Putting off NEET-PG exam, an unhealthy move bound to worsen Covid healthcare

The government recently postponed class 12 CBSE exams. Understandable, as there were lakhs of students slated to appear and they could be at risk of contracting Covid-19. But postponing NEET-PG that enables MBBS doctors to specialise? That appears to be a short-sighted decision with far-reaching consequences in hospitals which are already suffering from shortage of everything—from life-saving oxygen and Remdesivir to the number of doctors attending to Covid patients.

The NEET-PG exams were originally scheduled to be held on January 10.  Without giving any reasons, the government put off the exams to April 18. At that time, the first wave of Covid had died down and cases were at a minimum. Now, using the second wave as the reason, it has again been put off to an unspecified date.

Those not in the medical field may not know this, that across the country, government hospitals and many private ones are run by medical post-graduate (PG) students. The Covid pandemic last year and the second wave that is on now have been mostly handled by PG students. Here, the word “student” is a misnomer as they are all in reality full-fledged doctors who are entirely competent to run hospitals and take care of a variety of sick patients. Typically, the PGs are supervised by senior residents, consultants and veteran specialists.

Plans disrupted

Dr. Shalini, VL, a doctor at a primary healthcare centre at Belur in Hassan district, says she took leave to prepare for the NEET exams. But the postponement has dented her plans for higher education as she’s not sure if she would get the time again to prepare in the midst of the Covid crisis.

“When I took leave, I arranged for an alternative doctor as there were a lot of pregnancy cases and the absence of even one doctor affects the rural hospital badly. When we take so much effort, lose pay, and prepare for these exams, it is not right for the government to cancel exams at the last minute,” she says.

Dr Shalini, who completed her MBBS in 2014, has worked in the PHC since 2015. Now she fears she may not be able to prepare again for the exams amid the Covid crisis as she was scheduled to get back to work on April 19.

One should not equate a medical PG student to an engineering student who wants to specialise or pursue higher studies. The engineering student is still a student, who needs to attend classes etc and do all that is normally required for anyone to clear the final exam. So it’s OK if an engineering PG exam is postponed. But that is not the case with a medical PG.

“It’s not like we are a bunch of 17-year-olds. We have gone through MBBS, internships and if there is any group that won’t ruin things now, it is doctors,” says an obviously distressed Dr. Kaustubh KV, a Hyderabad-based aspirant.

No bed available for #COVID patients , families are taking token to get cremation of their near once. Remdesivir out of stock . People are dying.
When country needs more Dr ,Govt postponed computer based #NEETPG Exam.
Election rallies and #kumbh mela to be continued..

— Dr Syed Faizan Ahmad (@drsfaizanahmad) April 15, 2021

The case for holding exams

In the case of class 12 CBSE students, there are lakhs who appear for the exam. In comparison, the current NEET-PG exam involved only 1,74,886 (less than 1.8 lakh) candidates for around 40,000 seats across various specialisations.

Across the country, there are hundreds of exam centres. This effectively means each centre may have had around 100 candidates on an average. Social distancing can also easily be enforced. And, remember, each student is a doctor who knows what needs to be done. On top of it, the National Board of Exams (NBE) which conducts the NEET-PG, had put in place strict protocols that would have included handing over masks, face shields and sanitizer packs to each candidate with strict instructions to don them through the exam period.

Surya BN, 24, from Hassan Institute of Medical Sciences, says that it was adding mental pressure on him and his fellow batch-mates who despite preparing for the exams, are unable to write them and hence forced to stay home.

In fact, the admit cards were made available online three days before the exam was scheduled to start on April 18. And, a prominent announcement on the NBE website stated that there were requests for the exams to be postponed. But that the exams will go on. And, the next day, on April 16 came the announcement about the postponement of the exams.

This has caused huge consternation among sections of the medical community and the students who were getting ready to take the exam.

Kaustubh, the Hyderabad aspirant, termed the postponement as plainly irritating. “How can they put it off after giving admit cards? It seems a wilful decision, bordering on being sadist,” he says.

Kaustubh had a few questions that were bothering him, like didn’t the government realise that these exams would help the Covid situation by making available more doctors in various hospitals? And, whether NEET-PG couldn’t have been held as an exception since it is such a useful exam?

A PG aspirant in Kolkata, who preferred anonymity, says the NEET-PG21 was already delayed by three months. “Now, this last minute postponement after issuance of the admit card is really frustrating. To prepare for the exams, I had stopped working as an intern.  Now, I have neither the job nor the PG seat. I have to now re-chart my plan and motivate myself afresh, which is tough.”

“In the entire country, around 1.75 lakh would have appeared for the entrance examination. It is not a huge number. If we can have election rallies, movie shows, I don’t think it was a big deal to conduct the examinations maintaining all Covid safety protocols,” lamented the Kolkata aspirant, a sentiment that was echoed by several other PG aspirants that The Federal spoke to.

The medical system is such that as the third-year PGs exit their course and leave the hospitals, they are replaced by first-year PGs, so there is no drop in the overall numbers.  Now, it is different. Dr. Meghna Rai at JSS Hospital in Mysuru, who has just entered third year PG, says the postponement was beyond belief.

Covid disarray

Already the system was in disarray due to Covid last year. Now with the current postponement, there is no clarity when the first year students would join. Already there is a shortage with the final batch of students about to give their exams and ready to leave, she says.

According to Dr Arunava Mondal, a house staff in Malda Medical College and Hospital and a PG aspirant, in every hospital, the patient management is handled by the first year post graduate trainee (PGT). The delay in PG entrance examination has snapped the supply of PGT, creating additional burden on 2nd and 3rd year PGTs.

Plea to all Indian doctors / nurses association’s / public & private hospital admins to collectively protest against large gatherings across the country . Our healthcare system will collapse with tsunami of cases @IMAIndiaOrg young doctors on Covid duties are already fatigued

— Dr Parul M Sharma (@DrParulSharma1) April 13, 2021

In the present scenario, many universities have already announced dates for the third year exams and in a matter of weeks, there is going to be a huge outflow of doctors from hospitals across the country.  With the PG entrance exam postponed, who is going to take their place? According to some estimates, this will mean a shortage of around 40,000 doctors.

Hassan aspirant Surya BN says, “Most students join hospitals immediately after MBBS exams and work for two-three months as junior doctors. They continue to work or pursue higher education depending on the results,” he says. “But now, most of us are sitting idle instead of working in hospitals. We could have easily earned some money and helped the government tackle the COVID crisis.”

Dissecting the crisis at a micro level brings in more clarity. For example, in Kerala, Dr. Jeevan, a junior resident (PG) representative at the Government Medical College, Thiruvananthapuram, says there are 200 house surgeons in his medical college. Their tenure ended on April 15. “We have all suffered a burnout and the situation is going from bad to worse,” he says.

According to him, each government medical college in Kerala on an average has 200 house surgeons. Their exit leads to a sudden shortage of doctors. “There are 90 Covid patients in the male ward of Thiruvananthapuram Medical College now, and there are only two doctors on duty.”

With the Covid second wave showing all signs of an exponential rise, this is the time when doctors are desperately needed in hospitals. The NEET-PG postponement does nothing to help the situation.

The irony of the decision to put off the exam is that it is these doctors who would eventually be treating Covid patients. For this section, which would need to go into the “war zone”, preventing them from writing an exam for fear of Covid is irrational.

Reason to leave country

Dr Naveen, who is preparing for PG-NEET in Tamil Nadu, says “most of the aspirants who prepared very hard for the last one year are now losing confidence”.

Medical PG infrastructure in India has been historically abysmal.  Thousands of bright doctors who could have been of great help if they had worked here have over the years been forced to leave India as there is no space in the higher education system to accommodate them. These doctors eventually thrive in the United States, United Kingdom and elsewhere, treating lucky patients there. For India, it is a permanent loss of these talented and highly skilled individuals.

In the current situation, with NEET-PG aspirants left in a lurch after the latest postponement, those that had decided to remain in India would now be tempted to attempt post-graduate exams conducted by the US and the UK and leave the country as many of their predecessors have done.

One rationale by the government for putting off the exams was a plea by a section of students who said they had been unable to study as they were busy working in hospitals with Covid patients. The volume of study for the PG exam is so huge that even without working in hospitals, aspirants generally struggle to be fully ready for the exam. In addition, the Covid pandemic does not seem to be going anywhere.

Another reason for the government putting off the exams was that a group of doctors had approached the Supreme Court pleading for a postponement. Even before the court could give any direction, as if on cue, Union Health Minister Harshvardhan tweeted the decision to postpone the exam. The government could have awaited the court ruling, at the least.

As some students have said, the medical education at the PG level has turned into a bigger mess since the Covid pandemic last year. Instead of sorting out the mess, the postponement has aggravated existing problems. This is bound to hurt the interests not just of PGs but also lakhs of patients who are depending on them for dear life.

(The writer’s son is a NEET-PG aspirant)

(With inputs from The Federal bureaux in Kolkata, Bengaluru, Thiruvananthapuram and Chennai)