Access paradox: On medical education in India

Private medical education widens access, but affects affordability

The scope (दायरा, विस्तार) of medical education in India has expanded so rapidly that it raises important questions about access (पहुँच, प्रवेश) to it. The number of seats has nearly (लगभग) tripled (तिगुना करना) in 12 years, thanks in part to (आंशिक रूप से) the government’s push (प्रयास, पहल) to improve access to health care, entailing (आवश्यक बनाना, अनिवार्य रूप से शामिल करना) infrastructure (आधारभूत संरचना, बुनियादी ढाँचा) upgrades (improvement, enhancement, betterment, modernization) and simplified regulations (विनियमन, नियम). However, much of (a large part or amount of something; a great deal of, a lot of, a significant portion of, plenty of) the growth has been happening in the private sector (private businesses, non-public sector, privately run enterprises, corporate sector), in addition to (के अतिरिक्त, के अलावा) new government colleges attached to district hospitals. This year, for the first time, private institutions host (to provide space, facilities, and resources for an event, institution, or activity; accommodate, house, hold, contain) more than half of all MBBS seats. Of the roughly (लगभग, करीब) 10,000 new seats, 79% are in such institutions, a sign (संकेत, चिन्ह) that growth in the near future (निकट भविष्य में, बहुत जल्द) will remain concentrated (केंद्रित, सघन) thus (as a result or consequence of this; therefore, consequently, hence, accordingly). The increase in seats is, in and of itself (considered alone; intrinsically, inherently, by itself, essentially), commendable (praiseworthy, laudable, admirable, creditable) as India’s students still compete fiercely (intensely, competitively, aggressively, strongly) for MBBS seats even as health-care centres (clinic, hospital) suffer a debilitating (weakening, exhausting, draining, crippling) shortage (scarcity, lack, deficiency, shortfall) of specialist practitioners (doctor, medical professional, physician). Thousands of students also seek (to attempt or desire to obtain or achieve something; try, attempt, endeavor, strive) education abroad (in or to a foreign country or countries; overseas). Therefore, expanding domestic ‘capacity’ (internal resources, infrastructure, and seats available within a country’s own borders; national infrastructure, local resources, internal capacity, domestic capabilities) is a natural response and the rising number of seats ought to (should, must, have to, be expected to) relieve (alleviate, mitigate, assuage, ease) the bottleneck (hindrance, obstacle, block, barrier) and keep talent at home (within one’s own country rather than abroad; within the country, domestically, locally).

But problems abound (to exist in large numbers or amounts; proliferate, be plentiful, be abundant, flourish). Whereas (in contrast or comparison with the fact that; while, whilst, although, on the other hand) an MBBS seat in a government college rarely (not often; seldom, infrequently, hardly ever, scarcely) exceeds ₹5 lakh for the full term (the entire duration of a course; entire period, complete duration, whole course, full duration), that in a private institution can cost 10 times more, sustained (continuous, unceasing, prolonged, relentless) in part by the unflagging (tireless or persistent; untiring, unfailing, unwearied, steadfast) demand (desire, requirement, need, wish) for health care. These institutions’ commercial viability (the ability of a business, product, or service to compete effectively and make a profit; profitability, economic feasibility, business potential, financial sustainability) is clustered in specific geographies (region, area, location, territory), especially in tier-I and -II cities (major metropolitan cities (Tier-I) and rapidly growing medium-sized cities (Tier-II) classified based on population and economic development; metropolitan areas) in the more prosperous (flourishing financially, wealthy, affluent, rich, thriving) States, where incomes are higher. Unless (except if; if not, except when, save, short of) their students deliberately (consciously and intentionally; on purpose, intentionally, purposefully, knowingly) fan out (to spread out over a wide area; spread out, disperse, scatter, diffuse) after graduation, their skills (expertise, proficiency, competence, capability) also become concentrated in these clusters (gather, assemble), whereas the paucity (scarcity, shortage, lack, dearth) of health-care providers is felt more keenly (intensely, acutely, strongly, sharply) in the rural areas farther away (at, to, or by a greater distance; more remote, more distant, further off, isolated). Rapid growth also raises the risk of highly uneven (unequal, inconsistent, irregular, disparate) quality, with institutions seeking to secure (to succeed in obtaining something, especially with difficulty; obtain, acquire, gain, get) NMC accreditation (certification, recognition, validation, endorsement) with the bare minimum (the absolute lowest amount or standard needed; least possible, absolute minimum, lowest requirement, bedrock) of facilities rather than (instead of; in place of, as opposed to, as an alternative to, contrary to) mindfully (carefully, thoughtfully, consciously, attentively) addressing (to think about and begin to deal with an issue or problem; tackle, deal with, confront, handle) local needs. ‘Capitation fees’, which persist (continue, remain, linger, endure) despite government bans, create new debt (a sum of money that is owed or due; liability, financial obligation, borrowing, loan) that can influence (affect, determine) behaviour (conduct, actions, manners, deportment) after graduation. Finally, sans (without; lacking, free from, devoid of) competitive salaries, housing and schools, and assured (guaranteed, secure, certain, sure) career progression (the process of making progress to better jobs or more advanced roles within a profession; professional advancement, career growth, occupational development, job mobility), graduates gravitate (to move towards or be attracted to a person, place, or thing; incline, lean, tend, veer) to private practice (the professional work of a physician, lawyer, etc., who is self-employed and not working for the government or a large institution; independent clinic, independent business, self-employment, private clinic) or abroad. Paradoxically (विरोधाभास, विसंगति), then, the surge (a sudden rise, increase, escalation, jump) in private capacity (the amount of infrastructure, seats, or services provided by non-governmental entities; private sector seats) obligates (require, compel, force, oblige) the government to keep adding capacity, including opening new AIIMS-like (resembling or modeled after the All India Institute of Medical Sciences (AIIMS), representing premier, high-quality public medical institutions; premier public institute, top-tier medical college, high-standard institution, elite hospital) institutions, so the number of cheap seats also keeps increasing. The NMC’s rule of having half of all private institution seats be charged at government rates should be enforced; (to compel observance of or compliance with a law, rule, or obligation; implement, apply, execute, impose) the NMC should also embrace (welcome, accept, adopt, support) mechanisms (procedure, process, system, method) that support surprise inspections (unannounced check, sudden audit, random evaluation, spot check) and the ability to inspect records without institutions’ permission. Finally, beyond compelling rural service, governments should reward it, in addition to ensuring that the daily needs of rural health-care workers and their families and of hospitals are both well-met (effectively addressed or fulfilled; fully satisfied, adequately catered to, properly provided for, fulfilled).

Courtesy: The Hindu

Important Word List With Meaning

1.access (noun)

Hindi Meaning - पहुँच, प्रवेश
English Meaning - entry, admission, opportunity.

2.paradox (noun)

Hindi Meaning - विरोधाभास, विसंगति
English Meaning - contradiction, inconsistency, incongruity, anomaly.

3.scope (noun)

Hindi Meaning - दायरा, विस्तार
English Meaning - extent, range, breadth, reach.

4.nearly (adverb)

Hindi Meaning - लगभग
English Meaning - almost, practically, virtually, approximately.

5.triple (verb)

Hindi Meaning - तिगुना करना
English Meaning - increase threefold, multiply by three, expand threefold.

6.thanks in part to (phrase)

Hindi Meaning - आंशिक रूप से
English Meaning - partially as a result of; due in part to, owing partly to, partly because of, as a partial consequence of.

7.push (noun)

Hindi Meaning - प्रयास, पहल
English Meaning - a vigorous effort to achieve something; drive, effort, initiative, thrust.

8.entail (verb)

Hindi Meaning - आवश्यक बनाना, अनिवार्य रूप से शामिल करना
English Meaning - to involve something as a necessary or inevitable part or consequence; involve, necessitate, require, demand.

9.infrastructure (noun)

Hindi Meaning - आधारभूत संरचना, बुनियादी ढाँचा
English Meaning - the basic physical and organizational structures and facilities needed for the operation of a society or enterprise.

10.concentrated (adjective)

Hindi Meaning - केंद्रित, सघन
English Meaning - gathered together or existing in high numbers in one particular area; clustered, localized, focused, gathered.

11.regulation (noun)

Hindi Meaning - विनियमन, नियम
English Meaning - an official rule or requirement made by a government or regulatory authority to control or govern an activity; rule, directive, provision, regulatory requirement.

12.in addition to (phrase)

Hindi Meaning - के अतिरिक्त, के अलावा
English Meaning - besides, as well as, along with, over and above.

13.roughly (adverb)

Hindi Meaning - लगभग, करीब
English Meaning - approximately, about, around, nearly.

14.sign (noun)

Hindi Meaning - संकेत, चिन्ह
English Meaning - indication, signal, symptom, hint.

15.in the near future (phrase)

Hindi Meaning - निकट भविष्य में, बहुत जल्द
English Meaning - very soon; shortly, imminently, before long, upcoming.

16.upgrade (noun)

English Meaning - improvement, enhancement, betterment, modernization.

17.affordability (noun)

English Meaning - the ability to be afforded; inexpensiveness, reasonableness, cheapness, cost-effectiveness.

18.much of (phrase)

English Meaning - a large part or amount of something; a great deal of, a lot of, a significant portion of, plenty of.

19.private sector (noun)

English Meaning - private businesses, non-public sector, privately run enterprises, corporate sector.

20.host (verb)

English Meaning - to provide space, facilities, and resources for an event, institution, or activity; accommodate, house, hold, contain.

21.thus (adverb)

English Meaning - as a result or consequence of this; therefore, consequently, hence, accordingly.

22.in and of itself (phrase)

English Meaning - considered alone; intrinsically, inherently, by itself, essentially.

23.commendable (adjective)

English Meaning - praiseworthy, laudable, admirable, creditable.

24.fiercely (adverb)

English Meaning - intensely, competitively, aggressively, strongly.

25.health-care centre (noun)

English Meaning - clinic, hospital.

26.debilitating (adjective)

English Meaning - weakening, exhausting, draining, crippling.

27.shortage (noun)

English Meaning - scarcity, lack, deficiency, shortfall.

28.practitioner (noun)

English Meaning - doctor, medical professional, physician.

29.seek (verb)

English Meaning - to attempt or desire to obtain or achieve something; try, attempt, endeavor, strive.

30.abroad (adverb)

English Meaning - in or to a foreign country or countries; overseas.

31.domestic ‘capacity’ (phrase)

English Meaning - internal resources, infrastructure, and seats available within a country’s own borders; national infrastructure, local resources, internal capacity, domestic capabilities.

32.ought to (modal verb)

English Meaning - should, must, have to, be expected to.

33.relieve (verb)

English Meaning - alleviate, mitigate, assuage, ease.

34.bottleneck (noun)

English Meaning - hindrance, obstacle, block, barrier.

35.at home (phrase)

English Meaning - within one’s own country rather than abroad; within the country, domestically, locally.

36.abound (verb)

English Meaning - to exist in large numbers or amounts; proliferate, be plentiful, be abundant, flourish.

37.whereas (conjunction)

English Meaning - in contrast or comparison with the fact that; while, whilst, although, on the other hand.

38.rarely (adverb)

English Meaning - not often; seldom, infrequently, hardly ever, scarcely.

39.full term (noun)

English Meaning - the entire duration of a course; entire period, complete duration, whole course, full duration.

40.sustained (adjective)

English Meaning - continuous, unceasing, prolonged, relentless.

41.unflagging (adjective)

English Meaning - tireless or persistent; untiring, unfailing, unwearied, steadfast.

42.demand (noun)

English Meaning - desire, requirement, need, wish.

43.commercial viability (noun)

English Meaning - the ability of a business, product, or service to compete effectively and make a profit; profitability, economic feasibility, business potential, financial sustainability.

44.cluster (verb)

English Meaning - gather, assemble.

45.geography (noun)

English Meaning - region, area, location, territory.

46.tier-I and -II cities (noun)

English Meaning - major metropolitan cities (Tier-I) and rapidly growing medium-sized cities (Tier-II) classified based on population and economic development; metropolitan areas,

47.prosperous (adjective)

English Meaning - flourishing financially, wealthy, affluent, rich, thriving.

48.unless (conjunction)

English Meaning - except if; if not, except when, save, short of.

49.deliberately (adverb)

English Meaning - consciously and intentionally; on purpose, intentionally, purposefully, knowingly.

50.fan out (phrasal verb)

English Meaning - to spread out over a wide area; spread out, disperse, scatter, diffuse.

51.skill (noun)

English Meaning - expertise, proficiency, competence, capability.

52.cluster (noun)

English Meaning - gathering, collection, congregation, assemblage.

53.paucity (noun)

English Meaning - scarcity, shortage, lack, dearth.

54.keenly (adverb)

English Meaning - intensely, acutely, strongly, sharply.

55.farther away (phrase)

English Meaning - at, to, or by a greater distance; more remote, more distant, further off, isolated.

56.uneven (adjective)

English Meaning - unequal, inconsistent, irregular, disparate.

57.secure (verb)

English Meaning - to succeed in obtaining something, especially with difficulty; obtain, acquire, gain, get.

58.National Medical Commission (NMC) (noun)

English Meaning - the statutory body established under the National Medical Commission Act, 2019, responsible for improving access to quality and affordable medical education, ensuring the availability of adequate and high-quality medical professionals, promoting equitable and universal healthcare, and regulating medical institutions, medical research, and medical professionals in India. It replaced the old Medical Council of India on September 25, 2020.

59.accreditation (noun)

English Meaning - certification, recognition, validation, endorsement.

60.bare minimum (noun)

English Meaning - the absolute lowest amount or standard needed; least possible, absolute minimum, lowest requirement, bedrock.

61.rather than (phrase)

English Meaning - instead of; in place of, as opposed to, as an alternative to, contrary to.

62.mindfully (adverb)

English Meaning - carefully, thoughtfully, consciously, attentively.

63.address (verb)

English Meaning - to think about and begin to deal with an issue or problem; tackle, deal with, confront, handle.

64.Capitation fee (noun)

English Meaning - an unauthorised payment demanded by some educational institutions from students for admission, in addition to the prescribed tuition fee; admission fee, illegal admission charge, donation, unauthorised fee.

65.persist (verb)

English Meaning - continue, remain, linger, endure.

66.debt (noun)

English Meaning - a sum of money that is owed or due; liability, financial obligation, borrowing, loan.

67.influence (verb)

English Meaning - affect, determine.

68.behaviour (noun)

English Meaning - conduct, actions, manners, deportment.

69.sans (preposition)

English Meaning - without; lacking, free from, devoid of.

70.assured (adjective)

English Meaning - guaranteed, secure, certain, sure.

71.career progression (noun)

English Meaning - the process of making progress to better jobs or more advanced roles within a profession; professional advancement, career growth, occupational development, job mobility.

72.gravitate (verb)

English Meaning - to move towards or be attracted to a person, place, or thing; incline, lean, tend, veer.

73.private practice (noun)

English Meaning - the professional work of a physician, lawyer, etc., who is self-employed and not working for the government or a large institution; independent clinic, independent business, self-employment, private clinic.

74.paradoxically (adverb)

English Meaning - ironically, contradictorily, surprisingly, unexpectedly.

75.surge (noun)

English Meaning - a sudden rise, increase, escalation, jump.

76.private capacity (noun)

English Meaning - the amount of infrastructure, seats, or services provided by non-governmental entities; private sector seats.

77.obligate (verb)

English Meaning - require, compel, force, oblige.

78.AIIMS-like (adjective)

English Meaning - resembling or modeled after the All India Institute of Medical Sciences (AIIMS), representing premier, high-quality public medical institutions; premier public institute, top-tier medical college, high-standard institution, elite hospital.

79.enforce (verb)

English Meaning - to compel observance of or compliance with a law, rule, or obligation; implement, apply, execute, impose.

80.embrace (verb)

English Meaning - welcome, accept, adopt, support.

81.mechanism (noun)

English Meaning - procedure, process, system, method.

82.surprise inspection (noun)

English Meaning - unannounced check, sudden audit, random evaluation, spot check.

83.well-met (adjective)

English Meaning - effectively addressed or fulfilled; fully satisfied, adequately catered to, properly provided for, fulfilled.