MUHS VC: Medical colleges need human resources, not buildings; MBBS student burnout on the rise

Lt Gen (Retd) Madhuri Kanitkar

The recent incidents of resident doctors killing and trying to kill themselves in the country’s medical colleges have once again put the spotlight on the immense stress on medicos in the country. I have been in academia for a long time – first as a student, then as a faculty member and dean, and now as vice-chancellor – and I can say that the situation is worsening.

While there were stray suicides even earlier, the sheer number of complaints about student burnout I get is unfortunate.

Societal changes and policy reforms have both led to this moment. For one, the joint family system, which exerted some control over youngsters’ lives while offering them a cushion of support, has given way to much smaller, liberal nuclear families. With an omnipresent social media, aspirations are on the rise.

We see students from all backgrounds – even the sons and daughters of rickshaw drivers and street hawkers – joining the top medical institutions in the country and I feel so happy with the equal opportunity provided to every child. This is indeed a remarkable achievement and a testament to ‘India shining’. But with this also comes the challenge of adjustment. When the social spectrum being represented in an institute belongs to different sections of society, assimilation can become a little difficult.

Then, the policy change and its impact need to be discussed. Earlier, most candidates would choose from the few colleges in their vicinity. There were separate tests to get into the top-tier institutes like AIIMS Delhi, PGIMER Chandigarh and JIPMER Pondicherry. Unless you found yourself able to compete at that level, you wouldn’t bother about them and pick a more accessible institute. This enabled students to remain closer to their social circle and the support that comes with it.

NEET Counselling: Medical seats up, so is workload

Today, the government has significantly increased the number of postgraduate (PG) medical seats and introduced a central counselling process. Couple this with the large-scale societal movements, and students often land up at medical colleges far away from their homes. You find yourself dealing with the stress of training and work, while also navigating an unfamiliar locale, food, language and people.

While this change happened, the workload in the public sector kept piling up. Where a medical college needs a 600-bed hospital, there are 1,000 beds. Most state governments are slow in recruiting faculty members , with the residents bearing the brunt. The phrase “toxic environment”, which I hadn’t heard before becoming VC, is now ubiquitous.

The teachers, often harbouring a sense of control, pile up much of the work to resident doctors . Additionally with shortage of support staff, junior doctors end up doing the jobs of everyone, from ward boys to nurses to runners. The seniors are just waiting for new joinees to offload their work. There's no honeymoon period for PGs.

While higher education opportunities have increased, infrastructure expansion in government colleges is slow. There are some hostels in large cities, where as many as six people are crammed into one room, with inmates taking turns to sleep in the limited bunks. This is no way to treat PG doctors , who are further demoralised by the relatively easier lives of their peers in other careers.

MBBS support systems

While medical colleges are becoming more inclusive, we haven’t put corresponding support systems in place. At the Armed Forces Medical College (AFMC) Pune, for instance, we had a full-time counsellor. Workshops on coping skills are conducted right from the time a new undergraduate (UG) batch comes. There’s a structured mentorship programme, with every faculty taking eight students, two each from every year of MBBS, under their wings. When I was the dean, I expanded it to give it the structure of a family – groups of UG and PG students with a faculty. The idea was to encourage interaction between students and teachers at various levels. Many problems were solved this way.

Then we also had a buddy system, so that students don’t just get stuck with people from only their state and region. It's the extension of the military ethos of having each other's backs. The pairs eventually got changed up, but as a result, AFMC didn't have many of the problems faced by other medical colleges.

I also keep encouraging resident doctors’ bodies to take steps from their side too and rope in counsellors. At AFMC, we encouraged the officers to take up housing and bring their spouses and children, so that they have a life outside of work. We also maintain a strong relationship with the alumni, who keep coming back to the institute, creating an atmosphere of fraternity and belonging.

Also read NMC chief’s mantra for regulating medical colleges: ‘Friendly handshake, less policing’

Medical colleges need human resources

Having said that, the public spending on health is just not up to the mark. If we are prioritising health, we should be spending 7-8% of GDP on health and medical education, which we are not. The second issue is corruption. I have no qualms in saying that as much as you put into the pot, it will leak out unless holes are plugged. Quite a lot of it may not reach either patients or students.

The state governments have been setting up new medical colleges through the slogan ‘one district one medical college’ geared towards vote banks and aspirations of the people. But as we witnessed during the Covid-19 pandemic, only having physical infrastructure and facilities won’t save lives. We need well-trained human resources. While buildings can be constructed and equipment purchased in a matter of years, it takes 10-12 years to produce a faculty. Both should be put in place in parallel.

In the absence of that, we are simply robbing Peter to pay Paul. For example, since the pay scales and terms of employment are better at the new AIIMS, many good doctors from state government institutes are joining them. So, on the one hand, we are opening new government colleges, on the other, we are drying them of faculty. Many of the institutes are operating at 40-50% faculty levels.

Also read ‘Don’t know how NMC permitted’: New medical colleges started without faculty or equipment, say students

Medical Colleges: Public spending

There’s another issue. Our spending is largely in tertiary care, which comes into play when people get sick. But as the adage goes, a stitch in time saves nine. The objective of achieving universal healthcare involves addressing the specific needs of various age, gender and community groups, starting with basics like nutrition, sanitation, clean water and good primary healthcare.

In the Armed Forces, medical officers and their assistants are responsible for taking care of the entire spectrum of health of a certain segment of troops, including testing drinking water and maintaining hygiene. This can be easily replicated in the civilian population, as we already have local government structures in place, even though they are fragmented at the moment and working in silos. The public health personnel have an additional burden of data collection and a lot of time is spent on these tasks.

It's not wrong to open medical colleges, but investing heavily in this one faculty and making everyone doctors may not be the way forward. Ideally, for every specialist doctor, there should be 10 primary healthcare family physicians and 100 nurses and paramedical professionals. Where's this pyramid? Everyone wants to be a doctor, thanks to the colonial legacy of glorifying only the medical profession.

This is also because there's no parity in pay scales. Aspirations drive growth, however, they also add stress and there is no end to aspirations – everyone wants to be a cardiologist, radiologist or some other specialisation, when what society really needs are family physicians. If we start providing people with a good quality of life and a reasonable pay, people will start considering other basic specialities, including family medicine, and society will be cared for.

By contrast, in many of the developed nations, a manual worker like a plumber is able to afford a fancy car. I was surprised to find that in Scandinavian countries like Norway and Sweden, only around 30% of the population goes to university. Others choose vocations and start earning.

Everyone's aspiration in India is to be among the highest earners, when society really needs a team working across all professions and all need respect. Equal importance should be given to every stream of education.

It’s said that AYUSH and modern medicine should be treated at par with each other, but when doctors are counted, the AYUSH professionals are not considered doctors per thousand population. Even though there’s a significant demand for allied professions, such as speech therapists, Maharashtra has only very few government colleges for training them.

In many ways, the Indian healthcare system is still better than others around the world – the United Kingdom’s (UK) National Health System (NHS), for instance, has long waiting periods. The haves in our country can always find the best of care but for the poor it’s a huge out-of-pocket expenditure. The government and the non-governmental organisations (NGOs) will have to step up. A lot of efforts have begun and will need a fast implementation plan to achieve the dream of universal healthcare.

Also read Push for AYUSH courses created many colleges, but BAMS, BHMS, BSMS graduates struggle to find jobs

MBBS admission overhaul

The admission process needs overhaul too. When any process becomes too large, it's difficult to manage. The central counselling continues for months and is often mired in court cases. I understand the urge to have ‘one nation one system’, but at some level, we also need space for federalism as health and education are state subjects too. If, with the ‘one college one district’ initiative, all states are becoming similar, then probably we could think about decentralising admissions.

Earlier, states like Maharashtra, Andhra Pradesh, Karnataka and Tamil Nadu had a concentration of colleges, while the North had only a few. The balance was skewed and being a single nation, every child needed to get equal opportunity. Therefore, centralised counselling was started. But once we have adequate colleges, we could try a different process. There can be a graded system where performance in board exams is also weighed, so that the pressure of one exam, which decides one’s entire life and leads to coaching factories and suicides, is eased. If there are alternatives, there won’t be so much pressure.

Lt Gen (Retd) Madhuri Kanitkar is a former general officer in the Indian Army, becoming the third woman to attain the three-star rank in the armed forces. She was previously dean, AFMC Pune, and is now the VC of MUHS

This piece first appeared in the 200th issue of the Careers360 magazine, published in August 2025

(as told to Musab Qazi)