India's doctor shortage: A ticking time bomb

NEW DELHI — Shruti Kharbanda wanted to be a doctor for as long as she could remember. But after graduating from high school two years ago in New Delhi and winning admission to medical school (in India, medical education begins after high school), she decided to become an engineer instead.

"Initially I didn't really like it, because I was interested in biology," Kharbanda said. "But I thought career-wise it is a better option."

Kharbanda's parents, both doctors, were the ones who discouraged her from entering medicine, noting that she would need to spend years pursuing an advanced degree with little reward to show for her hard work. "Compared to that, getting a bachelor's degree in engineering is the end of the struggle," she said.

The main problem is that in India, a basic medical degree without a specialization is of no use and there are so few graduate specialization seats that competition is fierce. In addition, the problem is likely to get worse before it gets better: Professors in India are leaving medical schools for better-paying jobs in private hospitals and in the pharmaceutical industry, forcing the schools to cut the size of their programs. And students who would have studied medicine a generation ago are pursuing more lucrative careers in the technical sector.

It is no wonder, then, that for every 10,000 people in India there are only six doctors, compared with nearly 55 in the United States and nearly 21 in Canada. Regulatory hurdles to the establishment of private medical schools have limited the opportunities to train for careers in medicine, prompting would-be doctors to go abroad, despite a boom in private health care.

So, like Kharbanda has done, many students are opting out of the field entirely. "It is a materialistic world, and the child can see that the remuneration a doctor gets is nowhere close to what an engineer gets. And a doctor has to struggle for more than 10 years," said Satish Kumar Suri, founder of New Delhi's Sahil Study Circle, a coaching center for students taking India's highly competitive medical and engineering entrance examinations.

Since thousands of students with a bachelor's degree in medicine may be competing for a single slot in graduate school, some retake the entrance exams for several years. That means an education that is supposed to take about 11 years often takes much longer. Once in graduate school, students become residents at overburdened government hospitals, where salaries are only a third of entry-level pay for a top engineering graduate.

A senior resident at the All India Institute of Medical Sciences — the top medical school in India, and perhaps all of Asia — earns just $7,200 a year. By comparison, the average salary offered last year to graduates of the Indian Institute of Management in Ahmedabad was $49,000.

"Society has changed," said Dr. Kumar Harsh, who recently graduated from the All India Institute of Medical Sciences. "Earlier, when I was a kid, a doctor was treated like a god. Nowadays the person who has maximum money has power and acceptance. Sometimes I regret getting into this line."

Many high school graduates are doing the math and, like Kharbanda, opting for engineering or technological fields.

Last year, 160,000 applicants took the medical school entrance exam, 25 percent fewer than the year before. By comparison, the number of applicants for entrance into the elite Indian Institutes of Technology rose by 28 percent last year, to 320,000.

Many Indians still want to become doctors, but they choose to do so abroad, where it is often easier to gain admission into specialized programs, and where salaries are higher. As many as 60,000 Indian physicians are estimated to be working in the United States, Britain, Canada and Australia. A report published last year by the Planning Commission of India says the country ranks at the top among nations whose physicians are working in the major developed countries.

Devi Shetty, a philanthropist and founder of Bangalore's Narayana Hrudayalaya, said he is deeply worried about the lack of seats available for students who want to become heart surgeons or other kinds of specialists. As many as 1,000 applicants could compete for one seat, he said.

"In India only 80 doctors can become cardiologists" in a given year, while "in the U.S. there are 800 positions to train cardiologists." As for kidney specialists, the United States has more nephrologists of Indian origin than India has, Dr. Shetty said, noting that "India has only 60 seats for nephrology."

The worst may be yet to come. Because so many professors are quitting for better-paying jobs in the private sector, some Indian states will soon reduce the number of graduate seats they offer — already far below the numbers required — in medical schools.

The Indian government knows that major reforms are called for. The national health ministry is considering modifications of some of the regulations to make it easier to establish private medical colleges in India. The government is also trying to expand the capacity of public medical schools and planning to set up new medical schools.

Medical professionals, however, say those plans are too little, too late.

Shailesh Mohite, a Mumbai medical professor, fears that the situation is going to spiral out of control. "Good government hospitals will become like primary health-care centers," he said, providing only the most basic care. "We are sitting on a bomb."

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