Medical Education in India: A Study of Supply-Side Dynamics

Abstract

India’s health system faces considerable challenges in the provision of health provision. Like in many other countries, health workforce gaps are a particular contributor to this issue shortage of doctors, skewed distribution, and mismatch in skills, all result in a system that is often provisioning below par. Recognising the demand–supply gaps in medical education, attempts have been made to increase the medical seat capacity, with public medical colleges leading the bulk of the seat capacity expansion, and infrastructure requirements for setting up medical colleges have also been relaxed.

While policy initiatives have led to an increase in the number of medical colleges and seats, yet gaps between demand and supply remain. India has the largest number of medical colleges in the world, but the number of medical graduates per 100,000 population is 4.1, which is among the lowest in the world. Despite the explicit focus on increasing the penetration of doctors in under-served regions, the bulk of seat capacity expansion has taken place in only a few, mostly developed states. In underserved areas where colleges have been developed, unaddressed structural issues have led to intra-country migration, which continues to skew the distribution of doctors. Teaching faculty shortfall (despite attempts to augment the teaching pool), continuing requirements for setting up and running medical colleges, and the unattractive economics of setting up medical colleges, have emerged as key barriers to scaling medical colleges. To counter this, the focus has largely been on relaxing the existing student intake norms, and augmenting physical infrastructure. However, adequate attention has not been given to addressing crucial economic barriers, and the structural barrier of faculty shortage, which remain critical impediments.

Amongst the supply gaps, the shortage of specialists is particularly acute. This is a matter of concern, considering that the disease burden associated with six of the top ten causes of deaths in India require the attention of specialist doctors. Select states have attempted to address this shortage by promoting alternative routes to specialisation (e.g., DNB, CPS), but a lack of uniform recognition across states and by the National Medical Commission has affected the uptake of these courses and, in turn, the availability of specialists.

The paper argues for a rethink of the existing regulatory and policy requirements pertaining to setting up and, more importantly, scaling up medical colleges, in order to ensure a greater number of seats per college, and for a more equitable distribution of seats. The paper simultaneously highlights the need to address the structural aspects that lead to the gaps between production and availability of doctors. It makes a case for addressing the teaching staff shortfall by targeting the core issue of the high financial opportunity cost of giving up full-time practice. The current policy focus on reforms like increasing the retirement age and allowing visiting faculty, bypass this core concern and provide only short-term solutions to this structural problem. The analysis emphasises the need for the optimal utilisation of the existing workforce through greater task shifting between specialists and general practitioners, and a stronger referral-based integrated system that enables better utilisation of scarce specialist resources. The analysis also brings forth the lacunae in India’s existing data collection systems, thereby necessitating more systematic mechanisms for data collection and dissemination.