Despite numerous policies in place to achieve self-sufficiency in the health sector, the number of Indian doctors serving the disparate rural population is drastically declining. Many efforts to drive the tech-savvy, white-collared and highly ambitious doctors to the unkempt peripheries of the country has been an utter failure. India still suffers an acute shortage of about 6,00,000 doctors, one million nurses, 200,000 dental surgeons and large numbers of paramedical staff. So, this issue is not just about Indian Doctors. Is it? Well, no, but I focus here mainly on the doctors’ dilemma.
Are the Doctors to be blamed?
Sadly, the doctors are only to be pitied. I say this because of the indifferent attitude of healthcare policy makers who ignore the changing needs of the evolving doctor community. It is no more the age of the general practitioner, and a simple medical degree is merely looked down as “dismal”. It is a general trend that specialists are sought after, and an MS/MD is the bare minimum for a doctor to practice satisfactorily. It is also true that despite the numerous medical colleges being set up, only a few are sanctioned or equipped to run post-graduate degrees. Hence, there is a huge disparity between the number of medical graduates and the number of post-graduate seats being offered in the country. This signals the clogging of an already overburdened health care system. Newly graduated doctors can only practice as residents in teaching institutes or as petty medical officers with a meagre paycheck that drives most of them crazy. The unfathomable amount of investment of time and money during their medical education only drives these hapless newbies to the brink of desperation. Only a few manage to land PG seats without paying hefty donations to institutes that exist for themselves. It is a sad situation, but a real and obviously debilitating experience for the many medical graduates that come out each year from various medical colleges across India.
An Obvious Solution
India is the biggest exporter of doctors in the world. With an overseas workforce equal to almost 10 percent of the Physicians in India, it is quite a contributor. The reason is obvious – a huge backlog of medical graduates waiting to get into a post-graduate course! With the increasing public awareness about healthcare issues and the demand for specialists and super-specialists, there is an increasing need for more post-graduate institutes that can cater to the backlog, but changes in India take time. So, another rather easy channel is to move out of the country to acquire specialist training from abroad, while others switch over to other allied healthcare areas like administration. This has in one way eased the burden on the post-graduate institutes in India but caused a dearth of doctors in the rural setup.
Many medical graduates from India seek to pursue education abroad or to set up practice abroad. Favoured locations have been UK, US, Canada, Australia, New Zealand and many other places. They provide excellent post-graduate trainings which is a bonus much beyond the financial implications. The recent decision by MCI to recognize foreign degrees attained abroad has indeed encouraged many who have settled abroad to consider coming back to India.
Some interesting stats about doctors of Indian origin:
One out of every 10 practicing physicians in Canada have Indian origin.
40,000 Indian doctors in the UK treat approximately half of its population.
50,000 physicians and approximately 15,000 residents and students in the US are Indians.
20% of doctors in Australia have Indian roots.
Isn’t that significant? Yes, it does. This makes India a formidable medical giant in terms of the sheer number of medical graduates it exports to other countries year after year.
Is there still an Exodus?
The number of Indian doctors abroad keeps increasing every single year despite numerous incidences of racial overtones and injustices toward Indian doctors. Reasons behind this exodus still being a comparatively better financial deal and most often a chance to explore possibilities of higher education. There is still a tendency among young or fresh doctors to consider opportunities abroad. Indian authorities need to sincerely consider a drastic change in health policies to improve the living standard, the emoluments, and an improved system to accommodate doctors serving the rural population. This could possibly improve the outlook among the growing number of junior doctors in India and give them a reasonably satisfying career in India itself.
Will the Exodus continue?
We will have to wait and see. If there are changes in the healthcare system in India with adequate facilities for fresh medical graduates, I should say there might be a change. With India becoming a major player in the medical tourism industry, the trend might change. [box type=”spacer”]We hope to see many more Indian doctors abroad come back to serve India with more vigour and valour.[/box]
Excellent article Dr. Lawrence! The only place where I would disagree with the article is the obvious emphasis, that as healthcare professionals, we keep placing on the need to specialize! Over the past 15 years since I passed out of medical college, I have been constantly hearing the refrain about pathetic working conditions for newly qualified doctors, meagre emoluments, lack of enough post-graduate seats for specialization and a whole lot of very real problems that exist in our healthcare as well as the medical education system. But has anything been done to get to the bottom of this issue and identify what really is the cause? The straight fact is that market forces decide to a large extent whether medical graduates choose to specialize or continue to train themselves to be good general practitioners. Does specialization solve the health needs of our country’s population? Or for that matter in any developed country? Not really.
We probably see a specialist doctor one or two times in a year. On the other hand, we probably go to a general practitioner anywhere between 6 to 8 times in a year, or more frequently if we have a chronic condition such as diabetes or hypertension to manage. Evidently, we need more generalists than specialists in this country. But do we have enough of them who chose general practice by choice? Do they have access to continuous medical education and training in various primary care-related skills? Are they adequately compensated financially and looked upon with respect by their specialist peers?
The answer is a resounding NO. However all this is set to change over the next few years. The return of the “Family Doctor” concept is a much-talked subject in recent times, both in media as well as in healthcare circles. Already, several organizations are working towards institutionalizing general practice in India and creating a standard of primary care physicians in the community who are on par with their US or UK counterparts, with most of the above issues being addressed. Increasing post-graduate seats is a good step towards self-sufficiency, but what is more important is that we create a parallel opportunity for qualified general practitioners to really strengthen the primary care system in India, both urban as well as rural, so that there does not necessarily have to be an exodus of the best brains that we have in our country.
Thanks Dr. Tarra for sharing your thoughts on this issue with much conviction and insight. I am completely with you in that India needs more generalists, but the outlook among the general public should change towards general practitioners. I would rather be a good general practitioner than a “half-baked” specialist.
The concept of the “Family Doctor” should really catch on fast to keep the younger brood of doctors pleased with a good general practice. However, I feel that there is a gradual decline in the quality of Indian Doctors due to the commercialization of Medical Education. I think that more emphasis should be placed in imparting good clinical skills to the medical students, which will go a long way in giving them confidence to practice medicine at par with post-graduates.
I also second your thoughts about providing parallel opportunities for qualified general practitioners which will provide enough incentive for many to serve the majority rural populace of India.
Let’s hope to see more amicable solutions being planned by the country’s think-tanks!
Shortage of Indian surgeons or Indian surgeons moving their base to foreign countries for better prospect is past now. With medical tourism in India on rise, even settled Indian surgeons are moving their bases back to India permanently. Indian government and many private companies in India have recognized the potential of medical tourism in India, are investing in huge numbers to make available advanced technology and infrastructure that will help our Indian surgeons to perform their best!!!
I hope that the “brain drain” era has come to an end when it comes to medical professionals. Despite the efforts cited above, I have a feeling that the efforts are yet to fructify into tangible results. I’ll keep my fingers crossed till then.