Tuesday, March 31, 2015

ESIC to run its existing medical colleges, says Labour Minster

Labour Ministry has decided that Employees' State Corporation (ESIC) will continue to run its four functional medical colleges at Rajajinagar (Bangalore), K K Nagar (Chennai), Joka (Kolkata) and Rohini (Delhi). 

However, the ministry has decided that ESIC will not to venture into the medical education sector and hence will not set up any new medical college in future. 

Besides, the ministry has also decided that ESIC will also make its eight under-construction medical colleges functional, which are progressing at different stages. 

"The Labour Ministry has decided to continue existing (functional and under construction) medical colleges. We will soon convene a meeting of the ESIC board to apprise the members about these decision," Labour Minister said while addressing a press conference. 

The ESIC in its 163rd board meeting held on December 5 last year, had decided to to exit from medical education, as it is not the core function as its core function is to provide social security i.E, cash benefit and medical benefit to insured persons under ESI scheme. 

Explaining further for reversing the decision of ESIC board, the minister said, "I have got several representations from medical students of these colleges, their parents and Members of Parliament. Some ministers also discussed the issue and asked to review the decision." 

ESIC's Director General Anil Kumar Aggarwal said that the incremental cost of running a medical college is about Rs 50 crore per year. 

Labour Secretary Shankar Aggarwal said that Labour Ministry has liberalised conditions to encourage states to take over these institution. 

He said that a new provision of revenue sharing has been inserted in the terms and conditions for the purpose. 

Besides, the state can pay the balance payment for completion of the under-construction project in three installments. 

The minister said that the first preference will be given to states while handing over these institutions and only then it would be given to private players to run under the Public Private Partnership mode. 

He further said that the ministry has not talked to any private players so far for these eight medical hospital and states are given 15 days more to respond to the proposals. 

Under the proposal, three medical colleges -- Faridabad (Haryana), Sanathnagar (Telangana) and Coimbatore (Tamil Nadu) rpt (Tamil Nadu) will be handed over to states as there are sufficient number of insured persons. 

The ministry has decided that if states are not willing to run these colleges then ESIC will run on PPP mode or on its own.

Monday, March 16, 2015

Interview with Dr Jagdish Prasad, DGHS

Dr Jagdish Prasad

Dr Jagdish Prasad is director general, Directorate General of Health Services (DGHS), Ministry of Health & Family Welfare, Govt of India. He has also served as the founder principal and professor & chief of cardiac surgery at Vardhman Mahavir Medical College and medical superintendent of the associated Safdarjung Hospital in New Delhi.

Dr Prasad did his MBBS and MS (General Surgery) from the All India Institute of Medical Sciences (AIIMS), New Delhi in 1977 and 1981 respectively. He did his super specialization (MCh) in cardiothoracic and vascular surgery from KEM Hospital, Mumbai in 1985. He has also done DNB in cardiothoracic surgery in 1986.
In recognition of his contribution to the field of medicine, particularly cardiothoracic and vascular surgery at Safdarjung Hospital and economizing the cost of cardiac surgery, the President of India conferred on him the Padma Shree Award in 1991.
In an exclusive interview with PG Times, Dr Jagdish Prasad shares his views on the overall healthcare sector in the country and some of the major issues concerning the medical profession:
How do you view the overall healthcare sector in India?
Overall healthcare sector is divided majorly into two — one is rural healthcare and the other is urban healthcare. Technically, we are very advanced as any other country such as in Europe or the US. Be it brain surgery, cardiac surgery or heart transplant, result-wise we are as good as they are. Take medical tourism – it will go up gradually, especially in private hospitals that are providing five star facilities which people want.
On the other hand, doctors are concentrated only in cities, not in villages. The reason behind this is not only doctors but the whole education system. There is no control over the education system in the country. Suppose if you are giving donation for studying in a private medical college, obviously you would like to earn the money. That means you can’t work for small amount, you would look for bigger opportunities. So this donation culture needs to be stopped completely.
Why doctors are protesting against rural posting?
Doctors are protesting against rural posting because they know infrastructures in the villages are very poor. Suppose you are posted at a village or in a block, you don’t get a house, how would you stay? There have to have some infrastructure, some schools. Now suppose a person who passes BA and becomes a deputy collector, and then a block development officer, the moment they become a block development officer, they get a car, a house, servants and, of course, power. Doctors don’t want power, but there has to be basic infrastructure such as house or at least they should have a quality infrastructure to work. A surgeon posted at a district hospital doesn’t have instruments, so how do you expect him to work.
But then it is both ways. Sometimes doctors are also bad — some doctors, who are posted at district hospitals, will go for one day in village and take the whole month’s pay. It will continue to run this way, until a consciousness comes that doctors should be provided basic infrastructure facilities such as house, water, instruments, electric supply, roads etc. Until the government develops these facilities, you can’t expect doctors to go and work in villages.
The time has come now that we must have a community type of basic healthcare centre and government should work on preventive and promotive healthcare structure. Even when you are healthy, you should have a regular health check-up rather than falling ill and then spend lots of money. For example, in the case of breast cancer, if diagnosed at very early stage, it can be 100% cured and one can lead a normal life but a little delay and you would end up spending lots of money. The same is with coronary heart disease, diabetes or hypertension, a regular check-up means prevention of further development of complications and your medical cost will also decrease. This, the government must understand and the people too.
There is digital India plan now being thought of, how do you plan to implement it in the Indian healthcare sector?
There is a big project that we have already planned but its implementation will cost a huge amount of money. Putting huge amount of money is not a very tough job but before that you also have to have an infrastructure.
No doubt, digital healthcare will make things very easier. Recently, we have introduced ‘Nischay’ (नि:क्षय) – a project where every tuberculosis patient is enrolled. We are giving palmtops to every 2.5-lakh population and they will keep the records so that we can follow every TB patient. This kind of digitisation we are doing in public healthcare system. In public healthcare system, or telemedicine system, it can play a tremendous role. For example, PGI Chandigarh is doing the treatment of psychiatric patients through telemedicine. They have connected with normal medical officer at district hospitals who collect the history of the patient and then introduce the patient to doctors sitting at PGI, explain the problem and the doctor then gives his advice.
So, digitization of whole system is going to help in big way in every sector — be it public service or education or healthcare treatment or diagnosis or teleradiology or telepathology. PGI Chandigarh has started telepathology. They (doctors at district level) put a slide on the microscope and send the picture to Chandigarh and then get the report. They think digitization requires a lot of money but that’s not true. If you digitalize the things then you can decrease the duplication of investigation to a great extent. Suppose, you have blood test done at one place and get the record, then if you visit to other doctors for consultation for the same disease, you don’t have to redo it and thus can save money. But then there is fault in doctors also, prescribing unnecessary medical test which is not required, and for that we are putting the Clinical Establishments Act which is getting objections from doctors. The Act is not to harass doctors but just to regulate the treatment and avoid the harassment of patients. Consider a chest pain case, which is a muscular pain, it can be cured without requiring angiography or angioplasty or anything but some doctors would prescribe it unnecessarily. This type of malpractice needs to be checked but it’s a difficult task.
To curb the unethical marketing practices of pharma companies, the government has issued a uniform code of conduct. How do you feel about it?
You have to change the basic foundation first.
How it can be changed?
We have to stop selling education in the country. Increase the facility, the infrastructure and don’t treat the doctors like an officer; they are professional people, they should be treated professionally. Doctors put hard labour; to become a surgeon it takes eight years, to become a cardiac surgeon ten years. It requires a constant hard labour and then you are treating them with a person who has just passed BA and becomes a bureaucrat. You need to give doctors some importance but the irony is… importance is realized only when they fall ill. Foundation of the doctors has to be taken care of; infrastructure has to be built up. The standard of education has come down. There is no uniformity in this sector, which is the biggest drawback in medical profession at the moment.
Do we need some changes in medical curriculum as well? There was news about NEET and Exit Exam.
It (NEET) was nixed… the Supreme Court judge could not understand that he has done a great harm to the country, to the whole citizens. It should have been implemented.
There was also news that the government has filed an appeal against this judgement?
Yes, it has been filed. Government has to change some policy. They have to check the basic structure, basic foundation, and correct it.
I will share an incident, 10-12 years back when I was on a tourist visit to Hong Kong, I saw there that at that time, one constable was paid (equivalent to approximately) Rs 1 lakh and the Prime Minister’s salary was Rs 5 crore in a year. The government was paying enough. Now compare this, I will give you another example, a CBI SP came to me (I will not take the name) and said, “Dr Prasad, can you refer some job for my wife, she is a senior doctor? As I have been transferred from state to centre and I am not getting that much (pay). It’s very hard to live here.”
So what pay government is giving? The cost of living has gone up. After doing 10 years of IPS service, if you are not able to give good education to your children then what are you forcing and to whom? This has to be changed. Things will change only when you make the facilities available. If you go to Cuba, education is totally free, they will give you books free, hostel is free, and almost everything is free but then they will post you in district hospitals. The doctor also does not hesitate to work in a district because he was trained, educated there only. Here (in India) students suddenly come from a village to Delhi, Mumbai, Allahabad, Lucknow, see the city environment where they get good facilities but when they look back at the village there is no light, no house, no roads. The infrastructure is also lacking, also there is lots of pay disparity, many other problems.
So, does that mean we need to set up more medical colleges, may be at district level?
No. No need to set up more medical colleges, we have enough medical colleges. It’s a wrong way to say that we can improve healthcare, get more doctors, by opening more medical colleges. No. Whatever doctors are available at the moment, if properly distributed, we will have enough. We have nearly 8 lakh doctors available in Ayurvedic system; we have to drag these doctors also for the basic disease treatment. Every single disease doesn’t require surgery.
But many doctors are against equating Ayurvedic doctors with modern doctors, some even call them quacks?
Government should take the policy decision, not protestors. How can they call Ayurvedic practitioners quack, they also study four and half years, they can cure some diseases which we cannot. They can’t call them quacks; they are qualified and registered practitioners. Ayurveda, Yoga, Homeopathy — all these forms are well-recognised systems of medicine which can’t be ignored. It has to be brought up in the mainstream.
There is no need to open more medical colleges. The need is to make the infrastructure good and available. Like in a village the need is to build a nice operation theatre, a blood bank should be available. You are making a district hospital but there is no blood bank. How the surgeon will operate? There is no instrument, there is no light, there is no water supply, there is no toilet… there are so many problems. The doctor has no place to stay, no house, they will ask you to rent a house. If you are making a hospital, make it a residential hospital – for the nurses, for the doctors, for the class-IV employees… why do people want to come to the All India Institute of Medical Sciences? Because every facility is available… they are working for the same amount of pay, even for less amount… nobody wants to leave, because the infrastructure is such. If they want to do research, they will do research; if they want to do good operations, they can do it; if they want good instruments, they will get it. So, if you make the facilities, definitely, they will come.
Antibiotic resistance is a major challenge in front of India and we are one of the largest consumers of antibiotics. How do you think we can cope up with this challenge?
Even though it is a tough task, the government has started surveillance in different places. We have taken the help of Pharmacopoeia Commission and we are taking pharmacovigilance. We have brought some medicines under the ‘Schedule H1′ category, which can only be given on prescription. We have also requested MCI to make it mandatory for every medical college to have a pharmacovigilance committee so that what antibiotics are used, why it is used, can be monitored. So that at the tertiary hospitals at least the use of antibiotics is not indiscriminate. Because the problem mostly occurs in the ICU, where lots of resistance come up. Few countries such as Sweden do not use antibiotics until and unless they do a culture test but in our country it is not possible. Suppose you are in a village and had a throat infection, you will go to a chemist and ask for an antibiotic. Though it may be get cured by a gargle but you will take some antibiotic. And you are not at fault because there is no doctor available to consult. This problem will take long time to resolve but there is definitely requirement to have a comprehensive check on the sale of antibiotics and lots of education is required for doctors as well, patients awareness is required too.
Nowadays, many of the doctors are attacked and manhandled at healthcare centres. How to tackle this issue?
In our country, the number of patients is more than the number of doctors, especially at public hospitals. If you go to Safdarjung Hospital’s gynae department, everyday you will see huge number of patients, mainly because all other hospitals close by evening. Imagine 100-110 deliveries in one day and suppose five patients require surgery but at one moment only two surgeries can be done because there are only two operation theatres. Other persons are also waiting, crying in pain. Those people can’t wait; they will ask: ‘operate my patient first’. At this point, both are agitated and annoyed — the doctor is agitated because he has been working since morning and the people are agitated because patient is suffering, the result is a tussle between them. This tussle is because the gap between the supply and demand. There is in no adequate infrastructure — only two operation theatres and 100-110 patients are waiting for delivery.
So, according to you, how to tackle this problem?
All the hospitals in the periphery should start working 24×7. After 4pm, apart from Safdarjung, Lady Hardinge and Ram Manohar Lohia Hospital, all other hospitals stop working. So, the entire load is on these three hospitals. Government should ensure that other hospitals too should be available for patients. Delhi government should make sure that all patients should go to the nearby hospital for delivery rather than flock into these three hospitals.
What message you would like to share with your fellow doctors?
I would only say: follow the ethics, do the research which is required. Talk to the patients nicely, and think of them as your brother, sister, mother. You must have a feeling of family towards your patients; treat them as your own.

Friday, March 13, 2015

PG Counselling for Dummies

Considering the counselling season is on full flow, here's a few tips on getting the best seat.
1. Branch > College ( in most cases ) because its near impossible to keep yourself motivated through the three year programme unless you are passionate enough to see it through. A PG programme will throw up unique challenges that you cant possibly envision or plan for hence the motivation must be there.
2. Speak to your seniors before you decide on anything. They have the benefit of something that you just don't have "experience" and boy it matters a lot. Speak your mind, discuss your insecurities, throw it all out there and then incorporate those into making your call
3. Write things down. Whatever you find out, anyone tells you, keep noting them down. They become a point of reference and help in giving a definitive shape to your ideas
4. If your at the position where you think you wont one of the famed colleges, try opting for a good city while balancing that with a good enough college obviously. It makes a difference.
5. If you want to get into a branch like medicine or surgery, look for colleges that have MCh/DM seats. Might give you a slight edge later on.
6. Don't believe everything that's posted on social media and sites like RxPG. Learn to question things and seek facts for yourself. The best is to speak to someone from that particular college and department. They are the ones who will give you the real picture.
7. Lastly, I would suggest, take the pains of visiting your to be college yourself. Absolutely nothing like first hand experience.

Thursday, March 12, 2015

TN gives conditional nod to take over ESIC medical colleges

Seeking to end the ‘uncertainty’ among the students, Tamil Nadu Government today conveyed its conditional ‘in-principle’ consent to take over two medical colleges of Employees’ State Insurance Corporation (ESIC), which is exiting medical education from 2015—16.
In a letter to Prime Minister Narendra Modi, Chief Minister O Pannerselvam said the State would take over the colleges —— one here and another proposed in Coimbatore —— provided certain conditions, including the corporation bearing a capital cost of over Rs. 570 crore, were accepted.
He also wanted the seats to be shared at 85 per cent for state government and 15 per cent to All India quota as per the current norms for government medical colleges instead of 65 per cent to the state, 20 per cent to ESI employees and 15 per cent to the national pool.
ESIC’s ‘sudden and drastic’ decision to exit from medical education had come as a rude shock to the students of the colleges —— one functioning in KK Nagar here with 138 students while the other one was coming up in Coimbatore. “Uncertainty’ about continuance of the colleges has fuelled anxiety and agitation amongst the students, he said.
Referring to ESIC’s conditions for the take over, he said one of the ‘conditions indicated’ was that the State government had to provide Rs. 571.23 crore as balance liabilities for these two ongoing projects.
The cost of the medical college and hospital being established in Chennai had been indicated to be Rs.494.62 crores while that of the one in Coimbatore Rs. 580.57 crore.
Terming the cost of the two projects as “very high”, he said establishment of a medical college and hospital by the State government worked out to only around Rs. 200 crore.
However, his government, with a view to ‘resolving the uncertainty’ ‘conveys its in-principle’ consent subject to certain conditions, he said.
These included ESIC committing to bearing the entire balance capital cost of Rs. 571.23 crore, meeting the recurring expenditure from State funds under ESI pattern of reimbursement with Centre contributing 87.5 per cent of it, and ESI staff being absorbed by the state government and that they agree to work as per its scales.
The title of the Land and Buildings should be transferred to the State as per the ‘conditionality’ of the Medical Council of India, he added.
Labour Minister Bandaru Dattatreya has informed Parliament last month that ESIC has spent Rs. 5,345.5 crore till September on its 12 medical college projects across the country, whose estimated cost was Rs.9,990.84 crore.
He had also said ESIC decided to focus on providing primary, secondary and super speciality medical care services to its insured persons and exit the field of medical education entirely as it is not its core function.

Saturday, January 17, 2015

Govt to decide on quota in super speciality posts in AIIMS: SC

The Supreme Court on Thursday put the ball in Centre’s court to take a call on providing reservation in appointment for faculty posts in speciality and super speciality posts in medical colleges including the prestigious All India Institute of Medical Sciences (AIIMS).
“We clarify that it is for the Central Government to take a decision as to whether there should be reservation in speciality and super speciality posts,” a five-judge bench headed by justice H.L. Dattu said.
The Centre had moved the apex court seeking review of a Constitution Bench judgement which had said it cannot take a view contrary to the one expressed in 1992 by a nine-judge bench in the Indra Sawhney case, also known as the Mandal case, that there could be no compromise with merit at super speciality stage.
As soon as Additional Solicitor General L. Nageshwar Rao opened his arguments, the bench said the judgement makes it clear that the Centre has to follow the advice given in the Indra Sawhney case.
“That’s all and nothing more than that,” the bench said and explained by saying that “we have not added a word other than what has been said in the Indra Sawhney judgement”.
“It is open for the Central Government to take a decision whether there can be a reservation in speciality and super speciality posts,” the bench, also comprising justices S.S. Nijjar, Ranjan Gogoi, M.Y. Eqbal and Vikramajit Sen said.
“At the best, we can add one sentence that it is for Central Government to take decision to amend the Constitution,” it said leaving it to the Centre to take a decision on the controversial aspect of reservation.
“Even now the ball is in your court. You can say whether in speciality and super-speciality posts there can be reservation or not. Choice is yours to follow the advice made in the Indira Sawhney judgement,” the bench said.
“If you want to give reservation, give it and if the matter comes to court then we will see,” the bench said while disagreeing with the Centre’s submission that “advice has taken the shape of direction in the judgement”.
The apex court had in July last year said, “We cannot take a different view, even though it has been suggested that such an observation (of Mandal verdict) was not binding, being obiter in nature.
“We cannot ascribe to such a view since the very concept of reservation implies mediocrity and we will have to take note of the caution indicated in Indra Sawhney’s case,” the bench had said.
Referring to various judgements including that of the Mandal case, it had said, “We impress upon the Central and State Governments to take appropriate steps in accordance with the views expressed in Indra Sawhney’s case and in this case, as also the other decisions referred to above, keeping in mind the provisions of Article 335 (claims of SC/ST to service and posts) of the Constitution.”
The court had pronounced its verdict on the plea of the Faculty Association of AIIMS against a Delhi High Court judgement.
The Association had contended that there cannot be any reservation for faculty posts to speciality and super speciality faculty courses in AIIMS.
AIIMS and the Centre had however taken a contrary stand and had pleaded that the reservation be given to SC/STs and Backward classes candidates in appointment to assistant professors and other senior posts in speciality and super speciality courses.

Punjab To Hold Its Own Medical PG Entrance

Starting this year, the Government of Punjab has decided to hold its own examination to fill PG medical seats.
Since a couple of years, it was the All India Post Graduate  Medical Entrance Examination (AIPGMEE) that students had to pass to get PG seats in the state medical colleges. However, it was observed that few students from Punjab were able to meet this criteria, resulting in the seats being occupied by students from other states.
Recently, a meeting, attended by representatives of Punjab’s different medical colleges and other educational institutions, was held in which the chairperson was Husan Lal, Secretary, Medical Education. Soon, Mr Lal announced the decision to hold separate PG entrance exam and said that the decision was taken after consultation with principals of state medical colleges.
In December last year, the AIPGMEE was held for the new academic session but now, those results would be used to fill 50% of the PG seats while the remaining 50% would be filled as per the results of the new exam.
News of this decision has been welcomed warmly by the state’s doctors’ associations who believe that this would help in protecting the rights and careers of their fraternity.
This move comes just a few weeks after the Punjab Government decided to conduct its own entrance test for admission to MBBS and BDS courses in the state’s colleges instead of continuing with the All India Pre-Medical Test (AIPMT).
The dates of the separate PG entrance exam by the state government and other details would be announced soon.

However, the central govt. has requested Punjab govt. to keep on hold its plan of conducting state PG exam as it had already given consent for using NBE-conducted AIPGMEE scores.

Wednesday, January 14, 2015

ESIC to shut its medical colleges

The Employees State Corporation (ESIC) has decided to shut its medical colleges as this is not its core function, leading to the students protesting the move here Monday.
The corporation has expressed its inability to meet the objectives to establish medical colleges and training institutes to serve the insured and non-insured persons of the ESIC scheme.
"The ESIC should exit the field of medical education entirely as it is not the core function of the ESIC and other objectives is unlikely to be met," said the order issued at an ESIC meet held Dec 4.
It was also decided to hand over the ongoing medical colleges and other medical education institutions, having separate infrastructure, to state governments willing for such a transfer.
Though it has been running hospitals under the scheme for the purpose, the ESI Act was amended in 2010 to allow it to set up medical colleges. Presently, 13 such institutions are in various stages of construction.
Currently the corporation, runs seven medical colleges including a dental college in north Delhi's Rohini area, with few others in various stages of construction. They are estimated to be over Rs.10,000 crore.
The corporation during the meeting has also urged all the medical colleges not to undertake any further admissions as the medical programmes will continue only till the admitted students pass out or are adjusted by medical colleges of the state governments.
The students studying in the existing medical colleges under the ESIC, however, have claimed that due to the ESIC's order, the faculties and administrative staffs have already tendered their resignations which is a reason the recognition of Medical Council of India (MCI) could be withdrawn.
"Every medical college has to have a required number of students, teachers and administrative staff to get recognised by the MCI. But due to the ESIC decision all the faculties have started leaving the institutions," Chandra Mohan, president of the ESIC students association, told IANS.
"If the MCI withdraws its recognition, non of the students are going to get any Amedical degree," Mohan, who is also a student of ESIC Dental college in Delhi, added.
The students will also stage a protest Tuesday at Jantar Mantar against the decision of the corporation.