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#Fraud: A badly broken medical training system threatens India and countries around the world

India’s medical education system is plagued by rampant fraud, unprofessional teaching practices and poses a public health challenge to India but other countries where Indian doctors practice, a Reuters investigation has revealed.

In a four-month investigation, Reuters has documented the full extent of the fraud in India’s medical-education system.

It found, among other things, that more than one out of every six of the country’s 398 medical schools has been accused of cheating, according to Indian government records and court filings.

The Reuters investigation also found that recruiting companies routinely provide medical colleges with doctors to pose as full-time faculty members to pass government inspections.

To demonstrate that teaching hospitals have enough patients to provide students with clinical experience, colleges round up healthy people to pretend they are sick.

Government records show that since 2010, at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings, including rigging entrance exams or accepting bribes to admit students.

Two dozen of the schools have been recommended for outright closure by the regulator.

Paying bribes – often in the guise of “donations” – to gain admission to Indian medical schools is widespread, according to India’s health ministry, doctors and college officials.

“The next generation of doctors is being taught to cheat and deceive before they even enter the classroom,” said Dr. Anand Rai.

Dr Rai exposed a massive cheating ring involving medical school entrance exams in the central Indian state of Madhya Pradesh in 2013.

Rai was given police protection after he received death threats following the bust.

The poor state of India’s medical education reflects a health system in crisis.

The country has the highest rates of mortality from diarrhea, pneumonia and tuberculosis, creating pressure to train more physicians. Patients are regularly denied treatment at public hospitals that are so overcrowded, often the only way to see a doctor is to pay a bribe.

The causes of the crisis are manifold: Too few doctors. A government-backed surge in private medical schools which, to boost revenue, frequently charge under-the-table fees for admission.

Outdated government regulations that, for example, require college libraries to keep paper copies of medical journals and penalize those that subscribe instead to online editions.

Even the regulatory body charged with maintaining standards in medical education – the Medical Council of India (MCI) – is embroiled in myriad controversies.

A one-time president of the MCI currently facing bribery allegations while the council itself is the subject of a string of lawsuits.

“The best medical schools in India are absolutely world class,” said David Gordon, president of the World Federation for Medical Education.

But, he added, the Indian government’s process of accrediting a “huge” number of recently opened, private medical schools “has at times been highly dubious.”

India has been rocked by a series of recent medical scandals, including doctors accused of serious crimes.

In November, a group of junior doctors at a medical college in the eastern city of Kolkata allegedly tied a suspected mobile phone thief to a pillar, slashed him with a razor and beat him to death with bamboo sticks, according to local police. Nine of the accused men remain in jail; they deny murder charges, say lawyers involved in the case.

Three suspects remain at large.

IMPACT ABROAD

The system’s problems are felt abroad, too.

Tens of thousands of India’s medical graduates practice overseas, particularly in the United States, Britain, Australia and Canada.

All of these countries require additional training before graduates of Indian medical schools can practice, and the vast majority of the doctors have unblemished records.

But regulatory documents seen by Reuters show that in both Britain and Australia, more graduates of Indian medical schools lost their right to practice medicine in the past five years than did doctors from any other foreign country.

In the United Kingdom, between 2008 and 2014, Indian-trained doctors were four times more likely to lose their right to practice than British-¬trained doctors, according to records of Britain’s General Medical Council. (The U.S. and Canada lack publicly available centralized databases of disciplined doctors.)

The British cases include that of Dr. Tajeshwar Singh Aulakh, who received his medical degree in 1999 from Punjabi University in Patiala, India, according to Indian government records.

He was assisting during a hip operation in 2008 in Shropshire, England, when he allegedly grabbed a scalpel, slashed the patient’s stitches and threw it toward a nurse, according to British government records.

The United Kingdom later struck him off its list of approved physicians.

CHEAP FAKE DEGREES

About 45 percent of the people in India who practice medicine have no formal training, according to the Indian Medical Association.

These 700,000 unqualified doctors have been found practicing at some of India’s biggest hospitals, giving diagnoses, prescribing medicines and even conducting surgery.

Balwant Rai Arora, a Delhi resident in his 90s, said in an interview that he issued more than 50,000 fake medical degrees from his home until his forgery ring was broken up by the police in 2011.

Each buyer paid about £60 for a degree from fictitious colleges.

Arora was twice convicted and jailed for forgery. 

India currently has about 840,000 doctors – or about seven physicians for every 10,000 people.

That compares with about 25 in the United States and 32 in Europe, according to the World Health Organization.

The shortfall has persisted despite India having the most medical schools of any nation.

That’s because the size of graduating classes is small – typically 100 to 150 students.

Indeed, gaining admission to India’s top medical schools is akin to winning the lottery.

The All India Institute of Medical Sciences in New Delhi has been rated the best medical school in India Today magazine’s past five annual surveys.

According to the registrar’s office, it takes in only 72 students for its undergraduate course each year out of about 80,000 to 90,000 who apply – an acceptance rate of less than one¬-tenth of one percent.

As in the United Kingdom, most medical school students attend an undergraduate program.

THE ROOT CAUSES

Health ministry officials and doctors say India’s medical¬-education system began to falter following a surge in new, private medical colleges that opened across the country during the past few decades, often in remote areas.

In 1980, there were 100 government-¬run medical schools and 11 private medical colleges.

Thirty-five years later, the number of government medical colleges has nearly doubled. The number of private medical schools, meanwhile, has risen nearly twenty-¬fold, according to the Medical Council of India. There are now 183 government medical colleges and 215 private ones.

Many of the private colleges have been set up by businessmen and politicians who have no experience operating medical or educational institutions, said MCI officials.

Sujatha Rao, who served as India’s health secretary from 2009 to 2010, said the boom in private colleges was driven by a change in the law in the early 1990s to make it easier to open new schools because the government was struggling to find the money to build public medical schools.

Not that a legitimate degree necessarily makes a difference.

A study in India published in 2012 compared doctors holding medical degrees with untrained practitioners.

It  found “no differences in the likelihood of providers’ giving a diagnosis or providing the correct treatment.”

The study, funded by the Bill & Melinda Gates Foundation, concluded that in India, “training in and of itself is not a guarantor of high quality.”

Under the government’s current regulations, private medical colleges generally must have campuses on at least 20 acres of land.

Because urban real estate in India is expensive, many schools open in rural areas where recruiting qualified, full¬-time doctors to teach is difficult because pay scales are low and living conditions are tough.

Interviews and MCI records show that some private colleges solve the problem by cheating – they recruit doctors to pose as full-¬time faculty members during government inspections.

The physicians work there for just a few days or weeks.

Two MCI officials estimated that there are several hundred Indian companies involved in recruiting them.

In October, a doctor in New Delhi received an email from a local company called Hi Impact Consultants with the subject line: “Urgent requirement of doctors for MCI Inspection in Ghaziabad”

The email offered up to 20,000 rupees a day (about $310) if the doctor appeared for an inspection at Saraswathi Institute of Medical Sciences in Hapur, east of New Delhi.

The doctor, who requested anonymity, has no connection with the college.

“If interested please revert back ASAP,” the email concluded.

The sender described itself as “a Medical Executive Search firm.”

In an interview, Sanjeev Priyadershi, Hi Impact’s executive director, confirmed that the firm had tried to recruit doctors to appear during government inspections at medical colleges where they don’t normally work.

“My client wanted to hire full¬-time faculty members for inspection purposes,” he said.

Dr. Shailendra K. Vajpeyee, the principal of Saraswathi, said the college is constantly struggling to recruit qualified professors.

Vajpeyee said he knew of Hi Impact Consultants, but denied he had employed them during his 18-¬month tenure.

“I don’t know why that email was sent” by the company, he said.

He declined to comment further about the matter.

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