Medical students and young doctors are Dr Govinda KC’s most ardent supporters. But as Dr KC is on his 19th fast-unto-death with his usual demands for medical education reforms, young doctors and medical students are protesting against the Medical Education Commission (MEC), the apex medical education regulatory body in the country, which Dr KC compelled the government to form. The commission’s first Common Entrance Exam (CEE) scheduled for October 13 is now the biggest source of despair for the majority of doctors in the country as it cruelly discriminates between government and non-government doctors.
The National Medical Education Regulation published on August 10 reserved 40% of all post graduate (PG) seats for doctors working in government institutions including those working in contract. Another 10% is allocated to foreigners leaving only 50% of the post graduate seats in open category. Meanwhile, the Ministry of Health refused to issue no objection certificates (NOC) to doctors working in government institutions in contract to ensure that all 40% of seats is reserved for permanent government doctors. The Ministry is now threatening to withhold funds for post graduate education in public institutes if these reservations are given to anyone except their employees.
There are currently 150 odd eligible permanent doctors who can appear in the CEE this year compared to nearly 10,000 non-government doctors. The 40% represents 450 PG seats which means there will be three seats for each permanent government doctor (The unfilled seats reserved for government doctors will be passed on to open category). This regulation and cunningness of the Ministry of Health at behest of Government Doctors Association of Nepal (GODAN) has effectively reserved 40% of all post graduate seats to 1% doctors. This distribution is unfair, unjust, restricts meritocracy and will erode quality medical education in the country.
Policy Corruption
The regulation was originally slated to reserve only 20% of PG seats to government doctors, which would still yield one and half seat to each permanent doctor. However, with undue influence from GODAN, the bureaucrats at the Ministry of Health, who were involved in revising the regulation upped the reservation to 50%. GODAN is the official organization of doctors working under the Ministry of Health. Hence, this provision was effectively revised by the Ministry of Health officials to benefit other employees at the ministry. Some of us protested after their deceitful plan of 50% reservation was leaked to public. It was lowered to 40% and included the doctors working in contract in the reservation category after that. Dr KC on the 10th day of his current fast added increasing open seats to 70% to his list of demands.
Government doctors are some of the better paid doctors in the country with plenty of financial incentives and opportunities for growth. They are better compensated for the work they do compared to others. There is absolutely no justification for reserving nearly half of all seats in public institutions for government employees.
People get offended when public roads are blocked for a few minutes for VIPs. Imagine half of all the roads being reserved for vehicles of government employees all the time. This is exactly what the regulation has done to post graduate medical education. This is one of the worst forms of policy corruption in the country done merely to benefit a few government employees at the cost of damaging the entire health care system in the country.
Other issues
The notice issued by the MEC regarding the exam is mired with confusion. A doctor competing in the exam in the open category can earn up to 10 points prior to the exam if he has served in rural areas. This provision will definitely encourage young doctors to work in rural areas. However, the regulation published a month back hasn’t given doctors any time to earn these points. Hence, it is only fair to apply this scoring system a few years later.
The MEC has also kept the seat distribution of MD/MS seats a secret. The regulation dictates that 50% of seats be allocated to open category but it doesn’t state how this distribution should be done. Foul play is further suspected due to the refusal of MEC to reveal the seat distribution. The matching system introduced by MEC replacing the existing open house counseling is also receiving stark criticism for being prone to manipulation and helping unfair competition. The open house counseling, wherein the top-ranked got to select a program first followed by the second-ranked and so on, guaranteed merit-based selection of programs. MEC’s matching system will provide successful candidates the opportunity to select and prioritize 25 MD/MS programs of their choice. With over 100 different MD/MS programs running across the country the matching system cannot guarantee merit-based selection unless candidates are allowed to select and prioritize every single program.
Consequences
The MEC has been the biggest source of frustration for doctors ever since its formation. The regulation, and the flawed notice in the recent times has added further pains during the time of COVID-19 pandemic.
The massive reservation for government employees will stifle opportunities for others leading to doctors pursuing medical education and careers abroad. Even now hundreds of doctors leave Nepal every year pursuing education and careers in the USA and the UK. In fact the 100 plus Nepali doctors who matched for the US residency programs for 2020 flew to the USA in chartered airplane in June in the middle of the pandemic. A study by the Center for Investigative Journalism (CIJ) has found that up to 60% of doctors who had studied MBBS under government scholarship leave Nepal for opportunities abroad. Policies like this will push more doctors in that direction
As the merit-based selection system is weakened, the quality of residency programs in the hospital will be severely compromised ultimately resulting in poor healthcare services. Also, as government employees are given free passes to post graduate seats, it will discourage hard work and incentivize mediocrity ensuring government-run health centers will always remain mediocre.
If this crosses over to other fields, it will totally ruin academia in Nepal. Imagine 40% of all post graduate academic seats in all areas reserved for the government employees!
Way Out
The field of medical education has always been the go-to field for opposition of affirmative action. Reservations for post graduate studies makes little sense in any field. There should not be any reservation in Post Graduate Medical Education–neither based on caste nor employment.
A fair merit-based system will foster a competitive residency program which will strengthen health care services. The MEC should only go forward with the exam after correcting the unfair and corrupt reservation in the regulation. It should be done swiftly so that the PG entrance exams which have already been delayed for four months are not pushed back much further.
(The author has been working as a staff physician in Charikot Hospital for two and a half years)
