REFLECTIONS
The unacknowledged cadre: hurdles for MBBS graduates in Kerala’s medical landscape
This personal narrative discusses challenges faced by MBBS graduates in Kerala’s public healthcare system. Based on observations as a government medical officer, this essay examines a culture where professional skills and humane values are often overshadowed by a system that prioritises postgraduate degrees above all else. It questions the fairness of a structure that sidelines clinicians without higher qualifications, even when they are capable and dedicated. MBBS graduates often suffer a lack of decision-making power and are frequently excluded from institutional leadership and recognition. They are treated as a secondary group, becoming invisible, undervalued, and disempowered. The narrative draws comparisons with historical instances of institutional oppression and shows how extra-clinical talents are often ignored in favour of strict hierarchies. This essay advocates for a change toward a more inclusive and fair system where one's abilities and contributions are not judged solely by the number of degrees held.
Copyright and license ©Indian Journal of Medical Ethics 2025: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0), which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.
I would like to congratulate the author Dr. Anoop Prathapan on his excellent discourse, pointing out the fallacies of an education system that crowns doctors with post graduate degrees, rather than valuing those MBBS with experience and with superlative managerial or communication skills, who may far surpass a post graduate degree holder working in the same hospital under similar circumstances.
Years ago, I faced the same problems in some degree when I had to take a considerable break between my MBBS and MD degrees( about 10 years)- this happened because my MBBS training at a premier institution in India did not prepare me in theoretical knowledge required to pass an MCQ based PG entrance exam and we did not have the resources to “pay’ for a PG degree seat. The whole MBBS and MD system is flawed and the value given to experience, continued medical education, or managerial skills in the system is very little and as the author so rightly points out, undermines the confidence of an “MBBS only” doctor in managing patients. I remember an instance when the charges I had put for suturing a deep and long wound of a patient who was bleeding profusely, were reduced and written off by the then physician in that mission hospital in Kerala, without letting me know.
I would also like to bring to notice the large number of undergraduates who each year join the fray- who have qualified from countries outside India. Their skills are often suspicious and cannot be standardized- the same can be said about undergraduates from different colleges in India- medical learning is not uniform in Indian medical colleges too.
The Indian medical system favours those who ‘keep quiet” and do not challenge the system as pointed out by the author. Whistleblowers are treated with disdain and socially ostracised. In this context I must also mention the IMA meetings held regularly in various towns and cities of Kerala. These meetings can serve as a place where undergraduates are given prominence and brought into the leadership of the organization.
The National Medical Council of India has to sit back and take a look at our undergraduate medical system – are we bringing out competent medical graduates each year, and if so, what criteria other than mugging up for NEET exams are used to assess competency? What is the role for empathy and kindness in our medical graduates ? What about soft skills ? Why are soft skills not given more emphasis in a domain that is based on care of the fellow human being? Does anyone any longer even look at the Hippocratic oath seriously?
I suggest that the NMC acknowledges the role played my medical undergraduates and honors them- every year many undergraduates fall through the system and do not qualify for post graduation- what can be done to encourage them in whatever role they play in the hospitals they work in. Or the NMC must look into extending the Medical degree course ( MBBS) to a total of 8-10 years, including a post graduate degree.
It is high time the medical education system of the country be given more thought and scrutiny and commendation to young doctors like Dr. Prathapan, who haven’t yet given up.