You might shell out big bucks when wheeled into the emergency ward of a large private hospital, but do you also get the best trained doctors in emergency medicine?
Most of these hospital emergency departments are staffed with MBBS graduates lured into illegal courses that claim to be giving a master’s in emergency medicine (MEM). From the number of patients they get to see, to the quality of faculty who train them, a number of questions have been raised. The Medical Council of India (MCI) has notified all such courses as illegal and hence not to be registered as additional qualification.
The MCI and the National Board of Examination (NBE) have strict criteria regarding how large a patient load an emergency department needs to start postgraduate specialisation in the discipline, and a highly competitive entrance exam to get a seat. Preying on the insecurity of those unable to clear such exams are a plethora of supposed MEM programmes offered by various hospitals that masquerade as postgraduate degree courses.
The two main MEM programmes offered include one by the Society of Emergency Medicine of India (SEMI), and the other by various corporate hospitals in conjunction with George Washington University (GWU) in the US. SEMI president Dr T S Srinath Kumar says they don’t claim to give a postgraduate degree.
“Our MEM is just a certificate given by SEMI. It is the MEM given by GWU that the MCI declared illegal, not ours,” he said. While he claims that SEMI-MEMs will be phased out by 2020, they started the course in 15 more hospitals last year and six more this year. Currently, about 86 centres are churning out about 350 MEMs each year. There are 79 seats for MD in emergency medicine in 28 medical colleges, and 248 DNB (Diplomate of National Board) seats for it in 50 institutions .
In the case of the MEM offered through a tie-up with GWU, the numbers have gone up from three centres to 11, with as many as 6-10 students in each centre – about 100 MEMs a year. About 74 doctors from eight centres got a GWU-MEM in 2016. Students are being charged Rs 4 lakh to 6 lakh per year as fees. Though they promote it as a postgraduate master’s programme of an American university on their website, the fine print says that the ‘degree’ is not recognised in the US.
The MCI does not allow parallel courses in colleges with MD (postgraduate course) seats to prevent students’ training from getting diluted. However, many hospitals and medical colleges running DNB courses are also running MEM courses. For instance, Peerless Hospital in Kolkata has four DNB seats, for which the requisite patient load is 6,000-10,000 annually (16-27 patients per day. It is also running the GWU-MEM with about 12 seats. So the faculty and the patient load meant to teach the 12 (4×3) DNB students is being used to teach an additional 36 MEM students since it is a three-year course. This severely limits the quality of the DNB training. This is happening in several institutions where MEM courses are being run along with DNB, though the NBE is categorical that it “does not allow concurrent administration of any programme with DNB Emergency Medicine”.
In many of the institutions running both DNB and MEM, faculty qualification too is an issue. Unlike the MCI, inspection reports of hospitals given DNB seats are not in the public domain. Hence, one does not know if the faculty counted during inspection and those shown on the hospital website are the same.
On hospital websites, most of the ‘faculty’ in the emergency departments have qualifications like MEM or even diploma in emergency medicine, which are not qualifications recognised by the MCI, the medical regulator of the country. The NBE spokesperson told: “MEM qualification has never been accepted as an eligible qualification for being DNB Emergency Medicine faculty. There is no approved faculty in any NBE accredited department with MEM qualification.”
However, in MIMS, Kozhikode, which has 8 DNB seats for emergency medicine, Dr PP Venugopalan is shown as faculty for both DNB and GWU-MEM, which has 10 seats. Barring him, no other emergency department faculty has any qualification other than MEM going by the hospital website. Dr Venugopalan also does not accept that GWU-MEM is illegal. “We have filed for reversal in the MCI and we have the course running in five hospitals of our group,” said Dr Venugopalan . However, MCI president Dr Jayshree Mehta told that the MCI had alerted the public at large not to enrol themselves in such courses and declared these courses “unrecognised and unauthorised” and therefore “not legal”.