It highlighted the cost of medical education, stating that the National Medical Commission (NMC) had issued guidelines for determining fees and all other charges for 50 percent of seats in private medical institutions deemed to be universities.
“Despite such measures, fees remain high – at ₹60 lakh to one crore or more in the private sector, which holds 48 percent of MBBS seats,” it said, adding that this drives thousands to seek medical education abroad where it is much cheaper.
However, it said that medical education outside India entails hardships of studying abroad and productive years of youth invested in repeated attempts at exams—the NEET-UG before taking admission, the Foreign Medical Graduates (FMG) Exam after completing the course, and compulsory 12-month internships in India.
“The subsequent regulatory issues in addressing the difficulties faced by FMGs and the need to maintain standards in allowing them to practice in India has been a challenge and has required interventions of the courts on more than one occasion.”
The low pass percentage of FMGs in the qualifying exam (16.65 per cent in 2023) indicates the sub-par quality of medical education abroad, including a lack of clinical training. “As policy intervention to dissuade medical education abroad is crafted, keeping costs in India within reasonable limits is essential,” the Survey said.
It also raised concerns about geographically skewed opportunities for medical professionals—more medical colleges in the South and more job opportunities in urban areas.
“By offering incentives, improving infrastructure, and fostering professional growth in these regions, we can attract and retain healthcare professionals, ensuring a more balanced and equitable distribution of doctors to strengthen public healthcare services nationwide.”
The Survey also raised the skewed distribution of seats in favour of specialisations like radiology, dermatology, gynaecology, and cardiology, while specialities like psychiatry, geriatrics, etc., are neglected. It expressed concern that the current shortage of specialists across specialities will further aggravate streams that are currently not preferred but will be required in the future.
“The need for clinical practitioners does not restrict demand for post-graduate education; these doctors form the resource pool for research and development in advanced fields of medicine, pharmaceuticals, biotechnology, etc. They are also crucial as faculty and trainers of the next generation. While we focus on increasing specialisation facilities, it is also necessary to maintain distribution across geographies and streams.”
Market estimates indicate that the remuneration of fresh graduates is around ₹ 5 lakh, and senior doctors earn between ₹12.5 -18.4 lakh per annum in cities.
“This is almost similar or lower to the packages available to other entry-level graduates. As seen from the consistently increasing number of aspirants, the attraction towards the medical profession seems to arise more from the social status attached to it rather than its earning potential. This may mean that the availability of meaningful work and commensurate remuneration may reduce with the number of doctors available in the future. This would reinforce the migration of doctors from India into greener pastures,” it said.
The OECD countries reported in 2021 that nearly 19,000 physicians from India were in their workforce, and migration in 2021 alone was over 2800 physicians.
“The trends in migration need to be factored in while incentives for service in the public health system are calibrated to ensure the availability of doctors in rural areas.
It said that the quality of education is directly related to the availability of qualified and experienced faculty and clinical exposure at the hospital.
“The granularity of regulations may appear necessary given that the medical profession deserves to be of the highest quality possible but also seem overbearing regarding associated compliance and monitoring costs. Despite the elaborate regulations and monitoring, issues like shortage of faculty, ghost faculty, low patient load in hospitals, etc., continue to affect the quality of training. There may be a need to revisit the incentive-disincentive and design of regulatory measures to improve compliance, reduce costs and prevent associated rent-seeking.”
