India has a population of 1.2 billion, but only 750,000 registered doctors. Compare that with the US, where 780,000 licensed doctors treat its population of 308.5 million.
Worse, the registration data for India are misleading, with a chunk of the registered doctors having left India to practise overseas. The real number of doctors in India is closer to 625,000. This means there are about 2,000 people for one doctor.
“Once registered with a state medical council, doctors don’t cancel their registrations if they go abroad or stop practice. There is no follow-up, the names stay registered, often even after death,” said Dr Ketan Desai, president, Medical Council of India (MCI), the over-arching body that regulates medical education in the country.
According to MCI estimates, more than 100,000 doctors registered in India are overseas, with India losing 54,000 to the US, 18,000 to the UK and 11,000 to Australia alone.
The Centre has made widespread amendments to Medical Colleges Regulations to produce more doctors by making the setting up of medical colleges transparent and easier. Apart from giving private companies the nod to set up medical colleges, the new regulations allow colleges to increase graduate and post-graduate seats and introduce courses and superspecialities. These include emergency medicine, child and adolescent psychiatry, paediatric cardiology, forensics, infectious diseases and pulmonary medicine, among others.
“Medical colleges, nursing and paramedic-training institutes should be set up by people with aptitude or expertise in healthcare or education. I’ve invited the entrepreneurs of the pharmaceutical industry and Indian Railways to meet the new parameters and set up colleges …,” Union Health Minister Ghulam Nabi Azad told Hindustan Times.
Though the National Rural Health Mission has added 15,000 doctors (including practitioners of alternative medicine), 700,000 accredited health workers and more than 70,000 nurses over the past two years, India still faces an acute shortage of trained manpower outside the metros.
The Centre is also considering a separate medical cadre for rural areas. “We are deliberating introducing a medical course to meet the shortage in the rural areas. This will be a three and a half year course in bachelor’s degree in medicine and surgery to produce doctors who will work in rural areas. District hospitals with specified bed capacities can be utilised as medical schools,” said Azad.
That apart, the ministry has introduced incentives for undergraduates and doctors seeking post-graduate (PG) diplomas. “MBBS students will get 10 per cent weight for each year of rural service up to a maximum of 30 per cent, while 50 per cent seats in PG diploma courses are now reserved for government medical officers who have served for three years or more in difficult areas,” said Azad.
The healthy ministry has offered to collaborate with the Ministry of Railways to set up hospitals, including teaching ones, under its own brand in collaboration with any big hospital, such as Christian Medical College in Vellore, or the All India Institute of Medical Sciences.
“If big hospitals develop or establish a branch in underserved areas — say, West Bengal, Jharkhand, Bihar or Uttar Pradesh — people will be saved the trouble of travelling all the way to Vellore or Delhi for treatment,” said Azad.
States in north India are far more underserved than the south or the west, with about 50 per cent of the country’s medical colleges located in the five states of Maharashtra (40), Karnataka (40), Andhra (32) and Kerala (19) and Tamil Nadu (18).
“Even a small union territory (such as Pondicherry) has seven medical colleges, which is far more than bigger states such as Orissa (6) or Assam (3),” said Dr Desai.
Azad said: “Land-availability is a problem in metros and ‘A’ grade cities, so we’ve shifted to the concept of total built area required for essential infrastructure including the medical college, hostels, hospitals, laboratories and libraries.”
This means Medanta — The Medicity in Gurgaon — can open a college in its 43-acre campus, as can Indraprastha Apollo Hospital on its 15-acre campus in Delhi.
Other amendments include increasing the post-graduate student-professor ratio to 2:1 from the present 1:1. This will add about 4,000 seats to post-graduate courses and help meet the shortage of specialists. “We already added 1,200 PG seats across 60 colleges and will add another 1,500 this month,” said Azad.