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November 16, 1999


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A Lose-Lose-Lose Proposition

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Dr Jayakrishna Ambati and Dr Balamuralikrishna Ambati

The steady stream of Indian American youth entering medicine consistently generates controversy over whether parents exert too much influence over their children's choice of career, an enduring intergenerational debate in our community. However, one disturbing facet of this issue is rarely touched upon and is almost hidden from view: the rising number of Indian American youth who go to India for their medical studies after completing their primary and secondary education here.

It has almost become fashionable to send one's sons or daughters back to India to become a doctor. However, the long-term consequences for Indian and American medical education, and more importantly, for the students themselves, are rarely pondered.

First, many of these students go to India to study medicine in so-called "donation" colleges. That is, their parents essentially buy them a seat, regardless of merit. This furthers the continuing corruption and degradation of India's higher education system and social fabric, while depriving many meritorious Indians of a shot at becoming a doctor, for want of the financial resources at the disposal of Indian Americans.

That these colleges are legal is no defense: a morally perverse practice cannot be legitimized by the sanction of a society that reeks of corruption.

Moreover, almost all the Indian American students aim to practice in America. These youth go to India to get a cheap education (at significant public expense), learn on Indian patients, and then quite often don't even do the year of house surgency -- a mandatory year of service after studies but before the MBBS is awarded) in India. They prefer cozy fourth-year medical student rotations in America.

Many have decried the "brain drain" of India youth getting excellent education in India, only to leave for the West after their education. If that's a drain, then this is nothing short of highway robbery.

Second, many of these students use American educational loans to finance their education in India. This not only funnels precious medical education funds away from American schools and students, but combined with the practice of "donation" colleges, amounts to fraud: many schools falsely increase their "tuition" for Indian American students to procure more of these funds.

At a time when student loan programs and education moneys in general are drying up, it is heinous to divert scarce resources for fraudulent uses. This cannot be rationalized by saying that the loans are repaid. The American taxpayer pays the interest on Stafford and Perkins loans (the most commonly used medical education loans) during medical school and two years of residency.

The pool of loan money is finite and shrinking and thus loans funneled to such fraudulent uses as purchasing a seat in a medical school deprive American students and schools of the funds. Fortunately, the US Department of Education and General Accounting Office are investigating the disbursement of loans for foreign schools.

Furthermore, the education at donation colleges is frequently below par. Indian Americans trained at these schools and returning to America to practice are often undertrained, compromising both patient care and the hard-won reputation of Indian doctors.

It is common knowledge that doctors educated in Indian medical schools excel in America. First-generation Indian American doctors trained at AIIMS, Guntur, Madras Medical College, Pondicherry, etc (schools where admission is based on merit, not money) have earned their reputation in America. Anyone familiar with medicine knows this. They also know that NRIs going back to India for their medical education are no Rhodes scholars.

Finally, the kids themselves get cheated in the end. With their mediocre education, they generally perform poorly on the US medical licensing exams, and are restricted in their options for residency training both by that and the fact that they are foreign medical graduates.

It is already very difficult for FMGs to get into highly competitive specialities like neurosurgery ophthalmology, and otolaryngology. In the coming years, wholesale cutbacks in residency spots will occur across the board, making access to even primary care fields difficult, let alone specialities. More importantly, restrictions on FMGs will grow in coming years, as federal funds will no longer fund residency training for FMGs. Hospitals cutting costs and reducing residency programs will target FMGs first.

Why do so many Indian parents send their children to India to study medicine? Often they think they save money (medical education in America can cost upwards of $ 100,000) and time (the US system is four years of college and an additional four years of medical school, while Indian medical education lasts only five-and-a-half years).

But they do not consider that the cost of a medical education is mostly in loans, which will be paid back over the course of a medical career (still a well-paying, if not lucrative, profession). As for time saving, parents and their children don't realize that many will spend a year or two after their return passing the required exams. Fifty per cent or more will fail on their first attempt because of the differences between American and Indian medical education. They will also whittle away time in "observerships" meant to familiarize FMGs with the American medical system but which really are time-killing periods before application season. The time advantage is a mirage.

Another reason for going to India is that many youth are not able to secure admission to a good college here, and hence their chances for getting into medical school will be limited. This is really a sad reason to go to an Indian medical school.

American citizens going abroad for medical education are automatically stigmatized and considered of a lower caliber in the minds of many a residency program director. More importantly, what message does this send to our youth? Do we really want to convey the idea that if you can't cut it here go into exile and try to beat the system? When we Indians pride ourselves on our academic achievements, this is the height of hypocrisy.

Learning is achieved not by trying to cheat the system, but by perseverance, dedication, and redoubling one's efforts; otherwise, we end up cheating ourselves.

Many Indian parents like to think that sending their children to India for higher education will inculcate culture and preserve Indian heritage in their offspring. They forget that culture is preserved less outside than in the home. Indian parents who think that sending their children to India will shield them from "negative Western influences" delude themselves: these influences are just are present in Bangalore or Bombay as they are in New York.

A home and a family that truly preserves and promotes Indian culture are a better barrier against the tide of temptation and a better medium to transmit one's heritage. Parents who send kids to India for this reason do a disservice by not addressing their failure to pass on Indian traditions and philosophy.

Also of great concern is that, all too often, the parents of these students insist on them becoming doctors. Many of them find themselves in a poor academic position due to a lack of discipline in their studies, a trait that has as much to do with parental upbringing as with anything else. It is a tragic irony that parents who, for whatever reason, did not instill discipline at the appropriate time turn around and almost force their children into career paths that are counterproductive in the long run.

It is time that the Indian community is frank with itself: NRI students go to India for medical education to save time, cost, parents' desire for cultural preservation, and their inability to get into medical school here.

But Indian Americans should take pride in their achievements and build their education and themselves on the shores of the land where they are going to live. No one wins when young Indian Americans are sent to India for their medical studies, except perhaps the corrupt administrators of donation colleges. This trend is bad for Indian education, American medicine, and especially the students who follow it. Sending youth back to India for medical education is a lose-lose-lose proposition.

Balamuralikrishna Ambati was 17 when he became a doctor, the youngest person to get a medical degree. His brother Jayakrishna Ambati was 21 when he received his medical degree. Both graduated from American medical schools.

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