A Doctor’s Love Letter to ‘The People’s Hospital’
Could a charity hospital founded by a crusading Dutch playwright, a group of Quakers, and a judge working undercover become a model for the U.S. health care system? In this episode of the podcast “An Arm and a Leg,” host Dan Weissmann speaks with Dr. Ricardo Nuila to find out.
Nuila’s new book, The People’s Hospital: Hope and Peril in American Medicine, uses the innovative model of the Ben Taub Hospital in Houston, where he practices, to argue for a publicly funded health system in the U.S. that’s available to everybody, with or without insurance.
Dan Weissmann
Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Transcript: A Doctor’s Love Letter to ‘The People’s Hospital’
Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
Dan: Ben Taub Hospital is a publicly funded safety net hospital in Houston, Texas. The majority of patients don’t have insurance of any kind.
Dr. Ricardo Nuila has been working at Ben Taub since he was an intern, a medical student. He took me on a tour.
Ricardo Nuila: I started here and, you know, literally I just did not want to leave here cuz I just, just really enjoyed my job here
Dan: He’s just published a book called “The People’s Hospital” that’s not just a love letter to the place, it’s a pitch:
Not only is this place way, way cheaper than what we’re used to, in many ways it’s better. And it’s a model, a real alternative to what-we’re-used-to.
So, I ask him to pick ONE patient’s story from the book to tell, he picks a patient he calls Stephen. A restaurant manager, a Republican. A guy who did not expect to end up here.
But he had a giant lump on the side of his throat, and his insurance didn’t cover much. He paid cash, upfront, to get seen in a local ER.
Ricardo Nuila: finally there was a doctor who had seen a CAT scan and said, you have tonsillar cancer, cancer, however, you don’t have, uh, insurance
Dan: Tonsillar cancer. Cancer of the tonsils. That landed hard. So did the “however.”
Ricardo Nuila: He felt shitty you know, that somebody could tell you cancer, but there’s nothing that we are gonna do about it because of, of how much and…
Dan: It’s like it’s too painful — or too obvious — to finish the sentence: Because of your insurance. Somebody tells Steven to try the public hospital, Ben Taub. He expects the worst. But that’s not what he finds.
Ricardo Nuila: He comes to love this place. He gives, this is like so Steven, but he, he gives gift cards to the people greeting at the door because they’re nice and they do their job well cuz they make his day,
Dan: And it’s not just that he likes the people at the door.
Ricardo Nuila: He feels like he got really good healthcare and that he also, um, thought that the price was extremely reason.
Dan: Stephen lost his insurance when he got too sick to work, and he doesn’t qualify for Medicaid. He owns a house, he’s got savings, Texas has really stringent Medicaid restrictions– so he’s paying out of pocket.
Ricardo Nuila: But his final bill is pennies of what he thought he would pay.
Dan: Stephen’s dad had gotten radiation treatment for cancer, and the sticker price was 700 thousand dollars. Stephen had gotten radiation AND chemo AND surgery — and had been hospitalized for a good while.
His bill was 32 thousand, three hundred and seventy-eight bucks. Real money for sure, but he can pay it. And it’s less than five percent of his dad’s bill for much less extensive treatment.
Ricardo Nuila: And the healthcare is really good. And so he’s almost proud that he’s had this experience
Dan: Steven’s become a convert. And as Ricardo Nuila walks me into a conference room, it’s clear: He hopes his book will create more converts.
Ricardo Nuila: you start to see this model and it makes you think, can things be different in healthcare? I think that that’s an option. But we as a country haven’t thought about that. Seriously. You know?
Dan: And if it seems politically unimaginable that we could have anything like this around the country– an effective, efficient, CHEAP, publicly-funded health system–
Well, the idea that Houston could have one, that was pretty unlikely too.
In fact, the story of how Ben Taub got here may be the most surprising story in Ricardo Nuila’s whole book.
This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life and to bring you a show that’s entertaining, empowering and useful.
Ben Taub Hospital sits at the edge of the Texas Medical Center– that’s a giant neighborhood full of hospitals and medical schools, including some of the best in the country, like the M.D. Anderson cancer center.
In his book, Ricardo Nuila writes about how some patients at Ben Taub can see from their rooms the gleaming buildings of Ben Taub’s neighbors.
So when I visit, I make him show me the view. We look out from a stairwell at a glass tower, M.D. Anderson’s Sheikh Zayed building.
Ricardo Nuila: that’s glamorous. Right? you get a glimpse into the rest of the medical center here. Ben Taub sticks out, I feel like, because it’s, it’s brick versus glass.
Dan: But as Ricardo Nuila makes clear in his book: This unglamorous brick building gets the job done.
In addition to Steven, there’s Ebonie, whose complicated pregnancy — there’s a lot of vaginal bleeding– gets tracked more precisely than it would elsewhere:
At other hospitals, nurses eyeball the pads that absorb that blood and note heavy, medium or light bleeding. At Ben Taub, they’ve adopted an innovative approach: weighing each pad to get an exact measurement.
Another patient, Christian, has bounced around other systems without anybody accurately diagnosing the dire kidney problems that have kept him in pain for years. Because he didn’t have good insurance, it wasn’t worth anybody’s time.
At Ben Taub, insurance isn’t an obstacle,
Ricardo Nuila: We organize things, which is basically, okay, we need to focus on your kidneys right now and we need to get you to see a geneticist. And both of those things happened.
Dan: they not only diagnose him, they get him on a form of dialysis that he can manage himself at home.
It’s cheaper, and delivers better quality of life for him.
Everything at Ben Taub is cheaper. The system spends about a third as much per patient as the national average. In part, that may be because nobody earns million-dollar salaries here.
But Ricardo Nuila makes the case over and over again that they take the time– because they have it– to make wise use of resources.
They don’t have as many MRI machines as other hospitals. But guess what? A lot of patients don’t need MRIs.
But Ben Taub can’t meet every need: One patient, Geronimo, needs a liver transplant, and that requires resources the hospital just doesn’t have.
But Ricardo Nuila and his colleagues put a lot of time into wrenching him back onto Medicaid, so he can get the transplant somewhere else. They rope in a Congressman to get it done.
Geronimo tells his mom:”I feel so important. Everyone treats me like I’m rich.”
Ricardo Nuila: That’s what I think a lot of people really want is just the sense that the person who’s responsible for your care is thinking through the problem with you and aware that you are not having a great day and wants to deal with that situation with you. And I just felt like this environment allowed me to like, have those moments.
Dan: So who pays for this environment? It may be cheaper, but it isn’t free.
Some patients are on Medicaid. Some are on Medicare. Some have private insurance. But the majority don’t have any insurance at all.
Some, like Stephen, pay cash. And a lot of the rest — about a third of Ben Taub’s patients — are treated for free.
The bulk of Ben Taub’s funding comes from a special property tax in Harris County, where Houston is located. It funds a whole system called Harris Health– Ben Taub, a second hospital, and a bunch of clinics.
And of course, none of this has always existed.
In fact, it’s only here, like this, because of a really wild story, with two big characters. One of whom wasn’t even from Houston. He was a writer I’d never heard of, a Dutch guy named Jan de Hartog.
Ricardo Nuila: de Hartog was one of the most amazing people that you could read about. He was a Nazi resistance fighter, Dutch ship captain.
Dan: And while he was hiding out in Denmark during the war– in between saving a few Jewish babies and running war missions in his tugboat–
he wrote a romantic dramedy that — later became a broadway hit. And then got adapted into a Broadway musical called I Do, I Do– which, Broadway-musical nerds in the house– starred Mary Martin and Robert Preston– you know, The Music Man– and had a song that your mom might still remember.
(musical sounds)
Dan: Yeah. So, interesting guy. And in the early 1960s he came to Houston to teach playwriting at a local University. It was a big time for him. He’d just gotten married — for the third time, but this one was for keeps- and become a Quaker.
Ricardo Nuila: And when he and his wife Marjorie come to Houston, they find that there’s all these whisperings about this charity hospital in town in Houston about how, how awful the conditions are. That the children in the maternity ward would cry all night for the, for a lack of milk, and so as part of his faith, he decides that he needs to volunteer there
Dan: When de Hartog writes about the hospital later, he describes the experience of walking in for the first time as literally mind-boggling.
He’s like: I know what a hospital smells like. Disinfectant, maybe some fresh laundry. And I know what a slaughterhouse smells like: Blood, and shit. And the smell here is slaughterhouse.
As he looks around, the sights are something else.
Ricardo Nuila: He sees a cockroach crawling into the tracheostomy of like a patient. He sees like people sitting in their own filth.
Dan: He and Marjorie do not up and quit. They stick around. And then they recruit a dozen Quakers and a few society ladies to come volunteer with them, and get the Red Cross to train them.
And it’s nuts. This is a rich city. The ZOO is air conditioned. But not this hospital.
And he starts to catch on: Why it’s so horrible.
Number one is racism.
The hospital serves mostly Black and Brown patients. When Jan and Marjorie start volunteering, the other volunteers are all society ladies, and the whole program is set up so they don’t touch patients. DeHartog later says he asked why, and the volunteer coordinator says, Southern ladies can’t have physical contact with black people.
But she doesn’t say black people. She uses the n-word.
When he asks staff why public officials don’t do something about the rotten conditions, they say: What politician is going to stick up for black people? The n-word comes up again.
And– de Hartog doesn’t make this connection, but it seems pretty on the nose: The hospital itself is named after Jefferson Davis, who led the Confederacy in the Civil War.
But there’s also a political mechanism for institutionalizing this neglect, without ever having to acknowledge the role of racism:
No one particular political entity — no one particular political leader– is responsible for the public hospital, financially. The city of Houston and Harris County are each supposed to kick in HALF. So it doesn’t belong to either of them. Here’s de Hartog describing the city-county dynamic in a lecture he gave many years later.
Jan de Hartog: And they were continuously at each other’s throats. The one said, you don’t pay enough. The other said, but you don’t. And they went back and forth
Dan: The top official for Harris County actually has the title County Judge. At that time, this was a guy named Bill Elliott.
And you’ll hear in this clip from a local newscast, he wasn’t exactly reaching for the bill. Here he is, explaining why the some problem with the hospital is actually the CITY’s fault.
Judge Bill Elliott: it’s absolutely ridiculous, uh, to say that, uh, this is a responsibility and this is the fault of Harris County.
Dan: And the city? At least one.council member is calling for a budget cut.
Which really pisses de Hartog off.
And de Hartog actually loves the city. It’s an exciting place. It’s booming– growing super-fast. And it’s not just an oil town.
Ricardo Nuila: Houston at that time was the home of NASA.
NASA narrator: Future manned space flight missions to the moon and perhaps the planets will be commanded from this control room of the Mission Control Center at NASA’s Manned Spacecraft Center,
Ricardo Nuila: It had built this Astrodome, it was the city of the future.
Dan: The Astrodome– you know, a sports stadium WITH AIR CONDITIONING. .
Astrodome Narrator: A fully enclosed building, large enough for any sport convention show or conclave with constant temperature and humidity independent of outside weather,
Dan: CBS News does a report about the booming city: NASA, the oil wealth, the Astrodome. And de Hartog is a main character– talking about how much he loves the town.
Jan de Hartog: it is a city of, a city of unlimited opportunities. It’s an immensely exciting town, and you feel that anything is possible,
Dan: It wraps up with Walter Cronkite talking about how everybody in town is absolutely nuts about football.
Walter Cronkite: Their brand of football is like their brand of city and brand of life. Play wide open. Take a chance, try anything. Above all, do it with zest and do it big.
Dan: Oh, and there’s this OTHER thing Houston is really becoming known for.
Cutting edge medicine. For twenty years, the city’s been building the Texas Medical Center — that giant campus where more than a dozen hospitals and med schools now operate right on top of each other. Baylor College of Medicine actually moved from Dallas to Houston to be part of it.
Ricardo Nuila: Houston is a really deeply medical city. And at that time they’re all working on extraordinary things
Dan: Yeah, in 1964, while Jan de Hartog is witnessing the suffering at the charity hospital, Dr. Michael deBakey is performing the world’s first coronary artery bypass at a private hospital in town.
But the medical establishment were not allies. Jefferson Davis hospital, on the outskirts of town, was about to be replaced by a new building in the Texas Medical Center.
But the Medical Society– the local doctors’ association — hadn’t wanted the charity hospital as a neighbor. They’d actually put up a ballot initiative to keep the new building at the old site.
Medical Society Voice-Over: you the taxpayer, will pay the extra cost That’s why your doctor recommends you vote for the new hospital to remain at its present site.
Dan: It hadn’t worked, but along with the budget cuts, officials were now talking about DELAYING the charity hospital’s move to the new building, which had just been completed. De Hartog and his friends, smell a rat.
They think the powers that be are actually going to sell the new building in the Medical Center to some other hospital that wants in. This has been a public conversation.
Jan de Hartog: There had been offers to buy it and they wanted to wait for the highest bidder
Ricardo Nuila: He writes a series of op-eds for the Houston Chronicle that start to get press, not just in Houston, but around the country and in fact around the world.
Dan: He describes the awful things he’s seen. And he appeals to Houstonians’ sense of pride in their bustling, futuristic city. A city he loves, too. Here’s how his first op-ed ends…
Jan de Hartog: I cannot believe that it is the will of the citizens of Houston, that our growing medical center rightly becoming famous all over the. Shall be allowed to harbor the cancerous sore of man’s inhumanity to man. It would turn the entire center planned as Houston’s glory into Houston’s shame.
Dan: Even just that first op ed made a lot of noise.
Jan de Hartog: the bomb exploded and the national magazines and newspapers and TV zeroed in on the hospital to find out what was going on,
Dan: … and immediately, the hospital DOES move into its new home in the Medical Center. But the funding issue isn’t solved.
So de Hartog keeps pushing.
Ricardo Nuila: He writes a book called “The Hospital”
Dan: He goes to churches around town, synagogues, everywhere he can, recruiting hundreds of volunteers.
But there’s no political progress — and conditions at the hospital actually get worse. Key nurses get burned out and quit. Things go to hell.
In a harrowing diary entry, he writes about full bedpans left on tables next to trays of food. About a patient crying out for help, and hearing back “Shut up!”
Jan de Hartog: Never before had I realized to this extent, the depth of our damnation, and at that deepest moment of desperation, when we knew nothing could be done, nothing would change for the simple reason that
Jan de Hartog: those who had the fate of the hospital in their hands were not there. Mayor Welsh didn’t work there. Uh, commissioner Bill Elliot Judge, the county judge did not work there.
Dan: But THEN, there’s a turn. Somebody shows up. That’s right after this.
This episode of An Arm and a Leg is produced in partnership with Kaiser Health News. That’s a non-profit newsroom about health care in America. KHN is not affiliated with the giant health care player Kaiser Permanente. We’ll have more information about KHN at the end of this episode.
So, Jan de Hartog keeps slogging away.
He gives a talk at a Baptist church– he reads that diary entry, the one with the bedpans, and the absence of Judge Elliott and other leaders.
And at first he thinks he didn’t go over so big. Nobody even raises their hand to volunteer.
But then it happens.
Jan de Hartog: When, uh, we were about to leave, a man turned up with a baby on his hip who said, uh, do you train people at night?
Dan: And the guy seems to be looking around, trying to make sure nobody’s listening. De Hartog tells the guy, yeah, we could do that…
Jan de Hartog: He said, I mean, a dead of night without anybody seeing.
Dan: De Hartog’s like, “um, sure, I guess. Why, though?”
Jan de Hartog: He said, well, I am Judge Elliot,
Dan: Judge Elliott. The county judge. Probably the most powerful politician in town. That’s who wants to volunteer. In secret. Without anybody seeing. He says to de Hartog
Jan de Hartog: I cannot do it as a judge, but I must do it as a man. And that was the moment that the whole damn thing changed..
Dan: Because Judge Bill Elliott followed through.
Ricardo Nuila: He trains himself in a clandestine manner to be an orderly, at night, and he verifies everything that de Hartog has said.
Dan: de Hartog actually oversees the judge’s final practical exam, where Bill Elliott tends to an African-American man named Willie Small.
Jan de Hartog: the judge with his thermometer went and put his hand on Willie’s shoulder and said, Mr. Small, sir, I’d like to take your temperature to hear that, to hear a southern judge, , say “Mr. Small, sir”
Dan: It was a symbolic moment. The judge had to touch, had to defer to, a Black man. So not only had the judge now seen everything, he took responsibility for what he had seen.
There’s a proposal for a county-wide property tax, to fund what’s called a Hospital District. Now there’s a referendum, and Elliott backs it all the way.
Jan de Hartog: and we all waited with baited breaths for the outcome. And it was no
Dan: Yeah. The referendum fails. And as de Hartog tells it, once it does, a real backlash starts to build. It gets personal.
Jan de Hartog: those who had resented our presence from the very beginning became vocal. Margie and I, were called communists
Ricardo Nuila: De Hartog just would not flinch. I mean, he and his wife’s lives were threatened.
Dan: Also, somebody threw a bag of excrement at their door.
Eventually, de Hartog says the Red Cross, which was training and supervising volunteers at the hospital, came to him and Marjorie and said, “It might be better for us if you left town for a while.”
They did — went on to all kinds of adventures.
Meanwhile, Bill Elliott kept pushing, and keeps pulling in allies– including, eventually, the Medical Society.
Ricardo Nuila: he rallies them to get behind it.
Dan: He gets the question on the ballot AGAIN later that same year. And it passes in November 1965.
It’s a big moment.
Ricardo Nuila: What’s also interesting is that it’s forgotten. Something that I’ve gleaned from all this is that you know, people will forget and you have to remind them.
Dan: And while we’re remembering: In 1965, the whole country is making some big commitments to health care for a lot of people. President Lyndon Johnson signs Medicare and Medicaid into law in July of that year.
It’s probably also worth noting that Medicare and Medicaid help make Ben Taub possible: About a third of the hospital’s patients are on one or the other. It’s a minority of patients, but it’s many millions of dollars of funding.
The 1960s were a notoriously divisive time. And so is this.
Ricardo Nuila doesn’t ignore today’s political polarization — or how that polarization makes it hard to imagine a national conversation about creating a different health care system.
Or the role that doctors have historically played in resisting that conversation.
It’s part of his story. His family story. And in a book about a place where a lot of sad things do happen, this may be the toughest one.
Ricardo Nuila: I was born into a family of doctors and my dad in many ways was a hero to me. I saw how much pride he took in his work of being a doctor
Dan: But over time– as insurance companies got tougher to deal with– the business side of running a medical practice looked a lot less apealing.
Ricardo Nuila: . He had to hire more and more staff. He hired his mother, my grandmother, who is, uh, the type of person not to back down from Chicago, you know, . And so, her job was to be on the insurance companies to make sure that they wouldn’t, screw him out of money.
Dan: His dad turned away patients who didn’t have insurance. His dad growled and grumbled– about insurance companies, and about patients who didn’t have money to pay.
When Ricardo finished college and got into medical school, he put off starting for two years. What he sees as his dad’s life in the business of health care is not appealing.
Ricardo Nuila: the grind wears on him, you know? The fighting with the insurance companies
Dan: I mean in the book, your dad is a bit of a stand-in for . For doctors as a doctoring, as profession and the, and the way in which doctors get alienated from medicine.
Ricardo Nuila: yeah, he is a stand in a bit for doctors. And it’s gonna be, I think the doctors have a lot to say about how healthcare goes in America,
Ricardo Nuila: And unfortunately, the history shows that they haven’t been a great piece of that, at least as far as universal healthcare is concerned.
Dan: This becomes part of Ricardo’s story with his dad. Dad invites him to form a family practice. Ricardo chooses Ben Taub. And over the years, it becomes clear: They’re on opposite sides of a political divide. There are painful conversations, and then they go months without speaking.
Ricardo Nuila: that’s how deep politics run, you know, it’s really, it’s really difficult when you overlay like politics onto like a family dynamic,
Ricardo Nuila: It just felt like he was like totally on board with this idea that, you know, healthcare is something that is earned and healthcare is something that people, if you can’t afford it, you don’t deserve it. Is what I heard from what he was saying.
Dan: is your dad an ideal reader of the book? Is your dad kind of who the person you wanna make that case to?
Ricardo Nuila: That’s really interesting.
Ricardo Nuila: I would say this, that, I did not write this to preach to the choir for sure.
Dan: But he’s not sure his dad would actually pick up a book like this.
Ricardo Nuila: It’s just because I know my dad, he, my dad’s the type of person who reads John Grisham on a beach, you know? So I’m not a hundred percent sure if he would pick up this book, you know?
Dan: Unless, say, his son wrote it. Ricardo does expect his dad to read The People’s Hospital. And even if he doesn’t agree with everything his son has written, Ricardo thinks his dad will be proud.
Ricardo Nuila: I can tell you now as a, as a father, , it’s not clear that your kids are gonna come out Okay. . You know what I mean? I’m just saying that like he has reason to be proud just because I’m a, a living and breathing person right now, you know?
Ricardo Nuila: And I’m, I’m working in as a doctor. So I, I feel, I feel good for him.
Ricardo Nuila: And I think that he’s probably very happy that I wrote about medicine cuz he loves medicine.
Dan: The last chapter of “The People’s Hospital” is called “faith” And in it, Ricardo Nuila describes a daily ritual that he says keeps him grounded. It starts with passing a plaque on his way in. Of course I have him show it to me.
Ricardo Nuila: I park like right over there, .
Ricardo Nuila: I come in here and I just look at, look at this every time.
Dan: So, and describe what we’re seeing here.
Ricardo Nuila: Well, we’re seeing, a plaque that, talks about when this hospital was founded, and the people who constructed the building. And there’s also the, I forgot this is, this is bad of me, but I forgot the name.
Dan: the snake around the stick?
Ricardo Nuila: I’m in big trouble now because I’m on the Caduceus Caduceus. I, it’s the Cadus. Yeah.
Ricardo Nuila: And it’s just a reminder, you know, that we have this structure in place to help care for people who don’t have, uh, the means and that, and
Dan: that people decided to put this building here. Yeah.
Ricardo Nuila: Exactly. It’s a community effort.
Dan: Ricardo Nuila writes that he sees that community as he walks from that plaque to his desk– all the co-workers, in every kind of job, doing their best.
And this is the faith that he says gets affirmed— reading from the book here:
If someone is suffering and there is the capacity within the community to help, in a way that doesn’t harm anyone else, then we not only owe it to that person, we owe it to ourselves to help.
Whatever your politics are, I think that’s pretty great.
Dr. Ricardo Nuila practices at Ben Taub Hospital. He’s associate professor of Medicine, Medical Ethics and Health Policy at Baylor College of Medicine. His book is called “The People’s Hospital.”
Honestly there’s a lot in this book, — more patient stories, more family stories, a very deft summary of a hundred years of health care economics and politics.
I’ll tell you: reading this book, I was reminded of an idea I’ve had before. That it might be cool someday to convene a kind of “Arm and a Leg” book club. Because I’d like to have someone to talk with about a book like this– like maybe you.
Right now, that’s just an idea. The how would take a LOT of figuring out.
But I’m curious how that idea sounds to you. You can let me know at Arm and a Leg show dot com, slash contact.
I mean, that’s always a good place to send ideas and stories and questions— so many of our best episodes come from you.
And I’m curious what you think about this virtual book club idea. If you’ve taken part in something like this, or helped to organize it, I’d love to hear how it went.
That’s arm and a leg show dot com, slash contact.
Next time on An Arm and a Leg: A woman named Lisa French asked her hospital what her surgery would cost her. They said, with your insurance, about thirteen hundred bucks.
They expected about 55 thousand more from insurance.
They got 75 thousand. But then they wanted more. 229 thousand more. They wanted it from Lisa French, and they sued her for it.
After eight years, the case finally got resolved last June. Lisa French won!
The case has a LOT to teach us about our legal rights.
That’s next time on An Arm and a Leg.
Till then, take care of yourself.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta, and edited by Afi Yellow-Duke.
The recording of Jan de Hartog’s lecture is courtesy of the Baylor College of Medicine Archives.
The audio of Bill Elliott is from a KHOU-TV newscast, thanks to the Texas Archive of the Moving Image.
Big thanks to the archivists who helped us find some of the tape for this episode!
That includes Emily Vinson at the University of Houston library
Matt Richardson and Sandra Yates at the Texas Medical Center Archives
And David Olmos at the Baylor College of Medicine archives.
Daisy Rosario is our consulting managing producer. Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Sessions.
Gabrielle Healy is our managing editor for audience. She edits the First Aid Kit Newsletter.
Bea Bosco is our consulting director of operations. Sarah Ballema is our operations manager.
This season of an arm and a leg is a co production with Kaiser health news. That’s a nonprofit news service about healthcare in America, an editorially-independent program of the Kaiser family foundation.
KHN is not affiliated with Kaiser Permanente, the big healthcare outfit. They share an ancestor: The 20th century industrialist Henry J Kaiser. When he died, he left half his money to the foundation that later created Kaiser health news.
You can learn more about him and Kaiser health news at arm and a leg show dot com slash Kaiser.
Zach Dyer is senior audio producer at KHN. He is editorial liaison to this show.
Thanks to Public Narrative — That’s a Chicago-based group that helps journalists and non-profits tell better stories– for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about Public Narrative at www dot public narrative dot org.
And thanks to everybody who supports this show financially.
If you haven’t yet, we’d love for you to join us. The place for that is arm and a leg show dot com, slash support.
Thank you!
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It is diagnosed based on the presence of certain symptoms, including difficulties with communication, social interaction, and repetitive behaviours or interests.
APRIL is Autism Awareness Month. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects communication, social interaction, and behaviour.
It is diagnosed based on the presence of certain symptoms, including difficulties with communication, social interaction, and repetitive behaviours or interests.
Autism is considered a spectrum disorder, which means that it presents differently in each individual affected by it. Some people with autism may have difficulty speaking or communicating with others, while others may have normal language skills but struggle with social interactions, such as making eye contact or interpreting non-verbal cues. Repetitive behaviours or interests, such as rocking or hand-flapping, are also common among people with autism.
While the exact cause of autism is still not fully understood, research suggests that both genetic and environmental factors can play a role in its development. There is no known cure for autism, but early diagnosis and intervention can significantly improve outcomes for individuals with autism.
Interventions for autism may include a combination of behavioural therapies, speech and language therapy, and medication to manage associated symptoms. The goal of treatment is to help individuals with autism develop skills and strategies to better manage their symptoms, increase their communication, social interaction abilities, and lead more independent and fulfilling lives.
Despite the challenges that autism can present, many individuals with autism have unique talents and strengths. With the right support, individuals with autism can achieve their full potential and contribute meaningfully to society.
It is important to raise awareness and understanding of autism to promote early detection, diagnosis, and intervention. By increasing awareness and acceptance, we can create a more inclusive and supportive world for people with autism and their families.
This article was written by Terry-Ann Malcolm-Alleyne. It was first published on
ejcsda.com
, the official website of the East Jamaica Conference of Seventh-day Adventists.
2 years 4 months ago
A girl's best friend
FLEXING its muscle among contraceptive options is the copper T IUD (intrauterine device).
It is a long-acting reversible contraceptive (LARC) method. The 'heavy weight' leader in contraceptives, the IUD is more than 99 per cent effective in preventing unplanned pregnancies for up to 10 years depending on the brand. An IUD can be removed by the nurse or doctor at any time during those years and fertility returns quickly.
Thinner than a matchstick, the IUD is inserted in the vagina and up to the cervix by a trained doctor or nurse who uses a special instrument during the procedure.
The T-shaped IUD has copper on the stem and arms of the device and two very thin nylon strings. In order to fit it in the applicator for insertion, the arms of the IUD are folded down to align with the stem. When it reaches the cervix, that is the top of the uterus or womb, the health-care professional releases its folded arms and the IUD springs into place, and into action, providing immediate contraceptive protection.
How something so small can have such a big impact has to do with its ability to create a 'hostile' environment for sperm. The IUD releases copper in small amounts that affect the motility or movement of the sperm preventing them from reaching the fallopian tubes to fertilise a released egg or to implant in the uterine cavity.
Hidden away in the uterus, the nylon strings on the end of the stem of the device need to be checked every month after the woman has had her period or menses. This is to ensure that it is still in place and guaranteeing maximum contraceptive protection. Checking requires inserting the longest finger into the vagina and feeling for the strings that the health-care provider had cut short when the IUD was first put in. But acceptors of the method must be careful not to pull on the strings as this can shift its position, or make it fall out.
An IUD is a great support to couples, as it plays a role in limiting or spacing pregnancies to improve chances for financial independence. Health-care providers can help to improve the popularity of this method by introducing it to clients and answering all the questions that may come at them.
Right now a girl's best friend is a longer-term contraceptive method, like the hormone-free IUD.
This article was contributed by Dianne Thomas, director of communication and public relations at the National Family Planning Board.
2 years 4 months ago
Limitations of humanitarian medical missions
IN our last article, we looked at some of the benefits of short-term humanitarian medical missions. Aside from the clear benefits, medical missions also raise several issues and concerns that have become clearer as the frequency of medical missions increase. Our article this week will focus on some of these concerns.
Cost-effectiveness
IN our last article, we looked at some of the benefits of short-term humanitarian medical missions. Aside from the clear benefits, medical missions also raise several issues and concerns that have become clearer as the frequency of medical missions increase. Our article this week will focus on some of these concerns.
Cost-effectiveness
Medical missions by their nature require significant financial input. Travel costs, hotel stays, visa costs, vaccinations, medical equipment/disposables, and food are all direct costs. The loss of income for the visiting healthcare providers must also be considered. Costs can vary significantly with many factors including the size of the humanitarian mission, the destination country etc, but often these costs may be as high as 10's to 100's of thousands of US (United States) dollars. Some authors have argued that if purely economic factors are considered this money could be directly invested in the local health economy as opposed to being used to support the medical mission. In one example, after a short-term medical mission was completed and the costs were tabulated, the money used for the mission would have been sufficient to pay for recruitment, education and retention of a local physician, nurse, allied health personnel along with maintenance of the clinic which hosted the mission for a period of one year. In another example, a medical mission to Ghana was accomplished at the cost of US$30,000. The cost to build a 30-bed wing addition to the hospital which hosted the mission was US$60,000. One question which is frequently asked is, in terms of skill acquisition, would paying for a local physician or nurse to spend time at a centre of excellence in a high-income country be more cost effective and sustainable than a humanitarian mission?
Awareness of local culture, health-care environment and systems
The environment in which health care is delivered is a vital component of the care's efficacy. Language can clearly be a barrier. While language interpreters can be useful, one can never be sure of what is lost in translation. Even when the health-care providers and patients share a common language, the use of idioms can be an issue. For example, when a Jamaican patient tells a physician that he had an "operation" last night a Jamaican physician and an American physician will construe different meanings from that sentence. Another interesting example is that of many Asian societies where unwelcome news is given to the patient's family and not directly to the patient himself. There is also a limited concept of patient autonomy compared to the western world. In Thailand, for example, it is uncommon for patients to directly question physician recommendations.
For most personnel that come from high-income countries, the practice of medicine is done on a background of technology. Acquiring lab results, patient historical data and ordering testing simply requires a computer screen and Internet access. For many low- and middle-income countries where humanitarian medical missions take place, it may be necessary to depend heavily on clinical acumen and decision-making without laboratory or radiologic data. One wonders how many developed world physicians can function effectively in such environments. Another issue is that of interaction with the local health-care system. Do they have access to local facilities for complications that arise because of treatment? For patients determined to need specialist care, do they know how to seek it? For the unfortunate patients that are harmed through negligent care do they have a way to seek redress/compensation through the legal system from a physician in another country who may never return?
Sustainability and duration of impact
An important consideration is what happens when the medical mission has left the host country. For some conditions, eg, surgery for hernia repair or cataract removal, once the patient has recovered without complication there is not likely to be an ongoing need to see a surgeon. For other conditions this is not the case. Let us take the example of a woman who is diagnosed with type 2 diabetes by a family physician on a medical mission. She is given her medications for free and has symptomatic improvement when she is reviewed during the last week of the month-long medical mission and is then given enough medication to last a further two months. At that period's end, the physician who diagnosed and treated her was no longer available. Is the medication that she was given available in Jamaica and if so, is it affordable for her? In the Jamaican context she can be seen at a public clinic at low monetary cost but are there any records summarising her care for the next treating physician? If she lives in an area where no health care is available locally and she cannot afford travel to access health care in the urban centre, is she really any better off than she was before the arrival of the medical mission? From the mission physicians' point of view, they may have provided care for four weeks, but has this had a long-term impact on the population they visited? An evidence-based assessment devoid of self-absolution would suggest not.
A critical issue that is often overlooked is the effect on the local health-care economy. For missions that are longer in duration, there is the possibility of "crowding out" local practitioners. If the patient can get access to health care at no cost, is there scope for a local practitioner who is unable to work for free? If it is not economically viable to have a practice in the area, the local practitioner may leave the community or significantly reduce his presence. When the medical mission ends, access to care may be less than it was before overseas physicians arrived. This effect can be seen not only in primary care but also in the provision of conditions/procedures which require significant investments of capital, and which depend on patient fees to repay the money invested and hopefully generate a profit. If medical missions are intermittently offering these services at no cost to patients, does it significantly impair the development of a sustainable local health-care system?
In our next article we will explore quality of health-care delivery.
Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.
2 years 4 months ago
Health Archives - Barbados Today
QEH Paediatric Ward gets new chairs courtesy Bajan diaspora
Parents and guardians attending children in the Paediatric Ward at the Queen Elizabeth Hospital can now spend time in a much more comfortable way.
Parents and guardians attending children in the Paediatric Ward at the Queen Elizabeth Hospital can now spend time in a much more comfortable way.
This is because of the donation of ten adjustable chairs, replacing worn-out ones, by a range of families, individuals and one association in the jurisdiction of the New York Consulate. The chairs were donated in response to a request to Mrs. Treva Holder, wife of Consul General Mackie Holder, from Head of the department, Dr. Angela Jennings. Mrs. Holder coordinated the project and shipment was facilitated by the Consulate General at New York.
The ten chairs were recently officially handed over by Mrs. Holder to Dr. Jennings. The presentation was attended by a number of hospital personnel as well as Earl Phillips, a member of the Barbados Support Group of New York, and a chair donor with his wife Gail.
CG Holder noted that the donation was yet another example of the quick response of the Barbadian community overseas to requests to assist, particularly related to the QEH and education matters. He added that the pledges to assist with the chairs were made within a day of the announcement, but it took some time to source, have them assembled and shipped and on the ward.
Contributions were made by Lestra and Daniel Cox; Earl and Gail Phillips; Alicia Connell, Sonia Clarke and Ira Carrington; Virginia Mayers Holder and Shirley Holder; Dr. Joseph and Hon. Sylvia Hinds-Radix; Mayor Adrian Mapp; Plainfield Now – Ayiesha Mapp, Amelia Mapp, Adrain Mapp, Beverley Morris-Gill, Jazz Clayton-Hunt; the Barbados Support Group, (BSG), – Alicia Connell, Michelle Brathwaite, Earl Phillips, Leroy Hutchinson (2), and Consul General Mackie Holder and Treva Holder. Each three-position chair bears the name of the donor or donors.
It is intended that all the chairs on the ward will be replaced by the community under the jurisdiction of the NY Consulate. This continues the partnership, which began with Mrs. Holder and Dr. Jennings collaborating on the Care Buddy Project, initiated by Mrs. Holder, which provides all children in paediatrics with stuffed toys.
The Care Buddy programme was extended to children who contracted COVID-19 and now also covers children admitted to the Accident and Emergency Department. (PR)
The post QEH Paediatric Ward gets new chairs courtesy Bajan diaspora appeared first on Barbados Today.
2 years 4 months ago
Feature, Health
Colon cancer figures are very high in the country
Santo Domingo, DR
On the commemoration yesterday of World Colon Cancer Day, the Dominican Institute of Gastroenterology (INDDEG) reported that at least 148 patients were diagnosed with colon polyps out of 1,073 studies carried out on people from different regions of the country.
Santo Domingo, DR
On the commemoration yesterday of World Colon Cancer Day, the Dominican Institute of Gastroenterology (INDDEG) reported that at least 148 patients were diagnosed with colon polyps out of 1,073 studies carried out on people from different regions of the country.
These statistics constitute a “very high” prevalence figure, representing 13.7% of the confirmed cases of colon cancer. An investigation carried out between July 2022 and January 2023 by Dr. Eddy Herrera and Dr. Elaine De los Santos, director and deputy director of INDDEG, revealed that the sex most often diagnosed with the disease is female.
However, men are more affected in general. The most frequent anatomical location is rectosigmoid.
The doctors define the disease as any mass or tumor originating in the colon or rectum’s wall or mucosa and protruding into the lumen.
The study “Prevalence of Colonic Polyps in the Dominican Institute of Gastroenterology” assures that the age range where colonic polyps were found is between 40 and 60 years old and warns of the need to look for outlets for early detection to save lives and prevent the diagnosis through healthier lifestyle habits.
2 years 4 months ago
Health
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Rare case of Kaposiform haemangioendothelioma of spine associated with fixed hyperlordotic deformity: a report
Kaposiform haemangioendothelioma (KHE) is a rare childhood disease classified by the International Society for the Study of Vascular Anomalies (ISSVA) as a locally aggressive vascular tumor. It has been reported to affect any site, with a predilection for the extremities and trunk.
KHE can manifest at any site, most frequently in the extremities and trunk, as an enlarging firm, purpuric cutaneous or soft tissue lesion with telangiectasia that typically crosses multiple tissue planes. Skin involvement is not present in approximately 10% of cases, with the retroperitoneum being the most frequently involved extracutaneous site.
Despite its limited metastatic potential, KHE is associated with a high rate of morbidity due to its locally invasive characteristics and compressive effects. It can also give rise to Kasabach-Merritt phenomenon (KMP), a potentially fatal thrombocytopenic coagulopathy associated with a risk of severe microangiopathic anemia.
Approximately twenty cases of KHE with bony involvement have been reported in the literature to date, with only five of those cases involving the spine specifically.
Leanne H. Q. Chin presents a rare case of KHE who presented with progressive fixed hyperlordotic deformity, multiple non-specific spinal lesions, and abnormal blood tests, posing a clinical and radiological diagnostic challenge.
A previously healthy 9-year-old boy was referred for abnormal gait. At the age of seven, he first complained of an acute episode of spontaneous lower back pain lasting 2–3 days, with persistent back stiffness affecting lumbar flexion. He had normal bladder and bowel movements with no associated numbness or weakness, but also presented with easy bruising and gum bleeding.
During physical examination, he was found to have a waddling gait and a fixed hyperlordotic deformity with anterior pelvic tilt. Apart from localised tenderness over the back during palpation, other clinical examinations were unremarkable.
Laboratory investigations revealed significant thrombocytopenia (Platelet count 19×10^9/L), mild anaemia (Haemoglobin level 10.0 g/dL, mean corpuscular volume (MCV) 73.4fL), normal white blood cell count (8.23× 10^9/L), normal prothrombin time (12.9 s), activated partial thromboplastin time (31.1 s), and international normalized ratio (1.1). Human leukocyte antigen (HLA)-B27 was negative.
Skeletal survey showed lordotic deformity of the lumbosacral spine, multiple sclerotic bone lesions involving the vertebral bodies and pedicles of T12-L3, sacrum, bilateral iliac bones and acetabulum. There was no pathological fracture or vertebral collapse. Displacement of bilateral paravertebral stripes were noted from T9–T12 levels. Magnetic resonance imaging (MRI) reveals scattered multi-level T1 and T2 iso-to-hypointense lesions involving both the vertebral bodies and posterior elements from T10 to sacrum, corresponding with sclerotic changes seen on the plain radiographs. These lesions showed surrounding T2 hyperintense signals and contrast enhancement as well. In the surrounding soft tissues, there were also ill-defined infiltrative T2 hyperintense signals with contrast enhancement seen involving the anterior and posterior paraspinal soft tissues including the retroperitoneum, bilateral psoas and posterior paraspinal muscles. There was also diffuse involvement with abnormal contrast enhancement of bilateral sacroiliac joints in a symmetrical fashion without overt joint space widening, erosion or ankylosis. There was also mild thickening of the anterior epidural space from L5 to S1. No signs of central cord, cauda equina, or nerve root compressions were seen.
Given the presence of "marrow lesions" on imaging and suspected bone marrow failure, the initial working diagnosis was underlying haematological disease such as myeloproliferative disorders. Bone marrow aspiration and trephine biopsy was subsequently done, but only showed non-diagnostic findings of active trilineage hematopoiesis, reactive plasmacytosis and non-specifc stromal damage suggestive of granulomatous inflammation.
Mantoux test, angiotensin converting enzyme (ACE) levels, metabolic screen and tumour markers were all negative. Whole body fuorodeoxyglucose (FDG)-positron emission tomography (PET)-computed tomography (CT) showed low grade metabolic FDG activity along the affected paraspinal soft tissue components (SUVmax 1.8; liver and mediastinal blood pool references SUVmax 1.4 and 1.0 respectively), but no metabolic activity in the associated bones.
Bilateral sacroiliac joints also show mild increased FDG activity (SUVmax 2.1) with no other abnormal uptakes elsewhere. Findings remained nonspecifc and differentials such as chronic infection (e.g. TB spondylitis), Langerhan cell histiocytosis, small round cell tumours and lymphoma were proposed.
Due to inconclusive results, CT-guided biopsy with platelet transfusion was performed after multidisciplinary team discussion. The patient was placed in prone position under conscious sedation. The lumbar bony site was biopsied using 11-gauge powered bone access system, obtaining three tissue cores. Paraspinal soft tissue was biopsied using 18-gauge core biopsy needle in a coaxial fashion, obtaining three tissue cores. Cores of tissue composed of cellular and reticulin-rich islands of spindle-shaped endothelial cells was seen on light microscopy. These formed slit-like vascular channels containing hemosiderin deposits and intravascular microthrombi in a fibrotic background. The tumour cells were arranged in short fascicles within the cellular islands with a whorl-like pattern. Lymphatic channels were inconspicuous with scanty bony fragments seen. Immunohistochemical (IHC) staining was focally positive for both vascular endothelial markers (CD34, CD31 and ERG), lymphatic endothelial markers (D2-40), and SMA. GLUT-1 and HHV8 are negative. The Ki67 index was low. Final histopathological diagnosis was suggestive of Kaposiform haemangioendothelioma.
Medical therapy with sirolimus followed by interval MRI reassessment was recommended after multidisciplinary consensus. Surgery was deemed not feasible at the time due to extensive involvement, and radiotherapy was not advocated in view of its adverse effects on spinal growth. Prior to the starting of sirolimus treatment, fibrinogen levels were checked and found to be low 1.52 g/L, consistent with Kasabach-Merritt syndrome. Both the fibrinogen levels and platelet counts showed significant improvement within two months of starting treatment without the need for transfusion.
Further reading:
Kaposiform haemangioendothelioma of the spine associated with fixed hyperlordotic deformity and Kasabach–Merritt Syndrome: a case report and literature review Chin, L.H.Q., Fung, K.K.F., Chan, J.P.K. et al. Skeletal Radiology https://doi.org/10.1007/s00256-022-04152-z
2 years 4 months ago
Orthopaedics,Orthopaedics News,Top Medical News,Orthopaedics Cases
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Multisystem Inflammatory Syndrome in Children: IAP Guidelines
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease2019
(COVID-19) or pediatric inflammatory multisystem syndrome (PIMS) was initially
reported in the United Kingdom and the United States in April 2020 following a surge in
COVID-19 infections in the population.
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease2019
(COVID-19) or pediatric inflammatory multisystem syndrome (PIMS) was initially
reported in the United Kingdom and the United States in April 2020 following a surge in
COVID-19 infections in the population.
It has the presentation of hyperinflammatory syndrome with involvement of multiple organs,
requiring timely treatment of anti-inflammatory drugs such as steroids and intravenous
immunoglobulins. It is an uncommon but potentially serious disease in children and adolescents; timely
diagnosis and treatment is associated with good outcomes.
The Indian
Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for
Multisystem Inflammatory Syndrome in Children.
The lead author for these guidelines on Multisystem Inflammatory
Syndrome in Children is Dr. Rakesh Lodha along with co-author Dr. Jolly Chandran and Dr. Mahendra
Jain. The guidelines come Under the Auspices of the
IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines
Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National
Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan
R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant
Kariya, Narmada Ashok, Pawan Kalyan.
Following
are the major recommendations of guidelines:
Diagnostic Criteria:
In May 2020, the World Health Organization (WHO) and the Centers for Disease Control (CDC)
issued separate diagnostic criteria based on available/published information in case reports
and case series analysis. These criteria are enlisted in Table 1.
TABLE 1: The
WHO criteria for MIS-C.
Criteria
All 6 criteria must be met
Age
Age 0–19
years
Fever
Fever for ≥3 days
Clinical signs of multisystem
involvement (at least two of the following)
- Rash, bilateral nonpurulent conjunctivitis, or mucocutaneous inflammation signs (mouth,
hands, or feet) - Hypotension or shock cardiac dysfunction, pericarditis,
valvulitis, or coronary abnormalities (including echocardiographic findings or elevated troponin/BNP) - Evidence of coagulopathy (prolonged PT or PTT; elevated
D-dimer) - Acute gastrointestinal symptoms
(diarrhea, vomiting, or abdominal pain)
Elevated markers of inflammation
Elevated markers of inflammation (e.g.,
ESR, CRP, or procalcitonin)
Rule out other diagnoses
No other obvious
microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes/tropical infectious diseases, i.e.,
malaria, dengue, scrub
typhus, leptospirosis, and enteric fever
Recent or current SARS-CoV-2
infection or exposure
- Any of the following tests positive:
- Positive SARS-CoV-2 RT-PCR
- Positive serology
- Positive antigen test
- Contact with an individual with
COVID-19
(BNP: B-type natriuretic peptide; CRP: C-reactive protein; COVID-19: coronavirus disease-2019; ESR: erythrocyte
sedimentation rate; MIS-C: multisystem inflammatory syndrome in children; PT: prothrombin time;
PTT: partial thromboplastin time; RT-PCR: reverse transcription–polymerase chain reaction; SARS-CoV-2:
severe acute respiratory syndrome coronavirus-2; WHO: World Health Organization)Investigations:Investigation in MIS-C depends upon severity of disease. Approach to a child with features
suggestive of MIS-C:Tier-1 tests: Complete blood count (CBC), C-reactive protein (CRP), erythrocyte sedimentation
rate (ESR), liver function test (LFT), kidney function test (KFT), blood sugar, blood gas, and severe
acute respiratory syndrome coronavirus-2 (SARS-COV-2) serology/reverse transcription–
polymerase chain reaction (RT-PCR).Tier-2 tests: Electrocardiogram (ECG), echocardiogram, B-type natriuretic peptide (BNP),
troponin-T, ferritin, lactate dehydrogenase (LDH), procalcitonin, interleukin 6 (IL-6),
prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, and fibrinogen.Positive tier 1 screen (both of these should be present): 1. CRP > 5 mg/dL and/or ESR > 40 mm/hour 2. At least one of these: Absolute lymphocyte count (ALC) < 1,000/µL, platelet count
< 150,000/µL, Na < 135 mEq/L, neutrophilia, and hypoalbuminemia
Isolated increased COVID-19 antibodies are not synonymous with MIS-C. For diagnosis of
MIS-C, it is mandatory to rule out common tropical infections including malaria, dengue, enteric
fever, rickettsial illness (scrub typhus), etc.Management :Multisystem inflammatory syndrome in children associated with COVID-19 can present as
critical illness. There can be a spectrum of presentations from mild symptoms to multiorgan
dysfunction syndrome. Steps of Management:Stabilize the patient (airway stabilization and adequate perfusion) Treat organ dysfunction and prevent further progression (beware of organ
dysfunction) Control of systemic inflammation by choosing the right immunosuppression Close monitoring for disease progression Long-term follow-up for complications. ABCD: Airway stabilization and Adequate perfusion, Beware of organ
dysfunction, Control systemic inflammation, and close monitoring for Disease
progressionClinical TypesMultisystem inflammatory syndrome in children for management purposes can be
grouped into four categories 1. MIS-C without shock: Any child who fulfills the WHO criteria for MIS-C and stable
without any feature of shock 2. MIS-C with shock/multiple organ dysfunction syndrome (MODS): Any child who
fulfills the WHO criteria for MIS-C and having features of shock in the form of
tachycardia, hypotension, requiring fluid bolus ≥ 30 mL/kg, or inotropic support.
MODS: Any child who fulfills the WHO criteria for MIS-C and has two or more organ
involvement [respiratory/cardiac/central nervous system (CNS)/liver/renal] 3. MIS-C with Kawasaki phenotype: Children who meet complete or incomplete
Kawasaki disease criteria as defined by the American Heart Association (Kawasaki
diagnosis is established by fever lasting 5 or more days and at least four of the
following five clinical criteria: Polymorphous rash (excluding bullous or vesicular
eruptions); Conjunctival injection; Oropharyngeal mucous membrane changes;
Extremity changes; and Lymphadenopathy) 4. MIS-C with refractory disease: Any child who fulfills the WHO criteria for MIS-C and
has not responded to first tier therapy [intravenous immunoglobulin (IVIg) and
low-dose steroids) after 48 hours. Airway stabilization and adequate perfusion: • These children should preferably be monitored in intensive care unit (ICU). Shock
can be vasodilatory/cardiogenic. • Judicious fluid resuscitation 10–20 mL/kg over 30–60 minutes and aggressive
hemodynamic support with prompt initiation of vasoactive agents. • Epinephrine can be used if there is hypotension with cardiac involvement,
norepinephrine if there is vasodilatory shock aiming good mean arterial pressure for
adequate organ perfusion. • In extreme cases with catecholamine, refractory shock vasopressin is advised.Treat organ dysfunction and prevent further progression (beware of organ dysfunction): • Antibiotics in first hour after obtaining blood cultures as per local hospital antibiotic
guidelines • Prevent organ dysfunction by maintaining good organ perfusion • Avoid fluid overload.Control of systemic inflammation by choosing the right immunosuppression: This therapy
is mainly targeted to reduce tissue inflammation or prevent progression of coronary
artery aneurysm/myocardial dysfunction. Initial combined treatment with IVIg and
corticosteroids may be beneficial. • IVIg: Dose: 2 g/kg (based on ideal body weight with maximum dose of 100 g) IV. This
can be given as a single infusion over 8–12 hours or 12–24 hours based on patient's
clinical status and cardiac function. In children who fail to respond, second dose may
be considered. • Methylprednisolone: Should be administered simultaneously with IVIg at low dose of
2 mg/kg/day; however in children with coronary artery changes or refractory disease,
pulsed dose of 10–30 mg/kg (maximum of 1,000 mg) may be administered. This is
slowly transitioned to oral prednisolone which is tapered over 2–3 weeks with clinical
and CRP monitoring. • Anakinra: In children with refractory disease despite glucocorticoid treatment or in
patients with contraindications to steroids, anakinra at dose of >4 mg/kg/day IV or SC
should be considered after expert consult. • Infliximab/tocilizumab: Currently not recommended for use in children. Close monitoring and disease progression: • Vigilant clinical monitoring for progression into hemodynamic instability or organ
involvement should be done. • Laboratory monitoring of inflammatory markers is recommended till patient is stable. • ECG and echocardiogram have to be repeated after 48 hours as per clinician's
discretion, subsequent echocardiogram at 1–2 weeks, 4–6 weeks, and 1 year if initial
echocardiogram abnormal. • If child appears unwell or deteriorates after 24–48 hours of treatment, consider expert
consult.Anticoagulation: • MIS-C with documented thrombosis/ejection fraction < 35%/coronary artery Z score
≥ 10/giant aneurysm with diameter > 8 mm: Enoxaparin 1 mg/kg (0.75 mg/kg/dose in
<2 months) SC for 2 weeks after discharge. • Low-dose aspirin (3–5 mg/kg/day; maximum 80 mg/day) should be used if platelets
>80,000/µL and continued till normal coronary arteries are confirmed at ≥4 weeks
after diagnosis. In patients with aneurysm or risk of thrombosis, it is desirable to continue antiplatelet
and anticoagulation as per their risk/need with clinicians' judgment.Long-term follow-up for complications: Mortality is reported in 1–2% of affected patients;
higher figures are often reported with delayed presentations. Coronary artery aneurysm
occurs in 25%, cardiac dysfunction in 50–60%, respiratory failure in 30%, renal involvement
in 12%, CNS in 3%, and systemic thrombosis in 3–6%. Reference:
- Centers for Disease Control and Prevention. (2020). Multisystem Inflammatory Syndrome in Children
(MIS-C) associated with Coronavirus Disease 2019 (COVID-19). [online] Available from: https://
emergency.cdc.gov/han/2020/han00432.asp. [Last accessed June, 2022]. - Elsevier.health. (2022). Multisystem Inflammatory Syndrome in children (MIS-C). [online] Available
from: https://elsevier.health/en-US/preview/multisystem-inflammatory-syndrome-....
[Last accessed June, 2022]. - Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of
Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated
With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol.
2021;73(4):e13-29. - McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem inflammatory syndrome in children
(MIS-C), a post-viral myocarditis and systemic vasculitis—a critical review of its pathogenesis and
treatment. Front Pediatr. 2020;8:626182. - Ministry of Health and Family Welfare. (2022). Revised Comprehensive Guidelines for Management
of COVID-19 in Children and Adolescents (below 18 years). [online] Available from: https://www.
mohfw.gov.in/pdf/RevisedComprehensiveGuidelinesforManagementofCOVID19inChildren
andAdolescents below18years.pdf. [Last accessed June, 2022]. - Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory
syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation,
hypothetical pathogenesis, and proposed management. Children (Basel). 2020;7(7):69. - World Health Organization (2020). Multisystem inflammatory syndrome in children and adolescents
with COVID-19: Scientific Brief. [online] Available from: https://www.who.int/publications-detail/
multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. [Last accessed
June, 2022].
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
2 years 4 months ago
Guidelines,Medicine,Pediatrics and Neonatology,Medicine Guidelines,Pediatrics and Neonatology Guidelines,Latest Guidelines
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Perioperative steroid therapy reduces complications in liver resection
A new study by Laila Jötten and team showed that after an elective liver resection, perioperative steroid treatment considerably lowers the overall complication rate without raising the risk of negative side effects. The findings of this study were published in BJS Open Journal.
By lowering the systemic inflammatory response, perioperative steroid treatment may enhance postoperative results in major abdominal surgery. In order to assess the effect of perioperative steroid treatment on outcomes following elective liver resection, researchers undertook this study.
Researchers extensively searched PubMed, Cochrane Library, and Web of Science for randomized clinical trials (RCTs) contrasting the use of perioperative steroids with placebo, standard of care, or no steroids in order to assess postoperative outcomes, particularly postoperative complications. The papers were evaluated rigorously and the data were retrieved by two independent reviewers. With mean differences (MDs) obtained for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, meta-analyses were carried out using a random-effects model.
The key findings of this study were:
1. 930 patients from 10 RCTs were included.
2. Administration of perioperative steroids considerably decreased the risk of postoperative complications overall.
3. For specific issues, there were no obvious changes.
4. The total blood bilirubin, interleukin 6, and C-reactive protein were all favorably impacted postoperatively.
5. There were no indicators of a rise in probable steroid-induced adverse events, such as bleeding, thromboembolic events, or infectious complications.
According to the current meta-analysis, using perioperative steroids lessens overall complications following elective liver resections. The number needed to treat was 10 and there were no notable adverse side effects, therefore it may be routinely recommended for clinical practice based on evidence of moderate certainty as determined by the GRADE system. However, to validate the findings of the present research and to definitively determine the benefit of perioperative steroid administration in elective liver surgery, a multicenter confirmatory trial is necessary.
Reference:
Jötten, L., Steinkraus, K. C., Traub, B., Graf, S., Mihaljevic, A. L., Kornmann, M., Michalski, C. W., & Hüttner, F. J. (2022). Impact of perioperative steroid administration in patients undergoing elective liver resection: meta-analysis. In BJS Open (Vol. 6, Issue 6). Oxford University Press (OUP). https://doi.org/10.1093/bjsopen/zrac139
2 years 4 months ago
Surgery,Surgery News,Top Medical News
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Melatonin has potential role in treatment of acute phase of vertigo
The acute phase of vertigo appears in several vestibular syndromes with different pathophysiology, such as Meniere's disease (MD), vestibular neuritis (VN), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). Due to the involvement of the inner ear, the symptoms may include not only recurrent attacks of vertigo but also fluctuating hearing loss or tinnitus.
In addition, multiple central nervous system conditions associated with migraine or cerebrovascular and neurodegenerative disorders have been described, which can manifest vertiginous attacks.
Vestibular syndromes imply that metabolic factors may act in
their development, such as (1) multiple neurotransmitters with different
effects: excitatory (glutamate, dopamine, and serotonin), modulating (histamine
and enkephalins), or inhibitory (GABA and glycine); (2) inflammatory cytokines
(TNF and IL3); (3) reactive oxygen species (ROS); and (4) other factors.
The treatment of the acute crisis is usually symptomatic,
which implies a similar pharmacological management, which generally acts by
exerting a sedative effect. For this reason, among others, antihistamines,
anticholinergics, benzodiazepines, or antidopaminergic drugs are used. However,
considering that the incidence of vertiginous syndrome is particularly higher
in the elderly population, in this and other risk groups, the use of a lower
dose of the aforementioned drugs or the use of other treatments with fewer side
effects could be useful.
In this study, authors Joaquin Guerra et al analyzed the
possible role that melatonin, a harmless hormone, could play in regulating the
acute phase of vertigo.
Melatonin and the
Vestibular Pathway
Melatonin performs extensive functions not only in the inner
ear but also in the vestibular pathway, regulating its function. Precisely, in
the inner ear, there is a wide and diffuse expression of melatonin MT1
receptors, distributed in many structures, including the organ of Corti, the
spiral and vestibular ganglion, vestibular sensory cells, dark vestibular
cells, transitional cells, or epithelial cells of the endolymphatic sac. With
respect to the central vestibular structures, MT1 and MT2 receptors are also
found in the vestibular nuclei, the thalamic vestibular pathway, and the cerebral
and cerebellar cortex. The cerebellum expresses the highest number of
melatoninergic receptors. Clinically, melatonin receptors found in the area
postrema, a structure in the medulla oblongata of the brainstem, can modulate
vomiting and other sympathetic responses that characterize the attack of
vertigo. The paraventricular nuclei and the reuniens connect with the limbic
system, and this may be the reason for their regulation in mood and sedation,
relevant elements for the control of vertigo.
Furthermore, several reports have attempted to explain the
disorganization of circadian rhythms in patients with vestibular disorders melatonin
has been proposed as a prophylactic agent in the prevention of migraine
attacks, a condition that can be associated with vertigo. In addition, in
patients with bilateral vestibular loss, there is a lack of synchronization
between temperature and the rest-activity cycle, which affects the physiology
of melatonin regulation. Although the effect of melatonin can be exerted by
direct action, it is true that it has the potential to modulate other
compounds, enhancing or inhibiting them, and thus their actions.
Role of Melatonin as
an Anti-Inflammatory and Antioxidant Vestibular Agent
Vertigo patients show higher levels of reactive oxygen
species (ROS) and superoxide metabolites than healthy subjects, as shown by
multiple reports from subjects with different vestibular syndromes, such as
BPPV, MD, or unspecified situations of chronic subjective vertigo. It includes
higher levels of hydrogen peroxide, oxidation products of thiol and other ROS,
and lower activity of superoxide dismutase (SOD), glutathione content, and
catalase. Oxidative stress may be due to the physiological stress that vertigo
induces. The antioxidant effect of melatonin is well known, since it acts as a
direct scavenger of free radicals with the ability to detoxify both reactive
oxygen and reactive nitrogen species.
The otoprotective function of melatonin has been
demonstrated after exposure to gentamicin in the inner ear; this otoprotection
is mainly based on the inhibition of the genesis of free radicals or scavenging
them. Gentamicin induces an increase in the levels of ROS and proapoptotic
Bcl-2-associated protein X (Bax) in utricular hair cells, in turn inhibiting
the expression of B-cell lymphoma 2 (Bcl-2). Melatonin reverses this event by
inhibiting the expression of caspase-3. This protein is essential in the
activation of programmed cell death.
Interestingly, in patients with chronic subjective
dizziness, an inflammatory response with elevated serum levels of tumor
necrosis factor α (TNF) and interferon c (IFNc) has been reported. Along with
similar lines, patients with MD show an elevation of various interleukins
(IL-1β, IL1RA, and IL-6) and TNF baseline levels. Furthermore, in these
patients, the two subgroups can be differentiated according to their IL-1β
profile; those with higher basal levels exhibit increased levels of cytokines
and chemokines (CCLs). Interestingly, the proinflammatory immune response
appears to increase in those subjects exposed to allergenic extracts of
Aspergillus and Penicillium involving TNF, which points to a possible allergic
association.
The levels of IL-1β, CCL3, CCL22, and CXCL1 have been
proposed as differentiating markers of MD from other vestibular syndromes that
can confuse the diagnosis, such as VM, whose clinical expression can be very
similar. In VN, the CD40 receptor, which belongs to the family of TNF, and its
ligand (CD40L) have been suggested to be involved in the progression and
genesis of the disease, thus increasing the production of several
proinflammatory cytokines, such as TNF.
As described above, vestibular syndromes exhibit
inflammatory reactions during acute attacks and subjects with chronic vertigo
have higher basal levels of inflammatory mediators, so that melatonin
theoretically would be able to regulate not only attacks but also recurrences,
given its regulation of the release of various cytokines. Although no report
has specifically focused on the role of melatonin in the vestibular system and
these cytokines, this hormone could centrally or peripherally control the levels
of CCLs, ILs, and TNF. Melatonin may exert beneficial effects by blocking the
activity of vestibular oxidative and inflammatory stress through several
pathways.
Melatonin as a
Modulator in the Vestibular Neurotransmission
Gamma-aminobutyric acid (GABA) is the predominant inhibitory
neurotransmitter in the vestibular pathway. Of the three GABA receptors
described, GABA-A and GABA-B are involved in vestibular neurotransmission.
Studies show that GABA plays a plausible role in inner ear afferent
transmission, but its role as the primary transmitter at this level is unclear.
It is accepted that its function is to modulate neuronal transmission, through
the presynaptic inhibition of Ca2+ channels and/or the activation of Cl
channels. Therefore, it can indirectly decrease the release of presynaptic
neurotransmitters to affect the excitability of postsynaptic cells.
The central vestibular nuclei receive inhibitory inputs that
are mediated by GABA-A and GABAB receptors. These GABA-A inputs arise primarily
from the commissural fibers of the vestibular nuclei and the cerebellum. Theoretically,
the treatment with agonists of the GABA-A (benzodiazepines) and GABA-B
(baclofen) receptors is based on an effect on the central vestibular sensory
pathways. Melatonin can also regulate the GABAergic synaptic transmission and
thus modulates the activity of its receptor. Its sedative effect is mainly
enabled by binding to the GABA-A receptor, as it occurs with benzodiazepines.
This sedative action may induce a decrease in blood pressure.
Several findings support a possible involvement of dopamine
as a modulator of excitatory vestibular neurotransmission in the postsynaptic
afferent terminals in at least 2 of the 5 dopamine receptors identified. In the
vestibular neuroepithelium of mammals, immunochemical tests show that D1 and D2
receptors (coupled to G proteins) are expressed in the vestibular hair cell
membranes. The responses of these receptors not only modulate postsynaptic
glutamate receptors but may also have a protective function on vestibular
dendrites. The existence of dopamine D2 receptors has been reported in the
vestibular nuclei. The use of antidopaminergic drugs (sulpiride and
prochlorperazine) exerts a modulating effect on vestibularneurons and controls
vomit. Although there is no report directly involving melatonin in this effect
in vestibular structures, it has been demonstrated that this hormone modulates
dopamine and can inhibit its release in specific areas in the CNS of mammals,
such as the hypothalamus, hippocampus, striatum, medulla-pons, and retina.
Other compounds involved in vestibular neurochemistry, such
as substance P or calcitonin gene-related peptide (CGRP), both implicated in
migraine, and thus potentially vestibular migraine (VM), are also inhibited by
melatonin. Furthermore, TNF stimulates CGRP transcription, whereas as
previously described, melatonin is capable of inhibiting TNF release. CGRP
antagonists are currently being developed for the treatment of migraine,
although they should not be considered as first-line treatments.
Regulation of
Melatonin in the Vestibular Sympathetic Activity
Melatonin release is controlled by the sympathetic innervation
of the pineal gland, which mediates the inhibitory effect of light on pineal
melatonin secretion. This pathway begins in the retina, influencing the
biological clock of the suprachiasmatic nucleus, and then inhibits the
paraventricular nucleus and interrupts the stimulation of the intermediolateral
nucleus, inducing melatonin synthesis.
Patients diagnosed with vertigo show less parasympathetic
activity; the ratio of sympathetic/parasympathetic activity is higher than in
healthy subjects. The effects of melatonin on the autonomic system cause a
reduction in the adrenergic flow and induce relaxation of the smooth muscle of
the arterial wall by increasing the availability of nitric oxide. Furthermore,
melatonin is capable of lowering blood pressure, specifically binding to its
MT1 and MT2 receptors in blood vessels, thus blocking the catecholaminergic
response.
In humans, exogenous use of melatonin has been shown to be
effective in reducing circulating catecholamine levels, as well as blood
pressure, carotid pulsatility index, and sympathetic nerve responses to
orthostatic stress.
Based on the data included in this review, it seems obvious
that the use of melatonin in the acute phase of vertigo can be highly
effective, although more studies and clinical trials are needed. However,
despite the fact that the effect in humans may be more limited than in
laboratory animals, it is evident that the adjuvant use of melatonin with other
drugs could not only improve the vestibular symptoms of acute vertigo crisis
but also prevent the increase of doses of commonly used drugs with the
consequent increase in pharmacological toxicity. This type of combined
treatment would be especially indicated in risk groups, such as the elderly
population. Moreover, melatonin is a practically harmless hormone; the lethal
dose 50 could not be found yet. Paradoxically, some reports showed transient
dizziness as a side effect. This symptom may be only a subjective report or it
may be associated with its sedative function, and it does not limit its use as
with other drugs employed in acute vertigo.
However, authors cannot ignore the possibility of
undesirable effects appearing in patients who are recovering after an attack of
acute vertigo, delaying vestibular compensation. These adverse effects have
been observed in posturographic results and in oculomotor tests, with a
decrease in saccade accuracy or smooth pursuit gain. Furthermore, the decreased
sympathetic response may theoretically exert a greater intolerance to
orthostatism, although this conclusion may be questionable. Moreover, there are
no reports of vestibular worsening demonstrated in neurophysiological tests,
such as vestibular evoked myogenic potential (VEMP). As previously described,
its safety profile, even at extremely high doses, is wide.
Although systemic administration is safe and favors effects
on different organs of the vestibular pathway, it remains to be seen whether
topical (transtympanic) administration could be effective for pathologies of
peripheral origin. A route of entry for various metabolites with oxidizing or
inflammatory power is the round window. The main advantage of this approach
relies on the fact that melatonin would perfuse directly to the inner ear, as
it occurs with the intratympanic corticosteroid treatment. Moreover, treating
melatonin topically could minimize the effect of mediators that access through
this route of entry, implied in the development of vestibular syndromes such as
labyrinthitis or endolymphatic hydrops. In conclusion melatonin administration
in vertigo could be a new therapeutic effect of melatonin, among the many
already described that this hormone exerts in human pathologies.
Source: Joaquin Guerra and Jesus Devesa; Hindawi
International Journal of Otolaryngology https://doi.org/10.1155/2021/6641055
2 years 4 months ago
ENT,ENT News,Top Medical News
DR MICHAEL MOSLEY: The secret to avoiding middle-age spread? Eat more protein!
DR MICHAEL MOSLEY: The frustrating thing for many women, particularly those in their 40s, is they start gaining extra pounds without any obvious change in lifestyle.
DR MICHAEL MOSLEY: The frustrating thing for many women, particularly those in their 40s, is they start gaining extra pounds without any obvious change in lifestyle.
2 years 4 months ago
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
All About MBBS in India: Full form, Admissions, medical colleges, fees, eligibility criteria details
Bachelor of Medicine and Bachelor of Surgery, also known as MBBS, is an undergraduate course for students who aspire to work as doctors in India or abroad. Medical Aspirants can apply for this course after completing their 10+2 exam or any other equivalent. The duration of this undergraduate MBBS course is 5.5 years with one year of compulsory rotation.
The MBBS program seeks to instill standard practices for history taking, assessment, differential diagnosis, and total patient care. It focuses on the study of clinical and paraclinical subjects like anatomy, biochemistry, physiology, pathology, Orthopaedics, Obstetrics and gynecology, medicine, and many more. Students receive practical instruction in hospitals and outpatient areas. The most effective treatments for a patient and the most helpful investigations are taught to the student.
It is a full-time course pursued at various accredited institutes/medical colleges nationwide. Some of the top accredited institutes/medical colleges offering this course include All India Institute of Medical Sciences, Delhi, Maulana Azad Medical College (MAMC), Christian Medical College, Vellore, and more.
Admission to this course is done through the NEET UG exam ( or simply called NEET exam) conducted by the National Testing Agency (NTA) and is followed by counseling based on the exam scores that DGHS/MCC/State Authorities execute. National Medical Commission (NMC) regulates medical education in the country.
The fee for pursuing MBBS varies from accredited institutes/medical colleges and may range from Rs. 20,000 to Rs.27 lakhs per year.
After completing the respective course, doctors can join the job market or pursue MD/MS/DNB programs recognized by NMC. Candidates can work as doctors in government or private hospitals or nursing homes or start private clinics. The salary range, on average, is from Rs. 4 lakhs to Rs. 12 lakhs per year.
What is MBBS?
Bachelor of Medicine and Bachelor of Surgery, also known as MBBS, is an undergraduate course. The course duration is five years and six months, including one year of compulsory rotation internship at the hospital. MBBS has an extensive curriculum, and the subjects of MBBS include clinical and paraclinical subjects.
The subjects for MBBS course include:
1. Anatomy
2. Physiology
3. Biochemistry
4. PSM (Preventive and Social Medicine)
5. Pharmacology
6. Pathology
7. Microbiology
8. Medicine
9. Surgery
10. Obstetrics and Gynaecology
11. Ophthalmology
12. Paediatrics
13. ENT
14. Radiology
15. Forensic Medicine
16. Orthopaedics
17. Psychiatry
18. Dermatology
19. Anaesthesia
After completing MBBS, the students can opt for different specializations in their postgraduation. They pursue postgraduate medical degrees like MD/MS or Diploma courses.
These candidates are eligible to work as a doctor in public and private hospitals and other setups like NGOs, and they can also work in the military forces.
MBBS course is offered as a full-time degree and cannot be done part-time.
Course Highlights
Course highlights of the Bachelor of Medicine and Bachelor of Surgery (MBBS):
Name of Course
Bachelor of
Medicine and Bachelor of Surgery (MBBS)
Level
Undergraduate
Duration of Course
Five
and a half years
Course Mode
Full
Time
Minimum Academic Requirement
Students who have
qualified for the Higher Secondary Examination with a minimum of 50% marks with
Physics, Chemistry, and Biology as subjects.
For 'Reserved
Category' students, the requirement is 40%.
Admission
Process / Entrance Process / Entrance Modalities
Entrance
Exam NEET-UG
Counseling
by DGHS/MCC/State
Authorities
Course Fees
Ranges
from Rs.20,000 to Rs. 27 lakhs
Average Salary
From Rs. 4 lakhs to Rs. 12 lakhs per year
Eligibility Criteria
Aspirants need to meet the eligibility criteria set to get admission to the MBBS course which include:
- The candidate must have completed 17 years of age at the time of admission or will complete that age on or before 31 December of his/her admission first year of the Undergraduate Medical Course.
- Indian Citizens/ Overseas Citizens of India (OCI) who intend to pursue Undergraduate Medical Courses in a foreign Dental Institute/Medical must also qualify for NEET (UG) exam.
- Also, to be eligible for the NEET-UG exam, the candidate must have passed Physics, Chemistry, Biotechnology/Biology, and English individually and must have obtained a minimum of 50% marks calculated together for Chemistry, Physics, and Bio-technology/Biology at the qualifying examination as is mentioned in the Regulations of NMC and DCI. They must have got a rank in the NEET merit list for admission to Undergraduate Medical Courses.
- In respect of the candidates that belong to Scheduled Tribes, Scheduled Castes, or Other Backward Classes (OBC) (NCL), the minimum marks obtained in Physics, Chemistry, and Biotechnology/Biology are taken together in the qualifying examination shall be 40% marks instead of the 50% marks for General-EWS Candidates and Unreserved.
- Regarding PWBD candidates, per DCI and NMC regulations, the minimum marks in the qualifying examination in Chemistry, Physics, and Biology (or Zoology and Botany)/Biotechnology taken together shall be 40% instead of 50%.
Admission Process
MBBS aspirants must complete a few steps in order to get admitted into a medical college. The detailed MBBS admissions procedure is listed below:
• Pass the NEET Exam-The NEET UG or National Eligibility Entrance Test for Undergraduate Courses is a national-level undergrad level examination conducted by the NTA for admission to MBBS/BDS/ BSMS/BUMS/BHMS/BAMS/ and other undergraduate medical courses in approved/recognized Medical/Dental /AYUSH and other Colleges/ Deemed Universities /Institutes.
• Participate in Online Counselling-Online counseling would be conducted by the Medical Counselling Committee (MCC) of the (DGHS) Directorate General of Health Services for Undergraduate Medical Courses. Information for online counseling would only be available on the MCC website for Undergraduate Medical/Dental Courses.
NEET (UG) has been a qualifying entrance exam since 2020 for admission to the MBBS/BDS courses in AIIMS and JIPMER (although such Medical Institutions are governed under separate Statutes).
Common Counselling
• Candidates qualifying for NEET (UG) – 2023 would be eligible for All India Quota and other quotas under the State Governments/Institutes, irrespective of the medium of the examination, subject to other eligibility criteria.
• Admissions to all Undergraduate Dental/Medical Courses seats will be made through NEET (UG) - 2023. The following are the seats available under different quotas:
• All India Quota Seats
• State Government Quota Seats
• Central Institutions/Universities/Deemed Universities
• Management/NRI Quota Seats in Private Medical / State Dental Colleges or any Private University
• Central Pool Quota Seats
• All seats, including NRI Quota and Management Quota, are in private unaided/aided minority / non-minority medical colleges.
• AIIMS Institutes across India/JIPMER.
• The Counselling for successful candidates for Seats under 15% All India Quota and 100%, including 85% State quota seats of Central Institutions (ABVIMS & RML Hospital/VMMC & Safdarjung Hospital/ESIC)/ Central Universities (including DU/ BHU /AMU)/ AIIMS/ JIPMER and Deemed Universities, will be conducted by the MCC/DGHS for Undergraduate Medical / Dental Courses.
• Admission in State Medical Colleges / Universities / Institutions / private medical colleges for seats other than 15% All India Quota shall be subject to reservation policy and eligibility criteria prevailing in the State/Union Territory as notified by the respective State/Union Territory from time to time.
• Admission to AIIMS / JIPMER / Central Universities (DU/BHU/AMU) / AFMC / GGSIPU / ESIC Medical Colleges / Deemed Universities. Counseling for admission to MBBS / BDS, etc. Courses in AIIMS / JIPMER / Central Universities [(including Medical Colleges under DU and Guru Govind Singh Indraprastha University (GGSIPU), BHU Medical College, AMU Medical College], ESIC Medical Colleges, and Deemed Universities will be conducted by DGHS, and reservation policy will be as per rules/regulations applicable to such Universities / Institutions.
Fees Structure
The fee structure for MBBS varies among accredited institutions/ medical colleges. Government colleges generally have lower fees, while private medical colleges charge more. The fee structure on average for MBBS is around Rs. 20,000 to Rs 27 lakhs per year.
Colleges offering MBBS
Various accredited institutes/ medical colleges across India offer MBBS.
As per the National Medical Commission website, the following accredited institutes/hospitals are offering MBBS for the academic year 2023-24.
Sl. No
State
Name and Address of Medical College/Medical Institution
Management of College
Annual Intake (Seats)
1
Andaman Nicobar Islands
Andaman
& Nicobar Islands Institute of Medical Sciences, Port Blair
Govt.
114
2
Andhra Pradesh
ACSR
Government Medical College Nellore
Govt.
175
3
Andhra Pradesh
All
India Institute of Medical Sciences, Mangalagiri, Vijayawada
Govt.
125
4
Andhra Pradesh
Alluri
Sitaram Raju Academy of Medical Sciences, Eluru
Trust
250
5
Andhra Pradesh
Andhra
Medical College, Visakhapatnam
Govt.
250
6
Andhra Pradesh
Apollo
Institute of Medical Sciences and Research, Chittoor
Society
150
7
Andhra Pradesh
Dr.
P.S.I. Medical College, Chinoutpalli
Trust
150
8
Andhra Pradesh
Fathima
Instt. of Medical Sciences, Kadapa
Trust
100
9
Andhra Pradesh
Gayathri
Vidya Parishad Institute of Health Care & Medical Technology,
Visakhapatnam
Society
150
10
Andhra Pradesh
GITAM
Institute of Medical Sciences and Research, Visakhapatnam
Private
150
11
Andhra Pradesh
Government
Medical College, Ananthapuram
Govt.
150
12
Andhra Pradesh
Government
Siddhartha Medical College, Vijayawada
Govt.
175
13
Andhra Pradesh
Great
Eastern Medical School and Hospital, Srikakulam
Trust
150
14
Andhra Pradesh
GSL
Medical College, Rajahmundry
Trust
200
15
Andhra Pradesh
Guntur
Medical College, Guntur
Govt.
250
16
Andhra Pradesh
Katuri
Medical College, Guntur
Trust
150
17
Andhra Pradesh
Konaseema
Institute of Medical Sciences & Research Foundation, Amalapuram
Trust
150
18
Andhra Pradesh
Kurnool
Medical College, Kurnool
Govt.
250
19
Andhra Pradesh
Maharajah
Institute of Medical Sciences, Vizianagaram
Trust
150
20
Andhra Pradesh
Narayana
Medical College, Nellore
Trust
250
21
Andhra Pradesh
Nimra
Institute of Medical Sciences, Krishna Dist., A.P.
Society
150
22
Andhra Pradesh
NRI
Institute of Medical Sciences, Visakhapatnam
Trust
150
23
Andhra Pradesh
NRI
Medical College, Guntur
Trust
200
24
Andhra Pradesh
P
E S Institute Of Medical Sciences and Research, Kuppam
Trust
150
25
Andhra Pradesh
Rajiv
Gandhi Institute of Medical Sciences, Kadapa
Govt.
175
26
Andhra Pradesh
Rajiv
Gandhi Institute of Medical Sciences, Ongole, AP
Govt.
120
27
Andhra Pradesh
Rajiv
Gandhi Institute of Medical Sciences, Srikakulam
Govt.
150
28
Andhra Pradesh
Rangaraya
Medical College, Kakinada
Govt.
250
29
Andhra Pradesh
Santhiram
Medical College, Nandyal
Trust
150
30
Andhra Pradesh
Sri
Balaji Medical College, Hospital and Research Institute, Chittoor
Trust
150
31
Andhra Pradesh
SVIMS
- Sri Padmavathi Medical College for Women, Alipiri Road, Tirupati
Govt.
175
32
Andhra Pradesh
S
V Medical College, Tirupati
Govt.
240
33
Andhra Pradesh
Viswabharathi
Medical College, Kurnool
Society
150
34
Arunachal Pradesh
Tomo
Riba Institute of Health & Medical Sciences, Naharlagun
Govt.
50
35
Assam
All
India Institute of Medical Sciences, Guwahati
Govt.
50
36
Assam
Assam
Medial College, Dibrugarh
Govt.
200
37
Assam
Dhubri
Medical College, Dhubri
Govt.
100
38
Assam
Diphu
Medical College & Hospital, Diphu, Assam
Govt.
100
39
Assam
Fakhruddin
Ali Ahmed Medical College, Barpeta, Assam
Govt-Society
125
40
Assam
Gauhati
Medical College, Guwahati
Govt.
200
41
Assam
Jorhat
Medical College & Hospital, Jorhat
Govt.
125
42
Assam
Lakhimpur
Medical College
Govt.
100
43
Assam
Silchar
Medical College, Silchar
Govt.
125
44
Assam
Tezpur
Medical College & Hospital, Tezpur
Govt.
125
45
Bihar
All
India Institute of Medical Sciences, Patna
Govt.
125
46
Bihar
Anugrah
Narayan Magadh Medical College, Gaya
Govt.
120
47
Bihar
Bhagwan
Mahavir Institute of Medical Sciences, Pawapuri (Formely known as Vardhman
Institute of Medical Sciences, Pawapuri)
Govt.
120
48
Bihar
Darbhanga
Medical College, Lehriasarai
Govt.
120
49
Bihar
Employees
State Insurance Corporation Medical College, Patna
Govt.
100
50
Bihar
Government
Medical College, Bettiah
Govt.
120
51
Bihar
Indira
Gandhi Institute of Medical Sciences, Sheikhpura, Patna
Govt.
120
52
Bihar
Jannayak
Karpoori Thakur Medical College & Hospital, Madhepura, Bihar
Govt.
100
53
Bihar
Jawaharlal
Nehru Medical College, Bhagalpur
Govt.
120
54
Bihar
Katihar
Medical College, Katihar
Trust
150
55
Bihar
Lord
Buddha Koshi Medical College and Hospital, Saharsa
Trust
100
56
Bihar
Madhubani
Medical College, Madhubani
Trust
150
57
Bihar
Mata
Gujri Memorial Medical College, Kishanganj
Trust
100
58
Bihar
Nalanda
Medical College, Patna
Govt.
150
59
Bihar
Narayan
Medical College & Hospital, Sasaram
Trust
150
60
Bihar
Netaji
Subhas Medical College & Hospital, Amhara, Bihta, Patna
Society
100
61
Bihar
Patna
Medical College, Patna
Govt.
200
62
Bihar
Radha
Devi Jageshwari Memorial Medical College and Hospital
Society
150
63
Bihar
Shree
Narayan Medical Institute and Hospital
Trust
150
64
Bihar
Shri
Krishna Medical College, Muzzafarpur
Govt.
120
65
Chandigarh
Government
Medical College, Chandigarh
Govt.
150
66
Chattisgarh
All
India Institute of Medical Sciences, Raipur
Govt.
125
67
Chattisgarh
Chandulal
Chandrakar Memorial Govt. Medical College, Durg
Govt.
200
68
Chattisgarh
Chhattisgarh
Institute of Medical Sciences, Bilaspur
Govt.
150
69
Chattisgarh
Government
Medical College (Bharat Ratna Shri Atal Bihari Vajpayee Memorial Med. Col.),
Rajnandgaon
Govt.
125
70
Chattisgarh
Government
Medical College, Kanker
Govt.
125
71
Chattisgarh
Government
Medical College, Korba
Govt.
125
72
Chattisgarh
Government
Medical College, Mahasamund
Govt.
125
73
Chattisgarh
Late
Shri Baliram Kashyap Memorial NDMC Govt. Medical College, Jagdalpur
Govt.
125
74
Chattisgarh
Late
Shri Lakhi Ram Agrawal Memorial Govt. Medical College, Raigarh
Govt.
60
75
Chattisgarh
Pt.
J N M Medical College, Raipur
Govt.
180
76
Chattisgarh
Raipur
Institute of Medical Sciences (RIMS), Raipur
Society
150
77
Chattisgarh
Rajmata
Shrimati Devendra kumari Singhdeo Government Medical College, Surguja ( C.G.)
Govt.
125
78
Chattisgarh
Shri
Balaji Institute of Medical Science
Society
150
79
Chattisgarh
Shri
Shankaracharya Institute of Medical Sciences, Bhilai
Society
150
80
Dadra and Nagar Haveli
NAMO
Medical Education and Research Institute, Silvassa
Govt.
177
81
Delhi
All
India Institute of Medical Sciences, New Delhi
Govt.
132
82
Delhi
Army
College of Medical Sciences, New Delhi
Trust
100
83
Delhi
Atal
Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi
Govt.
100
84
Delhi
Dr.
Baba Saheb Ambedkar Medical College, Rohini, Delhi
Govt.
125
85
Delhi
Hamdard
Institute of Medical Sciences & Research, New Delhi
Society
150
86
Delhi
Lady
Hardinge Medical College, New Delhi
Govt.
240
87
Delhi
Maulana
Azad Medical College, New Delhi
Govt.
250
88
Delhi
North
Delhi Municipal Corporation Medical College, Delhi
Govt.
60
89
Delhi
University
College of Medical Sciences & GTB Hospital, New Delhi
Govt.
170
90
Delhi
Vardhman
Mahavir Medical College & Safdarjung Hospital, Delhi
Govt.
170
91
Goa
Goa
Medical College, Panaji
Govt.
180
92
Gujarat
All
India Institute of Medical Sciences, Rajkot
Govt.
50
93
Gujarat
Banas
Medical College and Research Institute, Palanpur, Gujarat
Trust
200
94
Gujarat
B
J Medical College, Ahmedabad
Govt.
250
95
Gujarat
CU
Shah Medical College, Surendra Nagar
Trust
100
96
Gujarat
Dr.Kiran
C.Patel Medical College and Research Institute
Trust
200
97
Gujarat
Dr.
M.K. Shah Medical College & Research Centre, Ahmedabad
Trust
150
98
Gujarat
Dr.
N.D. Desai Faculty of Medical Science and Research, Nadiad
Private
150
99
Gujarat
GCS
Medical College, Ahmedabad
Trust
150
100
Gujarat
GMERS
Medical College, Dharpur Patan
Govt-Society
200
101
Gujarat
GMERS
Medical College, Gandhinagar
Govt-Society
200
102
Gujarat
GMERS
Medical College, Gotri, Vadodara
Govt-Society
200
103
Gujarat
GMERS
Medical College, Hadiyol, Himmatnagar
Govt-Society
200
104
Gujarat
GMERS
Medical College, Junagadh
Govt-Society
200
105
Gujarat
GMERS
Medical College, Navsari
Govt.
100
106
Gujarat
GMERS
Medical College, Rajpipla
Govt.
100
107
Gujarat
GMERS
Medical College, Sola, Ahmedabad
Govt-Society
200
108
Gujarat
GMERS
Medical College, Vadnagar, Mehsana
Govt-Society
200
109
Gujarat
GMERS
Medical College, Valsad
Govt-Society
200
110
Gujarat
Government
Medical College, Bhavnagar
Govt.
200
111
Gujarat
Government
Medical College, Morbi
Govt.
100
112
Gujarat
Government
Medical College, Panchmahal Godhra
Govt.
100
113
Gujarat
Government
Medical College, Porbandar
Govt.
100
114
Gujarat
Government
Medical College, Surat
Govt.
250
115
Gujarat
Gujarat
Adani Institute of Medical Sciences, Bhuj
Trust
150
116
Gujarat
Medical
College, Baroda
Govt.
250
117
Gujarat
MP
Shah Medical College, Jamnagar
Govt.
250
118
Gujarat
Narendra
Modi Medical College, Ahmedabad (Formerly known as Ahmedabad Municipal Corporation
Medical Edu. Trust Medical College)
Govt.
200
119
Gujarat
Nootan
Medical College and Research Centre, Mehsana
Trust
150
120
Gujarat
Pandit
Deendayal Upadhyay Medical College, Rajkot
Govt.
200
121
Gujarat
Parul
Institute of Medical Sciences & Research, Vadodara
Private
150
122
Gujarat
Pramukhswami
Medical College, Karmsad
Trust
150
123
Gujarat
SBKS
Medical Instt. & Research Centre, Vadodra
Trust
250
124
Gujarat
Shantabaa
Medical College, Amreli
Trust
200
125
Gujarat
Smt.
N.H.L.Municipal Medical College, Ahmedabad
Govt.
250
126
Gujarat
Surat
Municipal Institute of Medical Education & Research, Surat
Govt.
250
127
Gujarat
Zydus
Medical College & Hospital, Dahod
Trust
200
128
Haryana
Adesh
Medical College and Hospital, Shahabad, Kurukshetra, Haryana
Society
150
129
Haryana
Al
Falah School of Medical Sciences & Research Centre, Faridabad
Private
150
130
Haryana
BPS
Government Medical College for Women, Sonepat
Govt.
120
131
Haryana
Employees
State Insurance Corporation Medical College, Faridabad
Govt.
125
132
Haryana
Faculty
of Medicine and Health Sciences, Gurgaon (Formerly SGGST Medical College
& R Centre, Gurgaon)
Trust
150
133
Haryana
Kalpana
Chawala Govt. Medical College, Karnal, Haryana
Govt.
120
134
Haryana
Maharaja
Agrasen Medical College, Agroha
Trust
100
135
Haryana
Maharishi
Markandeshwar Institute Of Medical Sciences & Research, Mullana, Ambala
Trust
150
136
Haryana
N.C.
Medical College & Hospital, Panipat
Trust
150
137
Haryana
Pt.
B D Sharma Postgraduate Institute of Medical Sciences, Rohtak (Haryana)
Govt.
250
138
Haryana
Shaheed
Hasan Khan Mewati Government Medical College, Nalhar
Govt.
120
139
Haryana
Shri
Atal Bihari Vajpayee Government Medical College, Faridabad
Govt.
100
140
Haryana
World
College of Medical Sciences & Research, Jhajjar, Haryana
Trust
150
141
Himachal Pradesh
All
India Institute of Medical Sciences, Bilaspur
Govt.
50
142
Himachal Pradesh
Dr.
Radhakrishnan Government Medical College, Hamirpur, H.P
Govt.
120
143
Himachal Pradesh
Dr.
Rajendar Prasad Government Medical College, Tanda, H.P
Govt.
120
144
Himachal Pradesh
Government
Medical College, Nahan, Sirmour H.P.
Govt.
120
145
Himachal Pradesh
Indira
Gandhi Medical College, Shimla
Govt.
120
146
Himachal Pradesh
Maharishi
Markandeshwar Medical College & Hospital, Solan
Trust
150
147
Himachal Pradesh
Pt.
Jawahar Lal Nehru Government Medical College, Chamba
Govt.
120
148
Himachal Pradesh
Shri
Lal Bahadur Shastri Government Medical College, Mandi, HP
Govt.
120
149
Jammu & Kashmir
Acharya
Shri Chander College of Medical Sciences, Jammu
Trust
100
150
Jammu & Kashmir
All
India Institute of Medical Sciences, Vijaypur
Govt.
62
151
Jammu & Kashmir
Government
Medical College, Anantnag
Govt.
100
152
Jammu & Kashmir
Government
Medical College, Baramulla
Govt.
100
153
Jammu & Kashmir
Government
Medical College, Jammu
Govt.
180
154
Jammu & Kashmir
Government
Medical College, Kathua
Govt.
100
155
Jammu & Kashmir
Government
Medical College, Rajouri, J&K
Govt.
100
156
Jammu & Kashmir
Government
Medical College, Srinagar
Govt.
180
157
Jammu & Kashmir
Govt.
Medical College, Doda, Kashmir
Govt.
100
158
Jammu & Kashmir
Sher-I-Kashmir
Instt. Of Medical Sciences, Srinagar
Govt.
125
159
Jharkhand
All
India Institute of Medical Sciences, Deoghar
Govt.
100
160
Jharkhand
Dumka
Medical College, Dighi Dumka
Govt.
100
161
Jharkhand
Hazaribagh
Medical College, Hazaribagh
Govt.
100
162
Jharkhand
Laxmi
Chandravansi Medical College & Hospital
Trust
100
163
Jharkhand
Manipal
Tata Medical College, Baridih Jamshedpur
Trust
150
164
Jharkhand
M
G M Medical College, Jamshedpur
Govt.
50
165
Jharkhand
Palamu
Medical College, Palamu
Govt.
100
166
Jharkhand
Rajendra
Institute of Medical Sciences, Ranchi
Govt.
180
167
Jharkhand
Shahid
Nirmal Mahto Medical College & Hospital, Dhanbad
Govt.
50
168
Karnataka
Adichunchanagiri
Institute of Medical Sciences Bellur
Trust
250
169
Karnataka
A
J Institute of Medical Sciences & Research Centre, Mangalore
Trust
150
170
Karnataka
Akash
Institute of Medical Sciences & Research Centre, Devanhalli, Bangalore,
Karnataka
Trust
150
171
Karnataka
Al-Ameen
Medical College, Bijapur
Trust
150
172
Karnataka
Bangalore
Medical College and Research Institute, Bangalore
Govt.
250
173
Karnataka
Basaveswara
Medical College and Hospital, Chitradurga
Trust
150
174
Karnataka
Belagavi
Institute of Medical Sciences, Belagavi
Govt.
150
175
Karnataka
BGS
Global Institute of Medical Sciences, Bangalore
Trust
150
176
Karnataka
Bidar
Institute of Medical Sciences,Bidar
Govt.
150
177
Karnataka
Chamrajanagar
Institute of Medical Sciences, Karnataka
Govt.
150
178
Karnataka
Chikkaballapura
Institute of Medical Sciences
Govt.
100
179
Karnataka
Chikkamagaluru
Institute of Medical Sciences, Chikkamagaluru
Govt.
150
180
Karnataka
Dr. BR Ambedkar Medical College, Bangalore
Trust
100
181
Karnataka
Dr.
Chandramma Dayananda Sagar Instt. of Medical Education & Research,
Harohalli, Hubli
Trust
150
182
Karnataka
East
Point College of Medical Sciences & Research Centre, Bangalore
Trust
150
183
Karnataka
Employees
State Insurance Corporation Medical College, Bangalore
Govt.
125
184
Karnataka
Employees
State Insurance Corporation Medical College, Gulbarga
Govt.
125
185
Karnataka
Father
Mullers Medical College, Mangalore
Trust
150
186
Karnataka
Gadag
Institute of Medical Sciences, Mallasamudra, Mulgund Road, Gadag
Govt.
150
187
Karnataka
G
R Medical College Hospital & Research Centre
Trust
150
188
Karnataka
Gulbarga
Institute of Medical Sciences, Gulbarga
Govt.
150
189
Karnataka
Hassan
Institute of Medical Sciences, Hassan
Govt.
150
190
Karnataka
Haveri
Institute of Medical Sciences, Haveri
Private
150
191
Karnataka
Jagadguru
Gangadhar Mahaswamigalu Moorusavirmath Medical College JGMMMC
Trust
150
192
Karnataka
Jawaharlal
Nehru Medical College, Belgaum
Trust
200
193
Karnataka
JJM
Medical College, Davangere
Trust
245
194
Karnataka
JSS
Medical College, Mysore
Trust
250
195
Karnataka
Kanachur
Institute of Medical Sciences, Mangalore
Trust
150
196
Karnataka
Karnataka
Institute of Medical Sciences, Hubballi
Govt.
200
197
Karnataka
Karwar
Institute of Medical Sciences, Karwar
Govt.
150
198
Karnataka
Kasturba
Medical College, Mangalore
Trust
250
199
Karnataka
Kasturba
Medical College, Manipal
Trust
250
200
Karnataka
Kempegowda
Institute of Medical Sciences, Bangalore
Trust
150
201
Karnataka
Khaja
Bandanawaz University - Faculty of Medical Sciences, Gulbarga
Trust
150
202
Karnataka
Kodagu
Institute of Medical Sciences, Kodagu
Govt.
150
203
Karnataka
Koppal
Institute of Medical Sciences, Koppal
Govt.
150
204
Karnataka
K
S Hegde Medical Academy, Mangalore
Trust
150
205
Karnataka
K
V G Medical College, Sullia
Trust
100
206
Karnataka
Mahadevappa
Rampure Medical College, Kalaburagi, Gulbarga
Trust
150
207
Karnataka
Mandya
Institute of Medical Sciences, Mandya
Govt.
150
208
Karnataka
M
S Ramaiah Medical College, Bangalore
Trust
150
209
Karnataka
MVJ
Medical College and Research Hospital, Bangalore
Trust
150
210
Karnataka
Mysore
Medical College and Research Instt. (Prev. name Government Medical College),
Mysore
Govt.
150
211
Karnataka
Navodaya
Medical College, Raichur
Trust
200
212
Karnataka
Raichur
Institute of Medical Sciences,Raichur
Govt.
150
213
Karnataka
Rajarajeswari
Medical College & Hospital, Bangalore
Trust
250
214
Karnataka
Sambharam
Institute of Medical Sciences & Research, Kolar
Trust
215
Karnataka
Sapthagiri
Institute of Medical Sciences & Research Centre, Bangalore
Trust
250
216
Karnataka
SDM
College of Medical Sciences & Hospital, Sattur, Dharwad
Trust
150
217
Karnataka
Shimoga
Institute of Medical Sciences,Shimoga
Govt.
150
218
Karnataka
Shri
Atal Bihari Vajpayee Medical College & Research Institute
Govt.
150
219
Karnataka
Shri
B M Patil Medical College, Hospital & Research Centre, Vijayapura(Bijapur
Trust
200
220
Karnataka
Shridevi
Institute of Medical Sciences & Research Hospital, Tumkur
Trust
150
221
Karnataka
Siddaganga
Medical College and Research Institute, Tumakuru
Private
150
222
Karnataka
S.
Nijalingappa Medical College & HSK Hospital & Research Centre,
Bagalkot
Trust
250
223
Karnataka
Sri
Devaraj URS Medical College, Kolar
Trust
150
224
Karnataka
Srinivas
Institute of Medical Research Centre, Srinivasnagar, Mangalore
Trust
150
225
Karnataka
Sri
Siddhartha Institute of Medical Sciences & Research Centre, Bangalore
Trust
150
226
Karnataka
Sri
Siddhartha Medical College, Tumkur
Trust
150
227
Karnataka
S
S Institute of Medical Sciences& Research Centre, Davangere
Trust
200
228
Karnataka
St.
Johns Medical College, Bangalore
Trust
150
229
Karnataka
Subbaiah
Institute of Medical Sciences, Shimoga, Karnataka
Trust
200
230
Karnataka
The
Oxford Medical College, Hospital & Research Centre, Bangalore
Society
150
231
Karnataka
Vijaynagar
Institute of Medical Sciences, Bellary
Govt.
150
232
Karnataka
Vydehi
Institute Of Medical Sciences & Research Centre, Bangalore
Trust
250
233
Karnataka
Yadgiri
Institute of Medical Sciences, Yadgiri
Private
150
234
Karnataka
Yenepoya
Medical College, Mangalore
Trust
150
235
Kerala
Al-Azhar
Medical College and Super Speciality Hospital, Thodupuzha
Trust
150
236
Kerala
Amala
Institute of Medical Sciences, Thrissur
Trust
100
237
Kerala
Amrita
School of Medicine, Elamkara, Kochi
Trust
150
238
Kerala
Azeezia
Instt of Medical Science,Meeyannoor,Kollam
Trust
100
239
Kerala
Believers
Church Medical College Hospital, Thiruvalla, Kerala
Trust
100
240
Kerala
Dr.
Moopen s Medical College, Wayanad, Kerala
Trust
150
241
Kerala
Dr.
Somervel Memorial CSI Hospital & Medical College, Karakonam,
Thiruvananthapuram
Trust
150
242
Kerala
Government
Medical College, Ernakulam
Govt.
110
243
Kerala
Government
Medical College, Idukki.
Govt.
100
244
Kerala
Government
Medical College (Institute of Integrated Medical Sciences), Yakkara, Palakkad
Govt.
100
245
Kerala
Government
Medical College, Konni
Govt.
100
246
Kerala
Government
Medical College, Kottayam
Govt.
175
247
Kerala
Government
Medical College, Kozhikode, Calicut
Govt.
250
248
Kerala
Government
Medical College, Manjeri, Malappuram Dist.
Govt.
110
249
Kerala
Government
Medical College, Parippally, Kollam
Govt.
110
250
Kerala
Government
Medical College, Thrissur
Govt.
175
251
Kerala
Govt.
Medical College, Pariyaram, Kannur (Prev. Known as Academy of Medical
Sciences)
Govt.
100
252
Kerala
Jubilee
Mission Medical College & Research Institute, Thrissur
Trust
100
253
Kerala
Kannur
Medical College, Kannur
Trust
150
254
Kerala
Karuna
Medical College, Palakkad
Trust
100
255
Kerala
KMCT
Medical College, Kozhikode, Calicut
Trust
150
256
Kerala
Malabar
Medical College, Kozhikode, Calicut
Trust
200
257
Kerala
Malankara
Orthodox Syrian Church Medical College, Kolenchery
Trust
100
258
Kerala
Medical
College, Thiruvananthapuram
Govt.
250
259
Kerala
M
E S Medical College , Perintalmanna Malappuram Distt.Kerala
Trust
150
260
Kerala
Mount
Zion Medical College, Chayalode, Ezhamkulam Adoor, Pathanamthitta
Society
100
261
Kerala
P
K Das Institute of Medical Sciences, Palakkad, Kerala
Trust
150
262
Kerala
Pushpagiri
Institute Of Medical Sciences and Research Centre, Tiruvalla
Trust
100
263
Kerala
Sree
Gokulam Medical College Trust & Research Foundation, Trivandrum
Trust
150
264
Kerala
Sree
Narayana Instt. of Medical Sciences, Chalakka,Ernakulam
Trust
150
265
Kerala
Sree
Uthradom Thiurnal Academy of Medical Sciences, Trivandrum
Trust
100
266
Kerala
T
D Medical College, Alleppey (Allappuzha)
Govt.
175
267
Kerala
Travancore
Medical College, Kollam
Trust
150
268
Madhya Pradesh
All
India Institute of Medical Sciences, Bhopal
Govt.
125
269
Madhya Pradesh
Amaltas
Institute of Medical Sciences, Dewas
Society
150
270
Madhya Pradesh
Bundelkhand
Medical College, Sagar
Govt.
125
271
Madhya Pradesh
Chirayu
Medical College and Hospital, Bairagarh, Bhopal
Trust
150
272
Madhya Pradesh
Gajra
Raja Medical College, Gwalior
Govt.
200
273
Madhya Pradesh
Gandhi
Medical College, Bhopal
Govt.
250
274
Madhya Pradesh
Government
Medical College, Chhindwara, MP
Govt.
100
275
Madhya Pradesh
Government
Medical College, Datia, MP
Govt.
120
276
Madhya Pradesh
Government
Medical College, Khandwa, MP
Govt.
120
277
Madhya Pradesh
Government
Medical College, Ratlam
Govt.
180
278
Madhya Pradesh
Government
Medical College, Shahdol, MP
Govt.
100
279
Madhya Pradesh
Government
Medical College, Shivpuri, MP
Govt.
100
280
Madhya Pradesh
Government
Medical College, Vidisha, MP
Govt.
180
281
Madhya Pradesh
Index
Medical College Hospital & Research Centre, Indore
Trust
250
282
Madhya Pradesh
LNCT
Medical College & Sewakunj Hospital, Indore
Society
150
283
Madhya Pradesh
L.N.
Medical College and Research Centre, Bhopal
Trust
250
284
Madhya Pradesh
Mahaveer
Institute of Medical Sciences & Research, Bhopal
Society
150
285
Madhya Pradesh
M
G M Medical College, Indore
Govt.
250
286
Madhya Pradesh
Netaji
Subhash Chandra Bose Medical College, Jabalpur
Govt.
180
287
Madhya Pradesh
Peoples
College of Medical Sciences & Research Centre, Bhanpur, Bhopal
Trust
250
288
Madhya Pradesh
RKDF
Medical College Hospital & Research Centre, Jatkhedi, Bhopal
Society
150
289
Madhya Pradesh
Ruxmaniben
Deepchand Gardi Medical College, Ujjain
Trust
150
290
Madhya Pradesh
Shyam
Shah Medical College, Rewa
Govt.
150
291
Madhya Pradesh
Sri
Aurobindo Medical College and Post Graduate Institute, Indore
Trust
250
292
Madhya Pradesh
Sukh
Sagar Medical College & Hospital, Jabalpur
Trust
100
293
Maharashtra
ACPM
Medical College, Dhule
Trust
100
294
Maharashtra
All
India Institute of Medical Sciences, Nagpur
Govt.
125
295
Maharashtra
Armed
Forces Medical College, Pune
Govt.
150
296
Maharashtra
Ashwini
Rural Medical College, Hospital & Research Centre, Solapur
Trust
100
297
Maharashtra
Bharati
Vidyapeeth Deemed University Medical College & Hospital, Sangli
Trust
150
298
Maharashtra
Bharati
Vidyapeeth University Medical College, Pune
Trust
150
299
Maharashtra
Bharat Ratna Atal Bihari Vajpayee Medical College, Pune
Trust
100
300
Maharashtra
B.
J. Govt. Medical College, Pune
Govt.
250
301
Maharashtra
B.K.L.
Walawalkar Rural Medical College, Ratnagiri
Trust
150
302
Maharashtra
Datta
Meghe Medical College, Nagpur
Private
150
303
Maharashtra
Dr.
D Y Patil Medical College, Hospital and Research Centre, Pimpri, Pune
Trust
250
304
Maharashtra
Dr.
D Y Patil Medical College, Kolhapur
Trust
150
305
Maharashtra
Dr.
N Y Tasgaonkar Institute of Medical Science
Trust
100
306
Maharashtra
Dr.
Panjabrao Alias Bhausaheb Deshmukh Memorial Medical College, Amravati
Trust
150
307
Maharashtra
Dr.
Shankarrao Chavan Govt. Medical College, Nanded
Govt.
150
308
Maharashtra
Dr.
Ulhas Patil Medical College & Hospital, Jalgaon
Trust
200
309
Maharashtra
Dr. Vaishampayan Memorial Medical College, Solapur
Govt.
200
310
Maharashtra
Dr.Vasantrao
Pawar Med. Col. Hosp. & Research Centre, Nasik (Prev. NDMVP Samaj Medical
College)
Trust
120
311
Maharashtra
Dr.
Vithalrao Vikhe Patil Foundations Medical College & Hospital, Ahmednagar
Trust
200
312
Maharashtra
Government
Medical College, Akola
Govt.
200
313
Maharashtra
Government
Medical College, Alibag
Govt.
100
314
Maharashtra
Government
Medical College, Aurangabad
Govt.
200
315
Maharashtra
Government
Medical College, Chandrapur
Govt.
150
316
Maharashtra
Government
Medical College, Gondia
Govt.
150
317
Maharashtra
Government
Medical College & Hospital, Baramati
Govt.
100
318
Maharashtra
Government
Medical College, Jalgaon
Govt.
150
319
Maharashtra
Government
Medical College, Latur
Govt.
150
320
Maharashtra
Government
Medical College, Miraj
Govt.
200
321
Maharashtra
Government
Medical College, Nagpur
Govt.
250
322
Maharashtra
Government
Medical College, Nandurbar
Govt.
100
323
Maharashtra
Government
Medical College, Osmanabad
Govt.
100
324
Maharashtra
Government
Medical College, Satara
Govt.
100
325
Maharashtra
Government
Medical College, Sindhudurg
Govt.
100
326
Maharashtra
Grant
Medical College, Mumbai
Govt.
250
327
Maharashtra
H.B.T.
Medical College & Dr. R.N. Cooper Municipal General Hospital, Juhu,
Mumbai
Govt.
200
328
Maharashtra
Indian
Institute of Medical Science & Research, Jalna
Trust
150
329
Maharashtra
Indira
Gandhi Medical College & Hospital, Nagpur
Govt.
200
330
Maharashtra
Jawaharlal
Nehru Medical College, Sawangi (Meghe), Wardha
Trust
250
331
Maharashtra
KJ
Somaiyya Medical College & Research Centre, Mumbai
Trust
100
332
Maharashtra
Krishna
Vishwa Vidyapeeth, Karad (Formerly known as Krishna Institute of Medical
Sciences University)
Trust
250
333
Maharashtra
Lokmanya
Tilak Municipal Medical College, Sion, Mumbai
Govt.
200
334
Maharashtra
Maharashtra
Institute of Medical Education & Research, Talegaon, Pune
Trust
150
335
Maharashtra
Maharashtra
Institute of Medical Sciences & Research, Latur
Trust
150
336
Maharashtra
Mahatma
Gandhi Institute of Medical Sciences, Sevagram, Wardha
Trust
100
337
Maharashtra
Mahatma
Gandhi Missions Medical College, Aurangabad
Trust
150
338
Maharashtra
Mahatma
Gandhi Missions Medical College, Navi Mumbai
Trust
150
339
Maharashtra
N.
K. P. Salve Instt. of Medical Sciences and Research Centre and Lata
Mangeshkar Hospital, Nagpur
Trust
200
340
Maharashtra
Padmashree
Dr. D.Y.Patil Medical College, Navi Mumbai
Trust
250
341
Maharashtra
Prakash
Institute of Medical Sciences & Research, Sangli
Trust
150
342
Maharashtra
Rajashree
Chatrapati Shahu Maharaj Government Medical College, Kolhapur
Govt.
150
343
Maharashtra
Rajiv
Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane
Govt.
100
344
Maharashtra
Rural
Medical College, Loni
Trust
200
345
Maharashtra
Seth
GS Medical College and KEM Hospital, Mumbai
Govt.
250
346
Maharashtra
Shri
Vasant Rao Naik Govt. Medical College, Yavatmal
Govt.
200
347
Maharashtra
Sindhudurg
Shikshan Prasarak Mandal (SSPM) Medical College & Lifetime Hospital,
Padave, Sindhudurg
Trust
150
348
Maharashtra
SMBT
Institute of Medical Sciences & Research Centre, Nandi hills, Nashik
Trust
150
349
Maharashtra
Smt.
Kashibai Navale Medical College and General Hospital, Pune
Trust
150
350
Maharashtra
Sri
Bhausaheb Hire Government Medical College, Dhule
Govt.
150
351
Maharashtra
SRTR
Medical College, Ambajogai
Govt.
150
352
Maharashtra
Symbiosis
Medical College for Women, Pune
Society
150
353
Maharashtra
Terna
Medical College, Navi Mumbai
Trust
150
354
Maharashtra
Topiwala
National Medical College, Mumbai
Govt.
150
355
Maharashtra
Vedanta
Institute of Medical Sciences, Palghar, Maharashtra
Private
150
356
Manipur
Government
Medical College, Churachandpur
Govt.
100
357
Manipur
Jawaharlal
Nehru Institute of Medical Sciences, Porompet, Imphal
Govt.
150
358
Manipur
Regional
Institute of Medical Sciences, Imphal
Govt.
125
359
Manipur
Shija
Academy of Health Sciences
Private
150
360
Meghalaya
North
Eastern Indira Gandhi Regional Instt. of Health and Medical Sciences,
Shillong
Govt.
50
361
Mizoram
Zoram
Medical College, Mizoram
Govt.
100
362
Orissa
All
India Institute of Medical Sciences, Bhubaneswar
Govt.
125
363
Orissa
Government
Medical College & Hospital (Renamed Bhima Bhoi Medical College &
Hospital), Balangir
Govt.
100
364
Orissa
Government
Medical College & Hospital (Renamed Fakir Mohan Medical College &
Hospital), Balasore
Govt.
100
365
Orissa
Government
Medical College, Keonjhar,
Govt.
100
366
Orissa
Government
Medical College, Sundargarh
Govt.
100
367
Orissa
Hi-Tech
Medical College & Hospital, Bhubaneswar
Trust
150
368
Orissa
Hi-Tech
Medical College & Hospital, Rourkela
Trust
100
369
Orissa
Instt.
Of Medical Sciences & SUM Hospital, Bhubaneswar
Trust
250
370
Orissa
Kalinga
Institute of Medical Sciences, Bhubaneswar
Trust
250
371
Orissa
MKCG
Medical College, Berhampur
Govt.
250
372
Orissa
Pt.
Raghunath Murmu Medical College and Hospital, Baripada, Odisha
Govt.
125
373
Orissa
Saheed
Laxman Nayak Medical College & Hospital, Koraput
Govt.
125
374
Orissa
SCB
Medical College, Cuttack
Govt.
250
375
Orissa
Sri
Jagannath Medical College & Hospital, Puri
Govt.
100
376
Orissa
Veer
Surendra Sai Institute of Medical Sciences and Research, Burla
Govt.
200
377
Pondicherry
Aarupadai
Veedu Medical College, Pondicherry
Trust
150
378
Pondicherry
Indira
Gandhi Medical College & Research Institute, Puducherry
Govt.
180
379
Pondicherry
Jawaharlal
Institute of Postgraduate Medical Education & Research, Puducherry
Govt.
200
380
Pondicherry
Mahatma
Gandhi Medical College & Research Institute, Pondicherry
Trust
250
381
Pondicherry
Pondicherry
Institute of Medical Sciences & Research, Pondicherry
Trust
150
382
Pondicherry
Sri
Lakshmi Narayana Institute of Medical Sciences, Pondicherry
Trust
250
383
Pondicherry
Sri
Manakula Vinayagar Medical College & Hospital, Pondicherry
Trust
150
384
Pondicherry
Sri
Venkateswara Medical College, Hospital & Research Centre, Pondicherry
Trust
150
385
Pondicherry
Vinayaka
Missions Medical College, Karaikal, Pondicherry
Trust
150
386
Punjab
Adesh
Institute of Medical Sciences & Research, Bhatinda
Trust
150
387
Punjab
All
India Institute of Medical Sciences, Bhatinda
Govt.
100
388
Punjab
Chintpurni
Medical College, Pathankot, Gurdaspur
Trust
150
389
Punjab
Christian
Medical College, Ludhiana
Trust
100
390
Punjab
Dayanand
Medical College & Hospital, Ludhiana
Trust
100
391
Punjab
Dr . B R Ambedkar State Institute of Medical Sciences, SAS Nagar Mohali
Govt.
100
392
Punjab
Gian
Sagar Medical College & Hospital, Patiala
Trust
150
393
Punjab
Government
Medical College, Amritsar
Govt.
250
394
Punjab
Government
Medical College, Patiala
Govt.
225
395
Punjab
Guru
Govind Singh Medical College, Faridkot
Govt.
125
396
Punjab
Punjab
Institute of Medical Sciences, Jalandhar
Trust
150
397
Punjab
Sri
Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar
Trust
150
398
Rajasthan
All
India Institute of Medical Sciences, Jodhpur
Govt.
125
399
Rajasthan
American
International Institute of Medical Sciences, Bedwas
Private
150
400
Rajasthan
Ananta
Institute of Medical Sciences & Research Centre, Rajsamand
Society
150
401
Rajasthan
Dr. SN Medical College, Jodhpur
Govt.
250
402
Rajasthan
Dr. S S Tantia Medical College Hospital & Research Centre
Private
150
403
Rajasthan
Employees
State Insurance Corporation Medical College, Alwar
Govt.
100
404
Rajasthan
Geetanjali
Medical College & Hospital, Udaipur
Trust
250
405
Rajasthan
Government
Medical College, Barmer
Govt.
100
406
Rajasthan
Government
Medical College, Bharatpur, Rajasthan
Govt.
150
407
Rajasthan
Government
Medical College, Bhilwara, Rajasthan
Govt.
150
408
Rajasthan
Government
Medical College, Chittorgarh
Govt.
100
409
Rajasthan
Government
Medical College, Churu
Govt.
150
410
Rajasthan
Government
Medical College, Dholpur
Govt.
100
411
Rajasthan
Government
Medical College, Dungarpur
Govt.
150
412
Rajasthan
Government
Medical College, Kota
Govt.
250
413
Rajasthan
Government
Medical College, Pali, Rajasthan
Govt.
150
414
Rajasthan
Government
Medical College, Sirohi
Govt.
100
415
Rajasthan
Government
Medical College, Sri Ganganagar
Govt.
100
416
Rajasthan
Jaipur
National University Institute of Medical Sciences and Research Centre,
Jagatpura, Jaipur
Private
150
417
Rajasthan
Jawaharlal
Nehru Medical College, Ajmer
Govt.
250
418
Rajasthan
Jhalawar
Medical College, Jhalawar
Govt.
200
419
Rajasthan
Mahatma
Gandhi Medical College and Hospital, Sitapur, Jaipur
Trust
250
420
Rajasthan
National
Institute of Medical Science & Research, Jaipur
Trust
250
421
Rajasthan
Pacific
Institute of Medical Sciences, Umarda, Udaipur
Society
150
422
Rajasthan
Pacific
Medical College & Hospital, Bhilo Ka Bedla, Udaipur
Trust
150
423
Rajasthan
R
N T Medical College, Udaipur
Govt.
250
424
Rajasthan
RUHS
College of Medical Sciences, Jaipur
Govt.
150
425
Rajasthan
Sardar
Patel Medical College, Bikaner
Govt.
250
426
Rajasthan
Shri
Kalyan Govt. Medical College, Sikar, Rajasthan
Govt.
100
427
Rajasthan
SMS
Medical College, Jaipur
Govt.
250
428
Sikkim
Sikkim
Manipal Institute of Medical Sciences, Gangtok
Trust
150
429
Tamil Nadu
ACS
Medical College and Hospital, Chennai
Trust
150
430
Tamil Nadu
All
India Institute of Medical Sciences, Madurai
Govt.
50
431
Tamil Nadu
Annapoorna
Medical College & Hospital, Salem
Trust
150
432
Tamil Nadu
Arunai
Medical College And Hospital
Trust
150
433
Tamil Nadu
Bhaarat
Medical College & Hospital
Trust
150
434
Tamil Nadu
Chengalpattu
Medical College, Chengalpattu
Govt.
100
435
Tamil Nadu
Chettinad
Hospital & Research Institute, Kanchipuram
Trust
250
436
Tamil Nadu
Christian
Medical College, Vellore
Trust
100
437
Tamil Nadu
Coimbatore
Medical College, Coimbatore
Govt.
200
438
Tamil Nadu
Dhanalakshmi
Srinivasan Medical College and Hospital,Perambalur
Trust
250
439
Tamil Nadu
ESIC
Medical College & PGIMSR, K.K Nagar, Chennai
Govt.
125
440
Tamil Nadu
Faculty
of Medicine, Sri Lalithambigai Medical College, and Hospital
Trust
150
441
Tamil Nadu
Government
Dharmapuri Medical College, Dharmapuri
Govt.
100
442
Tamil Nadu
Government
Erode Medical College & Hospital, Perundurai (Formerly IRT Perundurai
Medical College)
Govt.
100
443
Tamil Nadu
Government
Medical College, Ariyalur
Govt.
150
444
Tamil Nadu
Government
Medical College, Dindigul
Govt.
150
445
Tamil Nadu
Government
Medical College & ESIC Hospital, Coimbatore, Tamil Nadu.
Govt.
100
446
Tamil Nadu
Government
Medical College Kallakurichi
Govt.
150
447
Tamil Nadu
Government
Medical College, Karur
Govt.
150
448
Tamil Nadu
Government
Medical College Krishnagiri
Govt.
150
449
Tamil Nadu
Government
Medical College Nagapattinam
Govt.
150
450
Tamil Nadu
Government
Medical College, Namakkal
Govt.
100
451
Tamil Nadu
Government
Medical College, Omandurar
Govt.
100
452
Tamil Nadu
Government
Medical College, Pudukottai, Tamil Nadu
Govt.
150
453
Tamil Nadu
Government
Medical College Ramanathapuram
Govt.
100
454
Tamil Nadu
Government
Medical College, The Nilgiris
Govt.
150
455
Tamil Nadu
Government
Medical College, Thiruvallur
Govt.
100
456
Tamil Nadu
Government
Medical College, Tiruppur
Govt.
100
457
Tamil Nadu
Government
Medical College, Virudhunagar
Govt.
150
458
Tamil Nadu
Government
Sivagangai Medical College, Sivaganga
Govt.
100
459
Tamil Nadu
Government
Thiruvannamalai Medical College, Thiruvannamalai
Govt.
100
460
Tamil Nadu
Government
Vellore Medical College, Vellore
Govt.
100
461
Tamil Nadu
Government
Villupuram Medical College, Villupuram
Govt.
100
462
Tamil Nadu
Govt.
Mohan Kumaramangalam Medical College, Salem- 30
Govt.
100
463
Tamil Nadu
Indira
Medical College & Hospitals, Thiruvallur
Private
150
464
Tamil Nadu
KanyaKumari
Government Medical College, Asaripallam
Govt.
150
465
Tamil Nadu
K
A P Viswanathan Government Medical College, Trichy
Govt.
150
466
Tamil Nadu
Karpagam
Faculty of Medical Sciences & Research, Coimbatore
Trust
150
467
Tamil Nadu
Karpaga
Vinayaga Institute of Medical Sciences,Maduranthagam
Trust
150
468
Tamil Nadu
Kilpauk
Medical College, Chennai
Govt.
150
469
Tamil Nadu
KMCH
Institute of Health Sciences and Research, Coimbatore
Private
150
470
Tamil Nadu
Madha
Medical College and Hospital, Thandalam, Chennai
Trust
150
471
Tamil Nadu
Madras
Medical College, Chennai
Govt.
250
472
Tamil Nadu
Madurai
Medical College, Madurai
Govt.
250
473
Tamil Nadu
Meenakshi
Medical College and Research Institute, Enathur
Trust
250
474
Tamil Nadu
Melmaruvathur
Adiparasakthi Instt. Medical Sciences and Research
Trust
150
475
Tamil Nadu
Panimalar
Medical College Hospital & Research Institute, Chennai, Tamil Nadu
Trust
150
476
Tamil Nadu
PSG
Institute of Medical Sciences, Coimbatore
Trust
250
477
Tamil Nadu
PSP
Medical College Hospital and Research Institute
Trust
150
478
Tamil Nadu
Rajah
Muthiah Medical College, Annamalainagar
Govt.
150
479
Tamil Nadu
Saveetha
Medical College and Hospital, Kanchipuram
Trust
250
480
Tamil Nadu
Shri
Sathya Sai Medical College and Research Institute, Kancheepuram
Trust
250
481
Tamil Nadu
Sree
Balaji Medical College and Hospital, Chennai
Trust
250
482
Tamil Nadu
Sree
Mookambika Institute of Medical Sciences, Kanyakumari
Trust
100
483
Tamil Nadu
Sri
Muthukumaran Medical College, Chennai
Trust
150
484
Tamil Nadu
Srinivasan
Medical College and Hospital
Trust
150
485
Tamil Nadu
Sri
Ramachandra Medical College & Research Institute, Chennai
Trust
250
486
Tamil Nadu
Sri
Venkateswara Medical College Hospital and Research Institute, Chennai
Private
150
487
Tamil Nadu
SRM
Medical College Hospital & Research Centre, Chengalpattu
Trust
250
488
Tamil Nadu
Stanley
Medical College, Chennai
Govt.
250
489
Tamil Nadu
ST
Peters Medical College, Hospital & Research Institute
Trust
150
490
Tamil Nadu
Swamy
Vivekanandha Medical College Hospital And Research Institute
Trust
150
491
Tamil Nadu
Tagore
Medical College and Hospital, Chennai
Trust
150
492
Tamil Nadu
Thanjavur
Medical College,Thanjavur
Govt.
150
493
Tamil Nadu
Theni
Government Medical College, Theni
Govt.
100
494
Tamil Nadu
Thiruvarur
Govt. Medical College, Thiruvarur
Govt.
100
495
Tamil Nadu
Thoothukudi
Medical College, Thoothukudi
Govt.
150
496
Tamil Nadu
Tirunelveli
Medical College,Tirunelveli
Govt.
250
497
Tamil Nadu
Trichy
SRM Medical College Hospital & Research Centre, Trichy
Trust
250
498
Tamil Nadu
Velammal
Medical College Hospital and Research Institute, Madurai
Trust
150
499
Tamil Nadu
VELS
Medical College & Hospital
Trust
150
500
Tamil Nadu
Vinayaka
Missions Kirupananda Variyar Medical College, Salem
Trust
150
501
Telangana
All
India Institute of Medical Sciences, Bibinagar
Govt.
100
502
Telangana
Apollo
Institute of Medical Sciences and Research, Hyderabad
Trust
150
503
Telangana
Arundathi
Institute of Medical Sciences
Trust
150
504
Telangana
Ayaan
Institute of Medical Sciences, Teaching Hospital & Research Centre,
Kanaka Mamidi, R.R. Dist
Society
150
505
Telangana
Bhaskar
Medical College, Yenkapally
Trust
150
506
Telangana
Chalmeda
Anand Rao Institute Of Medical Sciences, Karimnagar
Trust
200
507
Telangana
Deccan
College of Medical Sciences, Hyderabad
Trust
150
508
Telangana
Dr.
Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Rangareddy
Society
150
509
Telangana
Dr.
VRK Women Medical College, Aziznagar
Trust
100
510
Telangana
Employees
State Insurance Corporation Medical College, Sanath Nagar, Hyderabad
Govt.
100
511
Telangana
Gandhi
Medical College, Secunderabad
Govt.
250
512
Telangana
Government
Medical College, Bhadradri Kothagudem
Govt.
150
513
Telangana
Government
Medical College, Jagtial
Govt.
150
514
Telangana
Government
Medical College, Mahabubabad
Govt.
150
515
Telangana
Government
Medical College, Mahabubnagar
Govt.
175
516
Telangana
Government
Medical College, Mancherial
Govt.
100
517
Telangana
Government
Medical College, Nagarkurnool
Govt.
150
518
Telangana
Government
Medical College, Nalgonda
Govt.
150
519
Telangana
Government
Medical College, Nizamabad
Govt.
120
520
Telangana
Government
Medical College, Ramagundam
Govt.
150
521
Telangana
Government
Medical College, Sangareddy
Govt.
150
522
Telangana
Government
Medical College, Siddipet
Govt.
175
523
Telangana
Government
Medical College, Suryapet
Govt.
150
524
Telangana
Government
Medical College, Wanaparthy
Govt.
150
525
Telangana
Kakatiya
Medical College, Warangal
Govt.
250
526
Telangana
Kamineni
Academy of Medical Sciences & Research Center, Hyderabad
Private
150
527
Telangana
Kamineni
Institute of Medical Sciences, Narketpally
Trust
200
528
Telangana
Mahavir
Institute of Medical Sciences, Vikarabad, Telangana
Trust
150
529
Telangana
Maheshwara
Medical College, Chitkul, Patancheru, Medak
Society
150
530
Telangana
Malla
Reddy Institute of Medical Sciences, Hyderabad
Society
200
531
Telangana
Mallareddy
Medical College for Women, Hyderabad
Society
200
532
Telangana
Mamata
Academy of Medical Sciences, Bachupally
Society
150
533
Telangana
Mamata
Medical College, Khammam
Trust
200
534
Telangana
Mediciti
Institute Of Medical Sciences, Ghanpur
Trust
150
535
Telangana
MNR
Medical College & Hospital, Sangareddy
Trust
150
536
Telangana
Osmania
Medical College, Hyderabad
Govt.
250
537
Telangana
Prathima
Institute Of Medical Sciences, Karimnagar
Trust
200
538
Telangana
Prathima
Relief Institue of Medical Sciences
Trust
150
539
Telangana
Rajiv
Gandhi Institute of Medical Sciences, Adilabad
Govt.
120
540
Telangana
R.V.M.
Institute of Medical Sciences and Research Centre, Siddipet
Trust
150
541
Telangana
Shadan
Institute of Medical Sciences, Research Centre and Teaching Hospital,
Peerancheru
Society
150
542
Telangana
Surabhi
Institute of Medical Sciences, Siddipet, Telangana
Society
150
543
Telangana
S
V S Medical College, Mehboobnagar
Trust
150
544
Telangana
TRR
Institute of Medical Sciences, Patancheru
Society
150
545
Tripura
Agartala
Government Medical College,Agartala
Govt.
125
546
Tripura
Tripura
Medical College and Dr. B R A M Teaching Hospital, Agartala
Trust
100
547
Uttarakhand
All
India Institute of Medical Sciences, Rishikesh
Govt.
125
548
Uttarakhand
Doon
Medical College, Dehradun, Uttarakhand
Govt.
175
549
Uttarakhand
Gautam
Buddha Chikitsa Mahavidyalaya, Dehradum
Trust
150
550
Uttarakhand
Government
Medical College (Prev. Uttarakhand Forest Hospital Trust Med.Col.), Haldwani
Govt.
125
551
Uttarakhand
Himalayan
Institute of Medical Sciences, Dehradun
Trust
150
552
Uttarakhand
Shri
Guru Ram Rai Institute of Medical & Health Sciences, Dehradun
Society
150
553
Uttarakhand
Soban
Singh Jeena Government Institute of Medical Science & Research, Almora
Govt.
100
554
Uttarakhand
Veer
Chandra Singh Garhwali Govt. Medical Sc. & Research Instt, Srinagar,
Pauri Garhwal
Govt.
175
555
Uttar Pradesh
All
India Institute of Medical Sciences, Gorakhpur
Govt.
125
556
Uttar Pradesh
All
India Institute of Medical Sciences, Rae Bareli
Govt.
100
557
Uttar Pradesh
Autonomous
State Medical College Pratapgarh
Govt.
100
558
Uttar Pradesh
Autonomous
State Medical College, Siddharthnagar
Govt.
100
559
Uttar Pradesh
Autonomous
State Medical College Society, Etah, Uttar Pradesh
Govt.
100
560
Uttar Pradesh
Autonomous
State Medical College Society, Fatehpur
Govt.
100
561
Uttar Pradesh
Autonomous
State Medical College Society Ghazipur
Govt.
100
562
Uttar Pradesh
Autonomous
State Medical College Society, Hardoi
Govt.
100
563
Uttar Pradesh
Autonomous
State Society Medical College Mirzapur
Govt.
100
564
Uttar Pradesh
BRD
Medical College, Gorakhpur
Govt.
150
565
Uttar Pradesh
Career
Instt. Of Medical Sciences & Hospital, Lucknow
Trust
100
566
Uttar Pradesh
Dr.
Ram Manohar Lohia Institute of Medical Sciences, Lucknow
Govt.
200
567
Uttar Pradesh
Era
Lucknow Medical College, Lucknow
Trust
150
568
Uttar Pradesh
F.H.
Medical College & Hospital, Etamdapur, Agra
Trust
150
569
Uttar Pradesh
Government
Allopathic Medical College, Banda, UP
Govt.
100
570
Uttar Pradesh
Government
Institute of Medical Sciences, Kasna, Greater Noida
Govt-Society
100
571
Uttar Pradesh
Government
Medical College, Badaun, U.P.
Govt.
100
572
Uttar Pradesh
Government
Medical College, Faizabad
Govt.
100
573
Uttar Pradesh
Government
Medical College, Firozabad
Govt.
100
574
Uttar Pradesh
Government
Medical College, Kannauj
Govt.
100
575
Uttar Pradesh
Government
Medical College, Rampur, Basti
Govt.
100
576
Uttar Pradesh
Government
Medical College, Shahjahanpur, UP
Govt.
100
577
Uttar Pradesh
Government
Medical College & Super facility Hospital, Azamgarh
Govt.
100
578
Uttar Pradesh
G.S.
Medical College & Hospital, Hapur, UP
Trust
150
579
Uttar Pradesh
GSVM
Medical College, Kanpur
Govt.
250
580
Uttar Pradesh
Heritage
Institute of Medical Sciences, Varanasi
Private
150
581
Uttar Pradesh
Hind
Institute of Medical Sciences, Barabanki
Trust
100
582
Uttar Pradesh
Hind
Institute of Medical Sciences, Sitapur
Trust
150
583
Uttar Pradesh
Institute
of Medical Sciences, BHU, Varanasi
Govt.
100
584
Uttar Pradesh
Integral
Institute of Medical Sciences & Research, Lucknow
Private
150
585
Uttar Pradesh
Jawaharlal
Nehru Medical College, Aligarh
Govt.
150
586
Uttar Pradesh
K.D.
Medical College Hospital & Research Centre, Mathura
Society
150
587
Uttar Pradesh
King
George Medical University, Lucknow
Govt.
250
588
Uttar Pradesh
Krishna
Mohan Medical College & Hospital, Mathura
Society
150
589
Uttar Pradesh
LLRM
Medical College, Meerut
Govt.
100
590
Uttar Pradesh
Mahamaya
Rajkiya Allopathic Medical College, Ambedkarnagar
Govt.
100
591
Uttar Pradesh
Maharani
Laxmi Bai Medical College, Jhansi
Govt.
150
592
Uttar Pradesh
Maharshi
Devraha Baba Autonomous State Medical College, Deoria
Govt.
100
593
Uttar Pradesh
Major
S D Singh Medical College and Hospital, Fathehgarh, Farrukhabad
Trust
594
Uttar Pradesh
Mayo
Institute of Medical Sciences, Barabanki
Trust
150
595
Uttar Pradesh
Moti
Lal Nehru Medical College, Allahabad
Govt.
200
596
Uttar Pradesh
Muzaffarnagar
Medical College, Muzaffarnagar
Trust
150
597
Uttar Pradesh
Naraina
Medical College & Research Centre
Society
150
598
Uttar Pradesh
National
Capital Region Institute of Medical Sciences, Meerut
Society
150
599
Uttar Pradesh
Noida
International Institute Of Medical Sciences
Trust
150
600
Uttar Pradesh
Prasad
Institute of Medical Sciences, Lucknow
Trust
150
601
Uttar Pradesh
Rajkiya
Allopathic Medical College, Bahraich, UP
Govt.
100
602
Uttar Pradesh
Rajkiya
Medical College Jalaun, Orai, Uttar Pradesh
Govt.
100
603
Uttar Pradesh
Rajshree
Medical Research Institute, Bareilly
Trust
150
604
Uttar Pradesh
Rama
Medical College and Hospital, Kanpur
Trust
150
605
Uttar Pradesh
Rama
Medical College Hospital and Research Centre, Hapur
Trust
250
606
Uttar Pradesh
Rohilkhand
Medical College & Hospital, Bareilly
Trust
250
607
Uttar Pradesh
Santosh
Medical College, Ghaziabad
Trust
150
608
Uttar Pradesh
Saraswati
Institute of Medical Sciences, Hapur
Trust
150
609
Uttar Pradesh
Saraswati
Medical College, Unnao, U.P.
Trust
150
610
Uttar Pradesh
School
of Medical Sciences & Research, Greater Noida
Trust
250
611
Uttar Pradesh
Shaikh-UL-Hind
Maulana Mahmood Hasan Medical College, Saharanpur
Govt.
100
612
Uttar Pradesh
Shri
Ram Murti Smarak Institute of Medical Sciences, Bareilly
Trust
150
613
Uttar Pradesh
S
N Medical College, Agra
Govt.
128
614
Uttar Pradesh
Subharti
Medical College, Meerut
Trust
150
615
Uttar Pradesh
Teerthanker
Mahaveer Medical College, Moradabad
Trust
150
616
Uttar Pradesh
T
S Misra Medical College & Hospital, Amusi, Lucknow
Private
150
617
Uttar Pradesh
Uma
Nath Singh Autonomous State Medical College Society Jaunpur
Govt.
100
618
Uttar Pradesh
United
Institute of Medical Sciences, Allahabad
Society
150
619
Uttar Pradesh
Uttar
Pradesh University of Medical Sciences, (Prev. UP Rural Inst. of Med.Sc&R)
Etawah
Govt.
200
620
Uttar Pradesh
Varun
Arjun Medical College, Banthra, Shahjahanpur
Trust
150
621
Uttar Pradesh
Venkateshwara
Institute of Medical Sciences, Gajraula
Trust
150
622
West Bengal
All
India Institute of Medical Sciences, Kalyani, Nadia
Govt.
125
623
West Bengal
Bankura
Sammilani Medical College, Bankura
Govt.
200
624
West Bengal
Barasat
Government Medical College & Hospital
Govt.
100
625
West Bengal
Burdwan
Medical College, Burdwan
Govt.
200
626
West Bengal
Calcutta
National Medical College, Kolkata
Govt.
250
627
West Bengal
College
of Medicine and JNM Hospital, Kalyani, Nadia
Govt.
125
628
West Bengal
College
of Medicine and Sagore Dutta Hospital, Kolkata
Govt.
125
629
West Bengal
Coochbehar
Government Medical College & Hospital, Coochbehar, WB
Govt.
100
630
West Bengal
Diamond
Harbour Government Medical College and Hospital, West Bengal
Govt.
100
631
West Bengal
Employees
State Insurance Corporation Medical College, Joka, Kolkata
Govt.
100
632
West Bengal
Gouri
Devi Institute of Medical Sciences and Hospital, Durgapur
Society
150
633
West Bengal
Govt.
Medical College, Kolkata
Govt.
250
634
West Bengal
ICARE
Institute of Medical Sciences & Research, Haldia, Purba Midanpore
Trust
100
635
West Bengal
Institute
of Postgraduate Medical Education & Research, Kolkata
Govt.
200
636
West Bengal
IQ-City
Medical College, Burdwan
Trust
150
637
West Bengal
Jagannath
Gupta Institute of Medical Sciences & Hospital, Kolkata
Trust
150
638
West Bengal
Jalpaiguri
Government Medical College
Govt.
100
639
West Bengal
Jhargram
Government Medical College & Hospital
Govt.
100
640
West Bengal
KPC
Medical College, Jadavpur, Kolkata
Trust
150
641
West Bengal
Malda
Medical College & Hospital, Malda
Govt.
125
642
West Bengal
Midnapore
Medical College, Midnapore
Govt.
200
643
West Bengal
Murshidabad
Medical College & Hospitals, Murshidabad
Govt.
125
644
West Bengal
Nilratan
Sircar Medical College, Kolkata
Govt.
250
645
West Bengal
North
Bengal Medical College, Darjeeling
Govt.
200
646
West Bengal
Prafulla
Chandra Sen Government Medical College & Hospital
Govt.
100
647
West Bengal
Purulia
Government Medical College & Hospital
Govt.
100
648
West Bengal
Raiganj
Government Medical College & Hospital, Raiganj
Govt.
100
649
West Bengal
Rampurhat
Government Medical College & Hospital, Rampurhat
Govt.
100
650
West Bengal
RG
Kar Medical College, Kolkata
Govt.
250
651
West Bengal
Santiniketan Medical College,
Bolpur, West Bengal
Trust
150
652
West Bengal
Sarat
Chandra Chattopadhyay Government Medical College & Hospital
Govt.
100
653
West Bengal
Shri
Ramkrishna Institute of Medical Sciences & Sanaka Hospitals, Durgapur
Trust
150
654
West Bengal
Tamralipto
Government Medical College & Hospital
Govt.
100
Syllabus
MBBS is a five-and-a-half-year undergraduate course
that provides training in medicine.
TIME TABLE — CURRICULUM 1st
MBBS - PHASE I
Subject
Lectures
Small Group
Teaching/Tutorials/Integrated Learning /Practical (Hours)
Self-directed learning (Hours)
Total
Foundation Course
39
Human Anatomy
220
410
20
650
Physiology*
138
308
15
461
Biochemistry
80
150
15
245
Early Clinical Exposure**
60
-
0
60
Community Medicine (+ Family
Adoption Program)
20
20 (+27)=47
-
67 (40+27)
(AETCOM)* * *
-
26
-
26
Sports and extracurricular
activities
-
-
-
10
Formative Assessment and Term
examinations
-
-
-
80
Total
518
941
50
1638#
Including Molecular Biology
** Early Clinical exposure hours are divided
equally into all three subjects.
*** Attitude, Ethics & Communication Module
(AETCOM) shall be longitudinal.
# Includes hours for Foundation course Sports &
ECA + FA & Term exams
TIME TABLE — CURRICULUM: II
MBBS, PHASE 2
Subjects
Lectures
Small Group
Learning(tutorials/seminars)/integrated learning (Hours)
Clinical Postings (Hours)*
Self-Directed Learning (Hours)
Total
Pathology
80
158
17
255
Pharmacology
80
158
17
255
Microbiology
70
140
10
220
Community Medicine (+ Family
Adoption Program)
20
23
27
10
80(43+10+27)
Forensic Medicine and
Toxicology
15
28
5
48
Clinical Subjects
75**
585***
660
Attitude, Ethics &
Communication Module (AETCOM)
29
8
37
Sports and extracurricular
activities
20
20
Pandemic module
28
Total
340
612
1603
Surplus hours
35
Final total
340
536
612
87
1638##
Surplus hours can be given to FAP/second-year
subjects needing more teaching, Skill lab training/ artificial
intelligence, and information technology in pre-clinical and para¬clinical
subjects.
## Includes 28 hrs of Pandemic module and 35 hrs of
Surplus
TIME TABLE -CURRICULUM: III
MBBS, PART 1/PHASE 1
Subjects
Teaching Hours
Tutorials/Seminars/Integrated
Teaching (Hours}
Self-Directed Learning (Hours)
Total
Electives
78
General Medicine
25
35
5
65
General Surgery
25
35
5
65
Obstetrics and Gynaecology
25
35
5
65
Paediatrics
20
30
5
55
Orthopaedics A) physical Med.
& Rehab.
15
20
5
40
Forensic Medicine and
Toxicology
25
45
5
75
Community Medicine +FAP
40
60 +27
5
132
Otorhinolaryngology
15
21
5
41
Ophthalmology
20
20
3
43
Clinical Postings*
600
Attitude, Ethics &
Communication Module (AETCOM)
0
19
6
25
Pandemic Module
12
12
Total
222
347
49
1296
Surplus
69
Final total
1365**
**Includes hours for Electives + Clinical posting
+Surplus
TIME TABLE — CURRICULUM:
III MBBS PART 2/PHASE IV
Subjects
Teaching Hours
Tutorials/Seminars/Integrated Teaching
(Hours)
Self-Directed Learning (Hours)
Total* (Hours)
General Medicine
70
125
15
210
General Surgery
70
125
15
210
Obstetrics and Gynecology
70
125
15
210
Pediatrics
20
35
10
65
Orthopaedics +PMR
20
25
5
50
Clinical Postings
795
Attitude, Ethics &
Communication Module (AETCOM)***
28
16
44
Dermatology
20
5
30
Psychiatry
25
10
5
40
Respiratory Medicine
10
8
2
20
Otorhinolaryngology
10
26
5
41
Ophthalmology
10
28
5
43
Radiodiagnosis and Radiotherapy
10
8
2
20
Anesthesiology
8
10
2
20
Pandemic Module
28
28
Electives
78
Total
399
530
102
1904
Surplus
319
Total
2223**
** Includes hours for Electives .1 Clinical
postings .1- Surplus Clinical posting re-scheduling:
• At least 3 hours of clinical instructions each
week must be allotted to training in procedural skill laboratories. Flours
may be distributed weekly or as a block in each posting based on institutional
logistics.
• The clinical postings may be 15 hours per week (3
Hrs per day from Monday to Friday).
Clinical Posting Schedules in weeks
Subjects
Periods of training in weeks
Total Weeks
II MBBS
III MBBS Part I
III MBBS Part II
Electives
2
2
4
General Medicine
8
4
8
20
General Surgery
8
4
8
20
Obstetrics &Gynaecology
8
4
8
20
Pediatrics
4
4
4
12
Community Medicine
4
4
8
Orthopaedics /PMR/ Trauma
2
2
4
8
Otorhinolaryngology
4
4
8
Ophthalmology
4
4
8
Respiratory Medicine
2
2
4
Psychiatry
1
1
2
4
Radio-diagnosis
1
1
2
Dermatology, Venereology &
Leprosy
2
2
2
6
Dentistry
2
2
Anaesthesiology
2(O.T.)
2(ICU)
4
Casualty/ Emergency med.
39
2
2
Total
40
53
132
Career Options
After completing MBBS, candidates can get government and private sector employment opportunities.
In the Government sector, the options include:
Candidates can be recruited in government job profiles in central and state health service departments. The jobs are permanent and subsequently offer administrative work in government health services. The most opted-for job opportunities in central Government are through Combined Medical Services (CMS). UPSC conducts CMS to recruit doctors for significant government institutions like Railways, municipal corporations, government hospitals, and dispensaries. Several state-health-service exams offer job opportunities to medicos within respective states.
Defense Services: Jobs in Army, Navy, and Air Force. The Indian Defence Ministry recruits MBBS graduates for infantry units, army hospitals, and emergency services. Such medicos who the Ministry recruits are trained in military camps and appointed for a permanent positions. This is done to make them work in sync with the army personnel and understand the emergencies where the army and other defense personnel step in to provide relief.
Opportunities in Research and Academics- medical institutions, including AIIMS, PGIMER, JIPMER, Indian Council for Medical Research (ICMR), Tata Institute of Fundamental Research (TIFR), Centre for Cellular and Molecular Biology (CCMB), etc., offer excellent opportunities for research and academics. Doctors can work for NGOs. Prominent among them are WHO, UNO, and Médecins Sans Frontières.
While in the Private sector, the options include:
Clinical practice- start your clinic, work in a clinic associated with a hospital, or work in private clinics; employment in Hospital Chains- operating in the private sector provides excellent opportunities to doctors who have just completed their MBBS degree and have not yet decided upon what to do further. People inclined towards research can pursue and join academia to train and guide budding medical professionals. Pharmaceutical firms offer lucrative opportunities to MBBS graduates in their research and development units. Doctors with management skills can opt for Hospital Management career options to enhance their knowledge of medicine. Master-level programs like Health Administration and Hospital Management can be done. Career opportunities in Public health include medical social workers, research consultants, entrepreneurs, counselors, and trainers.
Courses
after Bachelor of Medicine and Bachelor of Surgery (MBBS)
After completing MBBS, candidates can do postgraduation where MBBS is a feeder qualification. These include Postgraduation in various specializations both clinical and non-clinical.
These include:
- MD
Specializations: Aerospace Medicine, Marine Medicine, Radiotherapy, Anatomy, Medical Genetics, Respiratory Medicine, Anesthesiology, Microbiology, Sports Medicine, Biochemistry, Nuclear medicine, Immunohematology and Blood transfusion, Biophysics, Paediatrics, Infectious Diseases, Community Medicine, Palliative Medicine, Tropical Medicine, Dermatology, Venereology & Leprosy, Pathology, Hospital Administration, Emergency Medicine, Pharmacology, Radio diagnosis, Family Medicine, Psychiatry, Health Administration, Forensic Medicine, Physical Medicine & Rehabilitation, Geriatrics, General Medicine, Physiology, Pulmonary medicine
- MS
Specializations: ENT, Obstetrics & Gynaecology, Orthopaedics, General Surgery, Ophthalmology, Otorhinolaryngology, Traumatology & Surgery
- DNB
Specializations: Anaesthesiology, Anatomy, Biochemistry, Community Medicine, Dermatology, Venereology and Leprosy, Emergency Medicine, Family Medicine, Forensic Medicine, General Medicine, General Surgery, Geriatric Medicine, Hospital Administration, Immunohematology and Blood Transfusion, Maternal and Child Health, Microbiology, Nuclear Medicine, Obstetrics and Gynaecology, Ophthalmology, Orthopaedics, Otorhinolaryngology (ENT), Paediatrics, Palliative Medicine, Pathology, Pharmacology, Physical Medicine and Rehabilitation, Physiology, Psychiatry, Radiation Oncology(Previously Radio Therapy),Radio Diagnosis, Respiratory Medicine.
- MBA in Hospital Management or Healthcare Management.
- PG Diploma
Specializations: Anaesthesiology, ENT, Family Medicine, Obstetrics & Gynaecology, Ophthalmology, Paediatrics, Radio Diagnosis, Tuberculosis, and Chest Diseases
Frequently
Asked Questions (FAQs) – Bachelor of Medicine and Bachelor of
Surgery (MBBS)
- Question: What is the complete form of MBBS?
Answer: The full form of MBBS is Bachelor of Medicine and Bachelor of Surgery
- Question: What is MBBS?
Answer: Bachelor of Medicine and Bachelor of Surgery (MBBS) is an undergraduate course for students who aspire to work as doctors. They do it after completing their 10+2 exam or any other equivalent.
- Question: What is the duration of MBBS?
Answer: MBBS is an undergraduate program of five and a half years.
- Question: What is the eligibility for MBBS?
Answer: The candidate must complete the 17 years of age on or before 31st December of the year of admission and must have passed the higher secondary examination or the Indian School Certificate examination, equivalent to the 10+2 Higher Secondary examination. The student must have obtained 50% marks in Physics, Chemistry, and Biology and must have qualifying marks in English. For SC, ST, or OBC, the minimum marks shall be 40%.
- Question: What is the scope after doing MBBS?
Answer: MBBS offers candidates various employment opportunities and career prospects.
- Question: What is the average salary for MBBS candidate?
Answer: The MBBS candidate’s average salary ranges between Rs.6 lakhs to Rs. 12 lakhs depending on the experience.
- Question: How is the selection made?
Answer: The selection is based on NEET UG rank and marks obtained by the candidates and counseling conducted by MCC.
• Question: Is MBBS a 5-year or 6-year program?
Answer: MBBS is a 5.5-year program with one year of internship.
• Question: Can I do MBBS without NEET?
Answer: In India, to get admission to the MBBS program, students must take the NEET-UG examination and qualify for it. Therefore, students cannot get access to MBBS without giving the NEET-UG.
2 years 4 months ago
Health News,News,Health news,NMC News,Medical Education,Medical Courses
In Texas, Medicaid Coverage Ends Soon After Childbirth. Will Lawmakers Allow More Time?
Victoria Ferrell Ortiz learned she was pregnant during summer 2017. The Dallas resident was finishing up an AmeriCorps job with a local nonprofit, which offered her a small stipend to live on but no health coverage. She applied for Medicaid so she could be insured during the pregnancy.
“It was a time of a lot of learning, turnaround, and pivoting for me, because we weren’t necessarily expecting that kind of life change,” she said.
Ferrell Ortiz would have liked a little more guidance to navigate the application process for Medicaid. She was inundated with forms. She spent days on end on the phone trying to figure out what was covered and where she could go to get care.
“Sometimes the representative that I would speak to wouldn’t know the answer,” she said. “I would have to wait for a follow-up and hope that they actually did follow up with me. More than 476,000 pregnant Texans are currently navigating that fragmented, bureaucratic system to find care. Medicaid provides coverage for about half of all births in the state — but many people lose eligibility not long after giving birth.
Many pregnant people rely on Medicaid coverage to get access to anything from prenatal appointments to prenatal vitamins, and then postpartum follow-up. Pregnancy-related Medicaid in Texas is available to individuals who make under $2,243 a month. But that coverage ends two months after childbirth — and advocates and researchers say that strict cutoff contributes to rates of maternal mortality and morbidity in the state that are higher than the national average.
They support a bill moving through the Texas legislature that would extend pregnancy Medicaid coverage for a full 12 months postpartum.
Texas is one of 11 states that has chosen not to expand Medicaid to its population of uninsured adults — a benefit offered under the Affordable Care Act, with 90% of the cost paid for by the federal government. That leaves more than 770,000 Texans in a coverage gap — they don’t have job-based insurance nor do they qualify for subsidized coverage on healthcare.gov, the federal insurance marketplace. In 2021, 23% of women ages 19-64 were uninsured in Texas.
Pregnancy Medicaid helps fill the gap, temporarily. Of the nearly half a million Texans currently enrolled in the program, the majority are Hispanic women ages 19-29.
Texans living in the state without legal permission and lawfully present immigrants are not eligible, though they can get different coverage that ends immediately when a pregnancy does. In states where the Medicaid expansion has been adopted, coverage is available to all adults with incomes below 138% of the federal poverty level. For a family of three, that means an income of about $34,300 a year.
In Texas, childless adults don’t qualify for Medicaid at all. Parents can be eligible for Medicaid if they’re taking care of a child who receives Medicaid, but the income limits are low. To qualify, a three-person household with two parents can’t make more than $251 a month.
For Ferrell Ortiz, the hospitals and clinics that accepted Medicaid near her Dallas neighborhood felt “uncomfortable, uninviting,” she said. “A space that wasn’t meant for me” is how she described those facilities.
Later she learned that Medicaid would pay for her to give birth at an enrolled birthing center.
“I went to Lovers Lane Birth Center in Richardson,” she said. “I’m so grateful that I found them because they were able to connect me to other resources that the Medicaid office wasn’t.”
Ferrell Ortiz found a welcoming and supportive birth team, but the Medicaid coverage ended two months after her daughter arrived. She said losing insurance when her baby was so young was stressful. “The two-months window just puts more pressure on women to wrap up things in a messy and not necessarily beneficial way,” she said.
In the 2021 legislative session, Republican Gov. Greg Abbott signed a bill extending pregnancy Medicaid coverage from two months to six months postpartum, pending federal approval.
Last August, The Texas Tribune reported that extension request had initially failed to get federal approval, but that the Centers for Medicare & Medicaid Services had followed up the next day with a statement saying the request was still under review. The Tribune reported at the time that some state legislators believed the initial application was not approved “because of language that could be construed to exclude pregnant women who have abortions, including medically necessary abortions.”The state’s application to extend postpartum coverage to a total of six months is still under review.
The state’s Maternal Mortality and Morbidity Review Committee is tasked with producing statewide data reports on causes of maternal deaths and intervention strategies. Members of that committee, along with advocates and legislators, are hoping this year’s legislative session extends pregnancy Medicaid to 12 months postpartum.
Kari White, an associate professor at the University of Texas-Austin, said the bureaucratic challenges Ferrell Ortiz experienced are common for pregnant Texans on Medicaid.
“People are either having to wait until their condition gets worse, they forgo care, or they may have to pay out-of-pocket,” White said. “There are people who are dying following their pregnancy for reasons that are related to having been pregnant, and almost all of them are preventable.”
In Texas, maternal health care and Pregnancy Medicaid coverage “is a big patchwork with some big missing holes in the quilt,” White said. She is also lead investigator with the Texas Policy Evaluation Project (TxPEP), a group that evaluates the effects of reproductive health policies in the state. A March 2022 TxPEP study surveyed close to 1,500 pregnant Texans on public insurance. It found that “insurance churn” — when people lose health insurance in the months after giving birth — led to worse health outcomes and problems accessing postpartum care.
Chronic disease accounted for almost 20% of pregnancy-related deaths in Texas in 2019, according to a partial cohort review from the Texas Maternal Mortality and Morbidity Review Committee’s report. Chronic disease includes conditions such as high blood pressure and diabetes. The report determined at least 52 deaths were related to pregnancy in Texas during 2019. Serious bleeding (obstetric hemorrhage) and mental health issues were leading causes of death.
“This is one of the more extreme consequences of the lack of health care,” White said.
Black Texans, who make up close to 20% of pregnancy Medicaid recipients, are also more than twice as likely to die from a pregnancy-related cause than their white counterparts, a statistic that has held true for close to 10 years with little change, according to the MMMRC report.
Stark disparities such as that can be traced to systemic issues, including the lack of diversity in medical providers; socioeconomic barriers for Black women such as cost, transportation, lack of child care and poor communication with providers; and shortcomings in medical education and providers’ implicit biases — which can “impact clinicians’ ability to listen to Black people’s experiences and treat them as equal partners in decision-making about their own care and treatment options,” according to a recent survey.
Diana Forester, director of health policy for the statewide organization Texans Care for Children, said Medicaid coverage for pregnant people is a “golden window” to get care.
“It’s the chance to have access to health care to address issues that maybe have been building for a while, those kinds of things that left unaddressed build into something that would need surgery or more intensive intervention later on,” she said. “It just feels like that should be something that’s accessible to everyone when they need it.”
Extending health coverage for pregnant people, she said, is “the difference between having a chance at a healthy pregnancy versus not.”
As of February, 30 states have adopted a 12-month postpartum coverage extension so far, according to a KFF report, with eight states planning to implement an extension.
“We’re behind,” Forester said of Texas. “We’re so behind at this point.”
Many versions of bills that would extend pregnancy Medicaid coverage to 12 months have been filed in the legislature this year, including House Bill 12 and Senate Bill 73. Forester said she feels “cautiously optimistic.”
“I think there’s still going to be a few little legislative issues or land mines that we have to navigate,” she said. “But I feel like the momentum is there.”
Ferrell Ortiz’s daughter turns 5 this year. Amelie is artistic, bright, and vocal in her beliefs. When Ferrell Ortiz thinks back on being pregnant, she remembers how hard a year it was, but also how much she learned about herself.
“Giving birth was the hardest experience that my body has physically ever been through,” she said. “It was a really profound moment in my health history — just knowing that I was able to make it through that time, and that it could even be enjoyable — and so special, obviously, because look what the world has for it.”
She just wishes people, especially people of color giving birth, could get the health support they need during a vulnerable time.
“If I was able to talk to people in the legislature about extending Medicaid coverage, I would say to do that,” she said. “It’s an investment in the people who are raising our future and completely worth it.”
This story is part of a partnership that includes KERA, NPR, and KHN.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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atment with Vuity (pilocarpine HCl ophthalmic solution) 1.25% and 116 received placebo. Each dose was administered 6 hours apart for 14 days.The primary endpoint of the study — the
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A Judicial Body Blow to the ACA
The Host
Julie Rovner
KHN
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Opponents of the Affordable Care Act may have stopped trying to overturn the entire law in court, but they have not stopped challenging pieces of it — and they have found an ally in Fort Worth, Texas: U.S. District Judge Reed O’Connor. In 2018, O’Connor held that the entire ACA was unconstitutional — a ruling eventually overturned by the Supreme Court. Now the judge has found that part of the law’s requirement for insurers to cover preventive care without copays violates a federal religious freedom law.
In a boost for the health law, though, North Carolina has become the 40th state to expand the Medicaid program to lower-income people who were previously ineligible. Even though the federal government will pay 90% of the cost of expansion, a broad swath of states — mostly in the South — have resisted widening eligibility for the program.
This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Sandhya Raman of CQ Roll Call.
Panelists
Rachel Cohrs
Stat News
Alice Miranda Ollstein
Politico
Sandhya Raman
CQ Roll Call
Among the takeaways from this week’s episode:
- Thursday’s decision out of Texas affects health plans nationwide and is expected to disrupt the health insurance market, which for years has provided preventive care without cost sharing under the ACA. Even if the decision survives a likely appeal, insurers could continue offering the popular, generally not-so-costly benefits, but they would no longer be required to do so.
- The decision, which found that the U.S. Preventive Services Task Force cannot mandate coverage requirements, hinges on religious freedom objections to plans covering PrEP, the HIV medication, alongside other preventive care.
- Speaking of the ACA, this week North Carolina became the latest state to expand Medicaid coverage under the health law, which will render an estimated 600,000 residents newly eligible for the program. The development comes amid reports about hospitals struggling to cover uncompensated care, particularly in the 10 states that have resisted expanding Medicaid.
- Pushback against Medicaid expansion has contributed over the years to a yawning coverage divide between politically “blue” and “red” states, with liberal-leaning states pushing to cover more services and people, while conservative-leaning states home in on policies that limit coverage, like work requirements.
- On the abortion front, state attorneys general are challenging the FDA’s authority on the abortion pill — not only in Texas, but also in Washington state, where Democratic state officials are fighting the FDA’s existing restrictions on prescribing and dispensing the drug. The Biden administration has adopted a similar argument as it has in the Texas case challenging the agency’s original approval of the abortion pill: Let the FDA do its job and impose restrictions it deems appropriate, the administration says.
- The FDA is poised to make a long-awaited decision on an over-the-counter birth control pill, an option already available in other countries. One key unknown, though, is whether the agency would impose age restrictions on access to it.
- And as of this week, 160 Defense Department promotions have stalled over one Republican senator’s objections to a Pentagon policy regarding federal payments to service members traveling to obtain abortions.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: New York Magazine/The Cut’s “Abortion Wins Elections: The Fight to Make Reproductive Rights the Centerpiece of the Democratic Party’s 2024 Agenda,” by Rebecca Traister.
Alice Miranda Ollstein: Stat’s “How the Drug Industry Uses Fear of Fentanyl to Extract More Profit From Naloxone,” by Lev Facher.
Rachel Cohrs: The Washington Post’s “These Women Survived Combat. Then They Had to Fight for Health Care,” by Hope Hodge Seck.
Sandhya Raman: Capital B’s “What the Covid-19 Pandemic and Mpox Outbreak Taught Us About Reducing Health Disparities,” by Margo Snipe and Kenya Hunter.
Also mentioned in this week’s podcast:
- The New York Times’ “‘We’re Going Away’: A State’s Choice to Forgo Medicaid Funds Is Killing Hospitals,” by Sharon LaFraniere.
- KHN’s “Fresh Produce Is an Increasingly Popular Prescription for Chronically Ill Patients,” by Carly Graf.
- California Healthline’s “Prescription for Housing? California Wants Medicaid to Cover 6 Months of Rent,” by Angela Hart.
click to open the transcript
Transcript: A Judicial Body Blow to the ACA
KHN’s ‘What the Health?’Episode Title: A Judicial Body Blow to the ACAEpisode Number: 291Published: March 30, 2023
[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]
Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, March 30, at 11 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Good morning.
Rovner: Sandhya Raman of CQ Roll Call.
Sandhya Raman: Good morning.
Rovner: And happy birthday to you.
Raman: Thank you.
Rovner: And Rachel Cohrs of Stat News.
Rachel Cohrs: Hi, everybody.
Rovner: We’ve got breaking news, so we will get right to it. In Texas, we’ve got a major decision from a federal judge with national implications. No, not the abortion pill case — that is still out there. This time, Judge Reed O’Connor has ruled that the Affordable Care Act can’t require coverage of preventive services recommended by the [U.S.] Preventive Services Task Force because the PSTF, as an independent advisory board, can’t legally mandate anything. This case was specifically — although it was about a lot of things — but it was mostly about employers who didn’t want to cover preexposure prophylaxis [PrEP] for people at high risk of HIV because it violated their religious beliefs. And if the name Reed O’Connor sounds familiar, that’s because he’s the same judge who ruled in 2018 that the entire Affordable Care Act was unconstitutional, a finding that wasn’t formally overturned until it got to the Supreme Court. Alice, you’ve been following this case. What happens now?
Ollstein: I’m expecting the Biden administration to appeal at lightning speed, although that appeal will go to the 5th Circuit, which is very right-leaning. It’s ruled to chip away at the Affordable Care Act in the past. So who really knows what will happen there? But yeah, this is really huge. This is saying that this board that has decided what services insurance companies have to cover for free, with no cost sharing, going all the way back to 2010 is not constitutional, and thus what they say can’t be enforced. And so this throws the insurance market into a bit of chaos.
Rovner: Yeah, although one would think that it wouldn’t affect this year’s policies — I mean, for people who are going to be worried that all of a sudden, you know, oh my God, I scheduled my mammogram and now my insurer might not pay for it. It’s not going to be that immediate, right?
Ollstein: We’re not expecting that. I mean, we’re expecting the Biden administration to ask for courts to stay the impact of the ruling until further arguments and appeals can be made. But we really don’t know at this point. And I will say, you know, I’ve seen some misinformation out there about how the ruling deals with contraception. They do not block the contraception mandate. That is related to this case, but the court did not accept that part of the challengers’ claims.
Rovner: Yeah, we should say there are a bunch of different claims and the judge only accepted a couple of them. It could have been even broader. But, you know, unlike the previous Affordable Care Act cases, this one doesn’t threaten the entire law, but it does threaten one of the law’s most popular pieces, those requirements that plans cover preventive care that’s been shown to be cost-effective. This could be an uncomfortable case for the Supreme Court, assuming it gets there, couldn’t it?
Cohrs: It could be an uncomfortable case for the Supreme Court, but it’s also uncomfortable for insurers, too, who’ve promised this. People have come to expect it. And if it is cost-effective, I mean, certainly there may be plans that, you know, make choices to restrict coverage or impose some cost sharing. If this stands, if this is applied nationwide — again, very big ifs at this point — but if these really are cost-effective, then it’s kind of an open question what insurers will choose to do, because obviously they want people to enroll in their plans as well.
Rovner: Yeah, I was going to say, I could see insurers sort of deciding as a group that we’re going to keep providing this stuff, as you say, Rachel, because they want, you know, they want to attract customers, because for the most part it’s not that expensive. I mean, obviously, you know, things like colonoscopies can run into the thousands of dollars, but a lot of these things are, if not de minimis, then just not very expensive. And, as I mentioned, they’re very popular. So it’s possible that, even though they may strike down the mandate, there won’t be as much of an impact from this as some people are saying. But, as Alice points out, we don’t really know anything at this point.
Ollstein: And I think some of the concern is the kind of risk-pool sorting we used to see, you know. So the challengers said that their right to purchase insurance that doesn’t cover certain things was being infringed upon. And so if insurers start to create separate plans, some of which cover all kinds of preventive care, including sexual health care, and separate ones that don’t, and people who don’t think they need a lot of stuff, you know, sort themselves into some plans and not others, you can see that reflected in premiums that could lead to some of the major pre-ACA problems we used to see.
Rovner: If the idea that somebody doesn’t like something and therefore can’t buy something without it, you can see that leading to all kinds of problems down the line about people saying, well, “I don’t like that drugstores sell condoms, so therefore I should be able to go to a drugstore that doesn’t sell condoms,” although that’s not a mandate. But you can see that this could stretch very far with people’s religious beliefs. And indeed, the basis of this claim is that this violated the Religious Freedom Restoration Act. That’s one of the things that Judge O’Connor found, and that could be taken to quite the extreme, I imagine.
Ollstein: Right. I mean, they weren’t required to actually purchase PrEP. They weren’t required to use it. They weren’t required to prescribe it. Just the insurance company was required to cover it along with everything else they cover. And the folks said even purchasing insurance that had that as one of the things it could conceivably cover violated their religious rights.
Rovner: Yes. And this goes back to the contraceptive cases, where the religious organization said that, you know, by having birth control in their plans, it made them complicit in something that they thought was a sin. And that’s exactly what’s being stressed here, even among the individual plaintiffs: that having to buy insurance that has these benefits, even if they don’t use them, makes them complicit in, basically, sex outside of marriage. I mean, that’s what’s in the decision. It’s quite a reach. I’ll be interested to see, as this goes up, what people think of it. So, before we got Judge O’Connor’s opinion, what I thought would be the biggest news of the week comes from North Carolina, which on Monday became the 40th state to expand Medicaid under the Affordable Care Act, to cover people with incomes up to 138% of poverty. That’s about $20,000 in 2023. Well, it’s almost there. The newly eligible 600,000 people won’t be able to sign up until the legislature approves a budget, which is likely later this spring. North Carolina expanding the program leaves only a swath of states across the South, including Florida, Georgia, and Texas, and a couple in the Great Plains as still holding out on a 90% federal match. Is anyone else on the horizon or is this going to be it for a while?
Raman: I think one thing to note about how this is happening is that North Carolina was able to do this finally through the legislature after like a yearslong process. And it has been increasingly rare for this to happen through the legislature. The last time was Virginia, in 2018, but every other state that has done it in recent years has all been through ballot initiative and going that route. And the 10 holdouts that we have, you know, we have Republican-controlled legislatures who’ve been pretty against doing this. So I think if any of those states were to be able to do that at this point that haven’t been tempted by, you know, any of the incentives … [unintelligible] … get a higher match rate or anything like that, it would have to be through the ballot, which is already a difficult process, can take years. There have been various roadblocks to push back and even some of the states in the past that have been able to get it through ballot initiative — some of the legislatures afterwards have tried to like push back on it — when we saw with Utah a few years ago, where even if the voters had voted that they wanted to expand, they wanted to kind of pull it back.
Rovner: We thought in Maine, where the governor blocked it until basically he was out of office.
Raman: Yeah.
Ollstein: And in Missouri, where they just refused to fund it.
Raman: Yeah, so I think that’ll be definitely something to watch with how the budget goes in the next few months. But I guess, at least with North Carolina, this was something that was bipartisan. It was spearheaded in the legislature by Republicans, so I think they might not have the same issues there than Missouri, but it’s a tough haul to get the remaining 10 at this point after this many years.
Rovner: Yeah, I feel like North Carolina is much more like Virginia, which is that, finally, after a lot of wearing down, the Republican legislature and the Democratic governor were able to come to some kind of agreement. That’s what happened in Virginia. And that seems to be what’s happened here in North Carolina. Meanwhile, in those 10 states, hospitals which end up providing free care to people who can’t pay aren’t doing so well. In Florida, the state’s hospital association has been all but begging the state government to expand Medicaid pretty much since it was available to them, which is now going on 13 years. According to the American Hospital Association, 74% of rural hospital closures around the country took place in states that have not expanded Medicaid or where expansion had been in place for less than a year. And the New York Times has a story this week about the toll that that lack of insurance is taking — I’m sorry — and the New York Times has a story this week about the toll that lack of insurance for the working poor is taking there, not just on the state’s hospitals, but on the health of the state’s population. Lawmakers in these states are very happy to take federal money for all manner of things. What is it about this Medicaid expansion that’s making them say, “No, no, no”?
Raman: This was something that came up this week in the House. Appropriations’ Labor, HHS, Education Subcommittee had a hearing this week specifically on rural communities and some of the issues they face. And Medicaid expansion obviously did come up with some of the witnesses and some of the lawmakers as something that would be helpful given the number of hospital closures they’ve seen, and there might only be one health care facility for miles or in a county, and just how it would be helping them to kind of relieve paying for the uncompensated care that they’re already dealing with, you know, highlighted a number of the issues there. So it’s something that comes up, but I think one of the pushbacks that we saw was, you know, again, that it is a) tied to the Affordable Care Act, which has been such a partisan back-and-forth since its inception, and then b) just the messaging has always been about the cost. I mean, even if the general consensus is that it does save money over time for taking care of that care, something that came up was why states get more of a reimbursement for expansion than they do for traditional Medicaid. That was brought up a couple times, things like that. And so I think it’s hard to get some of those folks on board just because of how partisan it has become.
Rovner: Yeah, I remember I watched the hearing in Wyoming on this last year. They didn’t want to do it, it seemed, more for ideology. I mean, a lot of states that are doing this, you know, you can levy a tax on hospitals and nursing homes, who are happy to pay the tax because they’re now getting paid for these patients who couldn’t pay. And the state’s really not out-of-pocket, as it were, at all. But and yet, as we point out, these last 10 states, including some of the really big ones, have yet to actually succumb to this. Well, while we are talking about Medicaid, there have been a couple of interesting stories from my KHN colleagues in the past few weeks about so-called social determinants of health, those not strictly medical interventions that have a big impact on how sick or healthy people are. In California, Democratic Gov. Gavin Newsom wants to use Medicaid to pay for six months of rent or temporary housing for homeless people. And in Montana, health professionals can now prescribe vouchers for fruit and vegetables for patients with little access to fresh food. Is this the wave of the future, or will those who want to shrink rather than expand the welfare state and government in general roll programs like these back?
Cohrs: I think there certainly is a trend, a lot of momentum behind the idea of food as medicine and, you know, moving away and exploring some of these non-medication treatments or some of these underlying reasons why people do have health issues. I think certainly support for the Medicaid program is going to be a hot-button issue in D.C. over the next few months, but there is a lot that states can do on their own as well. And I know states have, you know, programs to kind of cover people that fall between the cracks of traditional insurance programs. California has a robust program for that, the local levels as well. So I think there may be ways to get around that, even if we do see some more restrictions. And again, the administration is Democratic at this point, so I think they may be friendlier to some of these innovations than prior ones, and that could change at any time. But this certainly isn’t something that’s going to go away.
Rovner: I wonder if we’re going to end up with blue states having all of these more robust pro — I mean, we already have blue states with more robust programs, but blue states having these more inclusive programs and red states not. Alice, you’re nodding.
Ollstein: Absolutely. And that’s been the trend for a while, but it could even accelerate now, I think, and you’re seeing that on both sides, with blue states looking to cover more and more things; also looking to cover more and more people, including undocumented people. That’s another trend in Medicaid. At the same time, you have red states that have long explored how to cover fewer and fewer, you know, trying to change the income eligibility threshold for expanded Medicaid, trying to do work requirements, trying to do, like, other restrictions. And so I think the patchwork and the divide is only going to continue.
Rovner: Well, moving on to abortion this week, we are still waiting, as I said, for that other decision out of Texas that could impact the future of the abortion pill mifepristone. But Alice, there’s another case at the other end of the country that could have something to say about the Texas case. What’s going on in Washington state?
Ollstein: This one has really flown under the radar. So this is an interesting situation where the same — a lot of the same Democratic attorneys general who were siding with the Biden administration in the Texas case are challenging the Biden administration in a different case in Washington state, basically saying that the remaining federal restrictions on abortion pills — mainly that providers have to get certified in order to prescribe the drugs or dispense them — saying that that should be tossed out, that it’s not supported by medicine and science. And so it’s interesting because you have the Biden administration fighting back against an effort to make the pills more accessible, which is not what a lot of people expect. It goes sort of against their rhetoric in recent months; they’ve talked about wanting to make the pills more accessible and they’re opposing an effort that would do that. But it is somewhat consistent with their position in the Texas case, which is, they’re saying, “Look, this is the FDA’s job. Let the FDA do its job. The FDA has a process, came up with these rules, got rid of some, kept others, and you outside folks don’t have the right to challenge and overturn it.”
Rovner: So what happens if the judges in both of these cases find for the plaintiffs, which would be kind of, but not completely, conflicting?
Ollstein: Yeah, so the Washington state case could just apply to the dozen states that are part of the challenge. And so you could have, again, more of a patchwork in which the abortion pills become even more accessible in those blue states and even less accessible in other states. You could also have these competing rulings that ultimately trigger Supreme Court review.
Rovner: Yeah, it’s not exactly a circuit split because it wouldn’t be opposite decisions on the same case; they’re different cases here. But as you point out, it’s really a case challenging the authority of the FDA to do what the FDA does. So it’s going to be really interesting to watch how this all plays out. While the future of mifepristone remains in doubt, the FDA is going to consider making at least one birth control pill over the counter. We know that morning-after pills, which are high doses of regular birth control pills, are already available without a prescription. So why hasn’t there been an over-the-counter birth control pill until now?
Ollstein: Everything concerning birth control, emergency contraception, abortion, it just — these fights drag on for years and years and years. So finally, we seem to be on the cusp of having a decision on this. It’s expected, from most people I’ve talked to, that they will approve this over-the-counter birth control. There’s a lot of data from around the world. A lot of other countries already have this. And one key unknown is whether the FDA will maintain an age restriction on it. A lot of progressive advocates do not want an age restriction because they think that this is important to help teens prevent unwanted pregnancies. And I think that’s going to be a big piece of the fight that I’m watching.
Rovner: And oh, my goodness, it was that age restriction that held up the over-the-counter morning-after pill for years. That was like a 13-year process to get that over the counter. It went on and on and on, and I covered it. All right. Well, there is abortion-related action on Capitol Hill too this week. We’ve got a potential abortion standoff brewing in the Senate over reproductive health policy at the Department of Defense. Who wants to talk about that one?
Raman: This one has been, I think, really interesting, since we’re all health reporters. And it’s been really something that I think my defense colleagues have been following so closely. But we have Senator Tuberville, who’s been holding up military nominations because the Pentagon has a policy that allows, you know, service members leave for reproductive care and it covers travel to seek an abortion. And so —
Rovner: Although it still doesn’t pay for the abortion.
Raman: It does not pay for the abortions. It’s for the travel. And so I know that my colleagues have looked at this and how this point, like, both sides have been getting a little frustrated, you know, with even some senators saying, “Hey, I agree that I don’t like this policy, but you need to find another way,” because as of earlier this week 160 promotions have been stalled. And so it’s just been kind of ramping up and holding up a lot of folks for kind of an unusual method.
Rovner: Yeah, and the defense secretary saying, I mean, this threatens national security because these are promotions — are important promotions. Flag officers, these are not, you know, just sort of — they’re routine, but they’re, you know, but if they don’t happen, if they get stalled, it’s a problem. In all of my years of seeing anti-abortion senators hold up things, this is not one I have seen before. It’s at least — it’s sort of new and imaginative, and I guess we will see how that plays out. Back in the states, though, it seems that the efforts to restrict reproductive rights are getting very extreme, very fast. Yes, the Oklahoma Supreme Court ruled earlier this month that a pregnant woman does have a right to an abortion when continuing the pregnancy threatens her life. But four of the nine justices there didn’t even want to go that far, suggesting that the legislature has the right to basically require saving the fetus even at the cost of the pregnant person’s life. In Texas, a lawsuit in which the ex-husband is suing the friend of his ex-wife for the wrongful death of his child for helping her get abortion medication is setting the stage for the so-called personhood debate: the idea that a new person with full legal right is created upon fertilization of an egg by sperm. Over the past few decades, several states have rejected personhood ballot measures as a bridge too far. But it feels like all bets are off now. I mean, it’s sort of like a race to see who can be the most extreme state.
Ollstein: I think the trends are revealing some interesting things. I mean, one, anti-abortion folks are well aware that people are still getting abortions, mainly in one of two ways: either traveling out of state or ordering pills online and taking them at home, both of which are very difficult to enforce and stop. And so there’s just a lot of, like, throwing spaghetti against the wall and seeing what sticks, in terms of, can we actually criminalize either of those things? If so, how is it enforced, or does it even need to be enforced? Or is just the fear and the chilling effect enough? I mean, we definitely see that. We definitely see medical providers holding off on doing even perfectly legal things because of fear and the chilling effect. And so there’s just a lot of experimentation at the state level right now.
Rovner: Yeah, I forgot to mention Idaho, where the legislature introduced a bill that would make it a crime — that creates abortion trafficking as a crime — for someone to take a minor, it’s not really across state lines, because the state can’t do that, so it’s like taking the minor to the border in an effort to cross state lines to get an abortion. There was, for many years in the late 1990s and early 2000s, something called the Child Custody Protection Act in Congress, because they needed that for the interstate part of it, that would make it a crime to take a minor across state lines in violation of the home state’s parental involvement laws. It passed both the House and the Senate at various times. It never became law. It’s been introduced recently, but nobody’s tried to take it up recently. I wouldn’t be surprised to see that come back up, too. But it really does seem that every day there’s another bill in another state legislature that says — after all the claims of the anti-abortion movement for decades, that we don’t want to punish the women, we only want to punish the providers — that’s gone out the window, right?
Raman: I guess I would add that, you know, we’re seeing a lot of this activity now. But something that I keep in mind is that a) it’s gotten a lot harder to know what’s going to, you know, using the spaghetti metaphor that Alice did, like what will stick. So there’s just a lot more flurry of action. And then I feel like I see increasingly, you know, people, since they don’t know that, just like fixating a lot on various things, just because you don’t know. I think, you know, even a few years ago, there were a lot of things that would have one sponsor or two sponsors and have no chance of going anywhere, as most bills introduced anywhere do. But now, a) a lot of these things are moving very, very quickly in the legislature, and b) since we don’t know, it’s hard to know where to kind of focus, even to some of the experts that I’ve talked to, where it’s just, “We’re not sure.” So just be aware of all of these things in various places because of kind of that uncertainty.
Rovner: Yeah, I know I’m generally loath to talk about bills that got introduced either in Congress or in state legislatures, because I think it unnecessarily creates expectations that for the most part don’t happen. But as both of you say, some of these things are happening so fast that, if you mention them one week, they’re law by the next week. So we will see as this continues to move quickly. All right. That’s the news for this week. Now it is time for our extra credit segment. That’s when we each recommend a story we read this week we think you should read too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week?
Cohrs: All right. So my story is from the Washington Post, and the headline is “These Women Survived Combat. Then They Had to Fight for Health Care,” by Hope Hodge Seck. And I thought it was just a really great feature on this very niche issue. And I think veterans’ kind of health care overall just doesn’t get as much coverage as it should, and —
Rovner: Particularly women’s veteran’s health care.
Cohrs: Exactly. Yes. And so these women were essentially going into combat situations to help relations with women in very conservative cultures, and they were exposed to the grenade blasts and a lot of these combat situations. But then their health care coverage upon returning wasn’t covered. And there is kind of a new bill with some momentum behind it that is trying to plug that loophole. So, yeah, I thought it was a very great feature on an issue that’s undercovered.
Rovner: Yeah, this was something I knew nothing about until I read this story. Alice?
Ollstein: I chose a piece by Rachel’s colleague at Stat, Lev Facher, called “How the Drug Industry Uses Fear of Fentanyl to Extract More Profit From Naloxone.” And this is really timely, with the approval this week of over-the-counter opioid-overdose-reverse medication. And basically it’s about how these drug companies are coming up with new forms of the drug, really huge doses, new delivery forms, injectables, and nasal sprays, and stuff that are not really justified by science and are sort of just an opportunity for more profit because the basic form of the drug that works extremely well and is very affordable, they are basically hyping the fear of fentanyl to try to push these stronger products they’re coming up with. And the fear is that municipal governments that have limited resources are going to spend their money on those not really justified new forms and get fewer medication for everyone than just using the basic stuff that we know works.
Rovner: Indeed. Sandhya?
Raman: My extra credit is from Margo Snipe and Kenya Hunter at Capital B, and it’s called “What the Covid-19 Pandemic and Mpox Outbreak Taught Us About Reducing Health Disparities.” And I thought this was an interesting look that they did, highlighting how, you know, there’s been a lot more talk about the various health inequities among, you know, racial and ethnic and sexual minority communities after these two pandemics have started. And they look at how some of the targeted efforts have narrowed some of the gaps in things like vaccines, but just how some of these lessons can be used to address other health disparities, you know, things like community outreach and expanding types of screenings and how many languages public health information is translated into and things like that. So, it’s a good read.
Rovner: Well, my extra credit this week is a long read, a very long read, by Rebecca Traister in New York Magazine, called “Abortion Wins Elections: The Fight to Make Reproductive Rights the Centerpiece of the Democratic Party’s 2024 Agenda.” And while I’m not sure I’m buying everything that she’s selling here, this is an incredibly thorough and interesting look at the past, present, and possibly future of the abortion rights movement at the national, state, and local levels. If you are truly interested in this subject, it’s well worth the half hour or so of your time that it takes to get through the entire thing. It’s a really, really good piece. OK, that is our show for this week. As always, if you enjoyed the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can tweet me still. I’m @jrovner. Alice?
Ollstein: @AliceOllstein.
Rovner: Rachel?
Cohrs: @rachelcohrs.
Rovner: Sandhya?
Raman: @SandhyaWrites.
Rovner: We will be back in your feed next week. Until then, be healthy.
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2 years 4 months ago
Health Care Costs, Insurance, Medicaid, Multimedia, Public Health, States, Abortion, Contraception, FDA, KHN's 'What The Health?', North Carolina, Obamacare Plans, Podcasts, texas, Women's Health
Health Archives - Barbados Today
Athletes to benefit from new programme
A plan which was in place since 2017 has finally been fulfilled and that is the ability to offer elite, emerging and developing athletes a place where their medicals can be done as well as a full sports medicine assessment.
The launch of the programme, which is a collaboration between the Barbados Olympic Association (BOA), the Barbados Sports Medicine Association (BSMA) and the Ministry of Youth, Sport and Community Empowerment, took place today at the BOA’s headquarters.
Speaking at the launch, president of the BSMA, Dr Carl Ward said that they will initially be catering for around 70 athletes. He said they are trying to offer more to the athletes but it will first start with an assessment clinic.
Ward said athletes will have a comprehensive medical yearly, as well as the medical that they would be required to have before travelling with a team on national duty.
Ward revealed that they will also have a referral system in place to deal with any problems that they may find.
One of the areas which they wish to address is the number of athletes who have been quitting their respective sports due to injuries that have gone untreated.
Another worrying trend which it hopes will be addressed is that of athletes who do not seek out trained professionals due to either financial reasons or lack of knowledge as to where they can find assistance.
Ward hopes that this will be the start of helping the developing and emerging athletes forge a pathway to the elite level regardless of injury.
Minister of Sport, Charles Griffith said that he also wanted some satellite places for the programme so that those who do not have transportation can still benefit from the programme.
However, Ward pointed out that a lack of human resources was the biggest problem with expanding the programme at the moment which is why they were catering for the current numbers.
Griffith voiced his concern that many athletes do not understand the impact that nutrition has on their careers.
He said a lot will now depend on coaches paying attention to and being aware of what is happening in terms of injuries. He also called for a mandate that all national federations be made to educate their coaches as to what is programs are in place.
Griffith also offered some space at the Wildey Gymnasium to help expand their program.
All three entities BMSA, BOA and the Ministry of Sport hope to collaborate in the future with the University of the West Indies.
(CG)
The post Athletes to benefit from new programme appeared first on Barbados Today.
2 years 4 months ago
Athletics, Health, Local News, Sports
Health Archives - Barbados Today
Athletes to benefit from new programme
A plan which was in place since 2017 has finally been fulfilled and that is the ability to offer elite, emerging and developing athletes a place where their medicals can be done as well as a full sports medicine assessment.
The launch of the programme, which is a collaboration between the Barbados Olympic Association (BOA), the Barbados Sports Medicine Association (BSMA) and the Ministry of Youth, Sport and Community Empowerment, took place today at the BOA’s headquarters.
Speaking at the launch, president of the BSMA, Dr Carl Ward said that they will initially be catering for around 70 athletes. He said they are trying to offer more to the athletes but it will first start with an assessment clinic.
Ward said athletes will have a comprehensive medical yearly, as well as the medical that they would be required to have before travelling with a team on national duty.
Ward revealed that they will also have a referral system in place to deal with any problems that they may find.
One of the areas which they wish to address is the number of athletes who have been quitting their respective sports due to injuries that have gone untreated.
Another worrying trend that it hopes will be addressed is that of athletes who do not seek out trained professionals due to either financial reasons or lack of knowledge as to where they can find assistance.
Ward hopes that this will be the start of helping to develop and emerging athletes to forge a pathway to the elite level regardless of injury.
Minister of Sport, Charles Griffith said that he also wanted some satellite places for the programme so that those who do not have transportation can still benefit from the programme.
However, Ward pointed out that a lack of human resources was the biggest problem with expanding the programme at the moment which is why they were catering for the current numbers.
Griffith voiced his concern that many athletes do not understand the impact that nutrition has on their careers.
He said a lot will now depend on coaches paying attention to and being aware of what is happening in terms of injuries. He also called for a mandate that all national federations be made to educate their coaches as to what is programs are in place.
Griffith also offered some space at the Wildey Gymnasium to help expand their program.
All three entities BMSA, BOA and the Ministry of Sport hope to collaborate in the future with the University of the West Indies.
(CG)
The post Athletes to benefit from new programme appeared first on Barbados Today.
2 years 4 months ago
A Slider, Athletics, Health, Local News, Sports
Health Archives - Barbados Today
Austin showered with praise on 100th birthday
Centenarian Lorna Austin was a woman of few words on Wednesday, and her memory may not be the sharpest, but friends and family who helped her celebrate her milestone were full of stories of how lively she was in her younger years.
Their recollections also shared a similar theme—that of a woman whose life focused on the love of her family.
During an intimate party held at her Christ Church home, the Guyanese-born mother of three was mostly quiet as a fuss was made about her.
Her daughter, Betty-June Leacock, told the media that the day was a special one for her and her family.
“She is actually only the second [centenarian] that I have encountered. I am still in awe of my own mum as a centenarian and I think it has been a wonderful day so far. I feel blessed to have my mom at 100 years and for others to come and share in the experience,” she told the media as she indicated her mother was in good health.
Her brother Nigel Austin mirrored those sentiments, adding, “She is an example of what perseverance and resolve are all about… a perfect example of that. I hope to be able to follow in those footsteps.”
He spoke about some of his mother’s life experiences, including studying in England, doing secretarial work at The Barbados Advocate, and being a secretary for the late Sir William Arthur Lewis during his time as President of the Caribbean Development Bank (CDB).
However, he said it was her love for her late husband, Leo Austin, that meant the most to her during her lifetime, and she felt the weight of his passing in 1996.
“Daddy always had like this umbrella over her to protect her; he had her like in a bubble. Anything she wanted, Daddy took care of. She was devastated when he passed. “We were really worried about her,” Austin recalled.
“Over time, she bounced back and at that age, she then decided to embrace technology. She got onto the computer, learned how to use [it], communicated with all of her friends overseas via email, [and] took all of the bookings for the apartments, which she rented out, via email.
“I know the days where she would say ‘Nigel, when you come over I want you to look at the computer for me, I am not getting online’ or ‘there is an email I want to send but these attachments are not going’. She was fascinated all of the time with technology. Then when cell phones came about, where we could take pictures and so on, up till now she is still amazed about how you could take photographs on a cell phone.”
The centenarian’s best friend, Norma Odle, spoke about their friendship.
“We had great times together [and] always kept close together. As the children came on, I even remember Old Year’s Night when Leo and Lorna would bring the kids over to my house with my kids, and the four of us, my husband and I and Lorna and Leo, would go dancing, [and] bring back home the top hats for the children the next morning.
“We had some beautiful times together… never left each other out. Since my husband died 28 years ago, Leo passed the year after him, and Lorna and I kept very close always,” she said.
Odle said that while Austin no longer remembered her, the love she had for her close friend had not faded.
“She doesn’t know me now but I am still close in heart with her…. I love her very much,” she said.
Representatives from the Barbados Association of Retired Persons as well as the National Union of Public Workers paid tribute to Austin during the celebrations.
The centenarian has three children and five grandchildren, most of whom still live in Barbados. (SB)
The post Austin showered with praise on 100th birthday appeared first on Barbados Today.
2 years 4 months ago
A Slider, Health, lifestyle, Living Well
