academic careers especially in private hospitals.

As you can see there are plenty of options( as is typical of the vast country that India is) but as one goes higher in academics the options keep narrowing down. Why is this so? One naturally expects to be at an advantage with more degrees and experience.

Government jobs provide moderate remuneration and secure job, but post grad degrees are not given their due merit, causing plenty of frustrations.

Private practice is tough and back breaking, uncertain but exciting, and money can be very good. But unfortunately not everyone achieves success. It often needs a high capital and family life can also suffer.

Going abroad is the best option. Passing the exams is the only hurdle. JIPMERites are good at that. There is plenty of money, prestige and fame for the loved ones back home and a foreign degree which the Indian people value more than the much more hard earned and most-of-the-time better quality Indian degree(s).

But the problem of returning to India is the limited options available. Also, the children do not seem to fit in, having to learn a second language, getting used to different teaching system, crowded schools and hustle and bustle of everyday life with the imminent dangers of accidents and diseases. I know I sound a bit silly, but such is the protected surroundings that the children starting their lives abroad are used to. I also agree that they are adaptable, but somehow I feel it is too much to expect them to do so. But what hits one the most is the corruption at all levels. This is the one single deterrent to anyone's decision to return to one's homeland. But those who do so are the ones : 1.with family committments 2.homesick and wary of foreign lifestyle(esp if they have daughters) 3.who have a proper base at home (nursing home etc., good job waiting for them at home) 4.the less fortunate, who would have liked to stay but have been unable to get a permanent job. (it is becoming difficut to getting jobs in UK).

As you can see it is a complex problem and which segment do we address? With the uncertainty at the government at the helm, who would even dare?

-- Anonymous, April 19, 1999

Thruth hits you right in the pit of the stomach and is hard to digest. This has been so beautifully presented by Sastry and Chandu Prassanan in the previous 2 messages. We all have to agree that when the dust settles down and we all have our full quota of degrees ( which does automatically qualify for being very competent), on thing stands in decideing where one would like to practise. Doctors like to have their life under control and the things which alter this balance deters their will to practise in a geographic location. Even in US it is difficult to find doctors to practise in underserved areas which is good for FMG as they can get a waiver job. It is for the same reason that a FMG will work in an underserved area but not work in Chatra, Bihar. Again the quality of life, economics comes into work. However getting seperate license for seperate state does limit the ability to move freely except in the VA medical system where you can get away with license of any state. It is going to be difficult for JIPMERites to stay in India for these reasons. UK is outright discriminitory, US is making the entry point all the more difficult and complicated. But JIPMErites have a lot of patience and grit and some connections and they keep on coming, they keep on coming. How can you keep these guys back when you cannot provide an honest living for the majority of JIPMERites?

-- Anonymous, April 19, 1999

Sorry, Sorry. Pardon me guys. I started the ball rolling but did not respond to all the comments earlier. Amit has really brought out some novel points in favour of increase in seats. Sure the JIPMER couples are quite a number. We could do with some more, and yes maybe we can have a C team in football. Why did I start this thread? There was pressure on JIPMER to increase the seats by 25 with this academic year. The modalities for making these admissons(reservations and the method of admission - remember there are 15 nomination seats) were not clear. Further, which was the group pressing for this increase. Pondicherrians, Tamil Nadu residents or others. Earlier statements about seat increase pointed towards a quota for TN & Pondicherry candidates. Now that would really alter the cosmopolitan fibre of JIPMER. So in this background the question of increasing seats is a clear NO. Is the faculty averse to increase? With the present infrastrucutre - Yes. Double batch - you did well. But The departments had trouble in ensuring that you had enough facilites. Many departments had to purchase microscopes etc in a hurry. Organising Ramnathapuram internship was quite a task. Though the seats were increased to 75 no expansion of the college took place. The institute has hit full capacity. The labs, dissection halls etc can at bst hold 65 students. Thanks to the system of additional batch we are managing. Any increase in the number of admissons will require an increase in the physical structure and an increase in the teaching faculty. And that's what we have replied to the Government. "Please allocate additional funds for correcting deficiences and increasing the infrastructure before increasing the number of seats". Only then can we maintain the student teacher ratio. I am purposely not mentioing about quality as that itself brings out the claws. A senior administrator of Pondicherry asked me - "So what's so great about JIPMER products?". I would like to feed him to you all. In the meanwhile plans are being made to increase infrastucutre Do we need the additional doctors? Who cares. Doctor Population ratio, jobs for doctors, quality of doctors - who cares. The need of the hour among the public is "My son/ daughter should become a doctor" (Read Shastry's story). We are fighting a losing battle. How to fund the additional seats. Capitation fee is not a good idea, though some, like Manipal have done well. A mixed system of capitation and free seats has its own problems as seen in several of the private medical colleges. However, there is need to increase the fee strucutre (IIT's have done it. In th IIM's the fee is nearly 3 lakhs). So why not JIPMER. Sooner or later we will have to revise the fees just for the survival of the institute. Unfortunately we do not have a system of educational loans, and scholarships are few. Maybe a corpus fund should be set up which will meet an enhanced fee for the most deserving or top ranking students. A fund of 7.5 crore would yield 1 lakh per student per year. This area needs to be worked on. Till then JIPMER Vazhgai

-- Anonymous, April 22, 1999

Hiking the tuition fees is a good way around the finance problem. But this is bound to raise the politician's eyebrows. Again the changes will not be automatically applicable to certain sections of the society. Also the funding @ 1 lakh per student, must be over and above the amount the government is already spending to educate a medical student? I was told at my time we costed the government 1 and half lakhs per head. It sure must be a lot more now. I think this should awaken a lot of NRI JIPMERites.

-- Anonymous, April 22, 1999

What are the current annual fees. Given the current market, inflation it would not be unusual to have fees as high as 1 lakhs in medical school tuition. Having lost proportion of the economy in India , I apologise in asking can a parent support 2 kids going to professional colleges on their salary. Alternatively students should be able to take loans from bank. It will probably make a lot of them take their med school very seriously. Imaging the amount that a doctor makes 1.0 lakh/ year should not be considered a huge fee. I know I have probably stirred some one to throw some punches at me.Good ahead .

-- Anonymous, April 23, 1999

There are a large number of people who can afford 1 lakh a year. The number of people earning 25000 + per month is large nowadays, and many invest in savings programs that provide for children's education in later years.

Nevertheless the figure remains a big one for many.

-- Anonymous, April 25, 1999

The crucial question is whether parents should foot the bill for children's education. This is a dilemna depending on whom you speak. In US it is customarily that the students foot the bill as it is impossible for any one to save for kids higher education. In Minnesota medical students (from Minnesota) pay $ 30,000 / year as tution out of state students pay $ 44,000/ yr. Obviously a larger portion of it comes out as student loans. Medical education is very expensive every where. Is it not possible that students take loan for education if the fees are Rs 1 lakh/yr. I dont think people would choke on a $ 6-7 lakh loan. Keeping education underpriced grossly destabilizes the market as realistically a lot of advances are not available. Also with fees as high as mentioned would automatically bring in other amenities like computer, internet and superior library and CD Rom capabilities. Medicine is an industry in US and physicians are commodities. If you generate more revenue you are entitled for a raise. A doctor with 1000 patients bring in a net worth of 15 million dollars / year of buisness, given the insurance premium od $125 a month on each patient .We have to think logistically and economic factors do play a role. Low medical education fees = poor facilities, which is in the long run unproductive and damaging to young bright minds ready to soak up as much knowledge as you can provide. Who would argue that medicine will become a less interesting career if the medical school fees went up. We need ways to fund the fees. What are banks for? We provided more computers bookmarked to EBM sites in our medical school. the enthusiasm went up and they selected me for the Minnesota Medical Foundation "1999 Distinguished Teacher Award". So much to show that technology and expertise can make students really interested in learning! Education does not come cheap, educators are expensive too. You got to pay your teachers hefty salaries comparable to what private practioner's make to keep in the good one as teachers.

-- Anonymous, April 28, 1999

It appears Sastry has a better footing in Community Medicine than me. Ravi (Rangachari) and I got the same feeling when he came home for dinner a few weeks ago. To quote Ravi "Under the facade of a happy go lucky person, he has a deep philosophical mind". He has identified the problems of the lopsided distribution of doctors. In fact in India the rush for MBBS seats is not based on needs of the society or the student. Often it is "purchasing" a status. This evident from the fact that in the last two years children have been shifted from engineering, veterinary and other courses to the newly opened Medical College in Karaikal eventhough the fee structure is high and the status of the institution is unclear. In this college there are 50 seats for Pondicherry. So 50+ 20 in JIPMER will soon halve the doctor population ratio. I wonder which category of Chandu's these will fall in. Somebody asked what is the fee at JIPMER. It is Rs. 250/- per year. With all other fees like JSA fund etc it comes to about 550/-. Kindergarten schools charge more than that in a month! The figure of one lakh that I quoted was an arbitrary one. Actually the expense will be much higher. Someone who has worked on medical economics could do the calculation. Last year the budget for JIPMER was 41 crores. You could just divide that by 75 and get a figure. A corpus fund would earn some money for the institute. Given the present structure, however, this is not feasible. After 18 long years and two revisions of pay I have reached a salary figure of 29k a month. Ofcourse 30% of that is taken back by the Govt. by way of taxes. Can I afford a medical college or for that matter any other top of the line institutions charging high fees? I wonder. In fact when my daughter was seeking admissions three years ago I was hard pressed to think of ways and means to raise her tuition fee for engineering. Luckily she got a scholarship. I may not be lucky the second time around next year when my son goes to college. If this is my dilemma imagine what about the millions who cannot raise this type of money. There is urgent need to set study loan schemes. A few years ago a student who had stood seventh in the school board examination and secured admission AFMC had to leave that institution as the Bihar board did not give him his marksheet in time. He later got admission in JIPMER. But he was unable to sustain himself and wanted to leave. But Jipmerites, what they are, came forward to support him and he has successfully joined the list of Jipmerites. I am sure there are many like him who do not get the required assistance. Hiking the fees would deny many admission to colleges, creating further disparity in the community.

-- Anonymous, May 04, 1999

KAN's recent letter indicates the difficulties faced by academic physicians in India. I agree that student loans should be made available. However the pay structure needs to improve so that the students can pay off their loans in a reasonable amount of time. With the college fees so low, you are just about providing the most effective medical education or are you bankrupting the system.I dont think students need to foot the entire expense in a Govt. sponsored hospital. There are other sources of fund including state subsidies ( TAX, electricity etc) donations and foundations ans scholarships. It is difficult even in US for doctor parents to completely support their children thru college and higher education if they have not made prior saving ( there are several options available). By a small amount of monthly saving one can come to an amount required by your kids in 10-18 yrs even after factoring for inflation. It is unrealistic for the annual college fees to remain at 550 rupees. I think the average cost of boarding and lodging in hostels every month must be around 2500 rupees now!

-- Anonymous, May 05, 1999

I cant see any need for an increase in seats in JIPMER- someone said that the quality of PG courses in Jipmer is indirectly considered good due to the quality of undergraduate training. I agree completely- JIPMER is an institute which has fantastic potential-the case material we get is undeniably exciting. Unfortunately we havent got even the basic resources to do an excellent job and I honestly feel that if we have to justify the term premier institute we have a great long way to expand. I have done my MD in Paediatrics in Jipmer and even then I remember the number of referrals- all Leukemias go to ICH, renal problems( including PUV) are transferred to Madras despite having a Urology department in the hospital, all major Cardiac surgeries were referred to Railway Hospital,Madras or Puttaparti, and tragedy of all-serious head injuries were referred to Dept of Neurosurgery.Iremember the number of Paed.Surgical patients dying after surgery, there is such a crying need for a proper Neonatal ICU that can provide state of the art ventilation, TPN etc, not to talk of adecent PAed.ITU. Iwonder if anyone else remembers the number of times we had to lie to the Anaesthetists that our child with Bulbar Poliomyelitis had Guiliian-Barre so that they would agree to ventilate them.What is really needed in JIPMER is a huge speciality and super-speciality expansion which does not have to come from incresing undergraduate seats but by taking in adequately trained people and creating the same now. I had a brilliant SR in JIPMER who would have been a dynamic boon to the department and Institute who would have liked nothing better than to stay but no-one had the enthusiasm to created a space for that person and there are many more such. As Rajneesh pointed out India needs much more input into paramedical forces. India already has 1:1000 doctors where the WHO only recommends 1 doc per 3000 population.We do not need more more doctors, but a better organisation of the existing ones.JIPMER was the third best Institute by recent assessment- we could easily be the best with a little more organisation and enthusiasm.

-- Anonymous, May 22, 1999

Thank you Suma for your candid observation and remarks on JIPMER. So where does it leave us. A perusal of the 2 colleges which are better than us indicate that these have superspecialisation, DM's and are automous. Too bad PGI Chandigarh never came in the picture as it doesnot have undergraduation and didn't count in the math. When we are talking about undregradate education yes JIPMER ranks among the top three. However looking back all the things which Suma said happened even when we were there. There were SR would be so bright that when they have finished teaching you , you feel that you have just seen a new " Star War' movie, but what did JIPMER do to keep these people going and enthused! With a library so disorganised , with career dependent on some interviewer in UPSC Delhi, the lack of autonomy and subsequent acceptance of mediocrity of medical treatment, these SRs were compelled to make a move to other parts of the world and have done well. Let's us be very honest. JIPMER despite ranking 3 for undergraduate education has less amenities to treat the very complicated and I can bet you that there are over 75 hospitals in India which have better facilities. All this stem from an acceptance for the ordinary , being complacent. I was told that the MRI was at one time sent away as some staff were not comfortable. Is that true? What then are we teaching our students. different than what we taught them 25 years ago. A good history and physical considered by all of us a every important compounded with technology and treatment facilities and saying that for 99% of cases the buck stops at JIPMER. Until that happens let's us not pride ourselves as number 3 , because it doesnt take long for realisation to set in! Bottomline if you want to get a good hospital you need money, autonomy, official who care and love to work with you and ability to attract and keep the star s SUMa said we should retain in JIPMER.

-- Anonymous, May 23, 1999

Pardon me if I've got the wrong end of the stick, but everyone's been talking about an increase in the number of seats as a function of staff, infrastructure etc.which can be improved only if JIPMER becomes autonomous. However, doesn't the student PATIENT ratio have something to do with the undoubtedly excellent undergrad training imparted at JIPMER? As I understand it, making JIPMER autonomous would also make it a paying hospital, like AIIMS & PGI. The average cash income of an agricultural family of 7 people, in Tamil Nadu and Pondicherry, was about 300 rupees (the rest of the income was in kind) in 91-93, when I was writing my thesis. Even if the income has gone up and even if they only have to pay for materials and medicine, would these patients be able to come to JIPMER? I can't really see clinical classes with 30 students to a patient doing much good to anybody.

-- Anonymous, July 21, 1999

Based on the much touted and now proved to be a fraud, the trickle down theory, the extra doctors produced are not going to stay away from the cities, middle east, europe and western hemisphere to move into the districts and villages.

The Pondy natives have by and large stayed around. One can't say the same of those from the north where the PHCs are lying empty.

If the idea was to give more reserved categories to get into med school, it would be fulfilled.

-- Anonymous, August 30, 1999

The question still remains whether one would stop increasing seats as doctors donot want to go to village. Pondy is a very advanced town and has all the comforts and should not be equalled to the PHC in North India where besides bad weather and mosquito's the physician might have to deal with lack of good school , sanitation , hostile crowd, etc. T he law of probability states that their is a greater chance that if you have more doctors , few will trikle in to the the PHC's we are talking about.It is some place to know why doctors choose to stay in cities or go abroad and I don't think greater legislation may not change that.

In US and UK, there is a shortage of physicians in the so called underserved areas. Thanks to our influx (FMG's) these spots are being rapidly filled. It finally boils down to economics. A graduate from AIIMS or JIPMER would still be very happy to go to these places in US than in a PHC in India, because at the end of their 3 yr period they see light at the end of a tunnel. I cannot say the same about a PHC in India. I may be wrong in thinking this way but I find it happening time and again.

Developed countries like Netherlands, Sweden have had an excellent ,medical system even in the most remote places. It is all a question of ' standards of living'.

My Professor in PGI used to say it is far more advantageous to train a sponsored candidate than an open candidate because in the long run most of the sponsored candidate stay back in India and serve their country while the so called 'open candidate' fly away! What is wrong with reservation if this is the case.

-- Anonymous, September 03, 1999

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