Does India need more medical colleges

Govt of India informed parliament in the year 2022 that India has already achieved a doctor patient ratio (1 Doctor per 850 People) which is better than the WHO prescribed norm of 1 doctor per 1000 people. Now many experts feel that there is no need to open new medical colleges, definitely not the ones that impart substandard education to the affordable, as explained further. Rather, the nation needs to strengthen existing teaching institutes and strive to make them world class. Medical profession regulator National Medical Council (NMC)s arm Under Graduate Medical Education Board, mandated to guide/licence undergraduate medical education has made some shocking revelation in a report. The report says that out of 246 medical colleges accessed in 2022-23, ghost faculty members were found in majority and a lot of these medical institutes don't even have 50 percent of the mandated strength of teaching faculty and senior residents, and, even after giving warnings colleges have failed to improve the shortcomings.

Some facts as of year 2023

Total Medical colleges in India - 707

Total MBBS seats-107000

Doctor density in India(2020) according to WHO is 7.3 per 10000 population. (Probably accounting for doctors expired, or left profession or nation without deregistering, as GOI claimed 1 doctor for 850 in 2022 i.e, about 12 doctors per 10000)

Besides the Indian Medical Graduates(IMG) around 15000 foreign medical graduates(FMG) come to India every year.

India had achieved an ideal 1:1000 doctor patient ratio in 2018, after that the doctor number has increased more in proportion of the population. Today it is estimated that there are around a million and a half registered modern medicine doctors in India.

With the current growth rate of population the nation needs around 1 lakh doctors per year for the next 10 years. And after that, the need for the new doctors will decrease as population growth rate is expected to come down by then.

This shows that India does neither need more medical colleges nor more new medical graduates. 

India's death rates & life expectancy are close to developed nations, and this proves that there is no gross insufficiency of medical services in India.

Still, when one says that India doesn’t have enough doctors, he probably implies that doctors are overworked, which probably is true, and support to the policy of more medical graduates probably stems from a desire to reduce the burden on doctors & ensure that doctor work optimally. But, it needs to be understood that the achievements in health care sector have come at pennies vis a vis rest of the world because, most doctors are working hard and more for barely decent living, in turn reducing cost per patient and increasing efficiencies per Rupee. Once she/he has to make a living working ‘optimally' i.e, doing less work, the cost will increase exponentially. Further, to keep attracting best talent, every doctor will need to be provided with a decent living commensurate with her/his hard work, study years, education level and qualifications, and not to forget the living for an average of 5 families employed in ancillary professions like nurse, housekeeping, paramedical personnel, pharma industry etc that each Doctor roughly creates on average.

As a nation, is India ready to either pay much more for same work, as in western nations¹ or choke the supply of quality healthcare providers by shooing away the best talents from field of medicine due to policies, or wasting scarce resources on making doctors who may quit profession for not being able to fulfil the expectation of decent living?

Let's hope that policy makers have calculated this while formulating a policy that emphasizes need of more medical schools.

And the public, sitting on fence, is enjoying the show, where it can happily see easy and more routes to fulfil the aspirations of seeing ward as a doctor, even if undeservedly.

Health care philosopher's thoughts for future better healthcare can be summarised as below-

1)  Now that India has numbers, it needs to stress upon quality of medical education in medical colleges to match the western standards.

2)  It needs to have a policy for proper distribution of doctors in various parts of India, and rather than being punitive it needs to be rewarding for services rendered in far fledged and remote areas.

3)  The distribution of doctors in various states and cities can also be helped by making a PAN India registry, and allowing PAN India single registration to practice in India.

4) The need is production of doctors more in GP category, as the specialist number production is probably sufficient now.

5) Medical education should be separated from healthcare, and a medical institute’s budget should be clearly divided in the health care delivery and teaching segment, so that the actual cost of educating a doctor can be estimated, without subsidising healthcare from medical education and thus loot in name of medical education be tamed.² Cross subsidizing healthcare that is state responsibility³ from medical student fees as being done by shrewd accounting today is unacceptable and unsustainable in long run. It artificially increases the cost of medical education, and to justify that a mockery of NEET-UG and NEET-PG has been made. Now, Neet- UG that has been reduced to fulfill purpose of auctioning medical education. To hide the number of seats staying vacant due to high fees, 1 million NEET-UG aspirants are declared eligible for 1lakh (100 thousand) odd seats out of 2 millions aspirants. This artificially inflated eligibility allows colleges including government ones to increase fees and still get candidates, but with poor academic performace. Effectively, now anyone with average marks can become a doctor provided s/he has a deep pocket.

It also pushes families into debt trap that increases financial stress on families, forcing young doctors to go unethical or even suicidal in some cases. It appears, that in a bid to sell medical education to the highest bidder, rather than most eligible ones, quality and merit has taken backseat, that doesn’t auger well for any nation. Similarly reducing cutoff to zero percentile in NEET PG makes a candidate with zero or lesser marks eligible for a speciality seat that may fetch college Rs one crore or two. One can only pray that one doesn't have to be treated by such a specialist.

¹ US average health expenses per capita 12940US dollar vs Indian everage of 6700 Rupees (~80$) at notional price and ~275$ at PPP

² Public funded hospitals and medical colleges have a fee structure that can go upto 25 lakh per annum for 4½ years of basic medical graduation, approx 15 times average annual income, and then upto double this sum per year for 3 years of residency/post graduation depending upon speciality in non public funded institutes.

³ Directive principles of state policy, Constitution of India mandate that the Governments must strive to provide healthcare to people of nation. Apex court in verdicts has reiterated that the right to health is essential component of Right to life.