India produces more than one lakh medical graduates every year with 50% contribution each from Govt medical colleges and private medical colleges. In spite of high production of medical graduates in India, it is a nightmare to try recruiting doctors for your organization. I remember, few years back (in 2018 to be precise) I was interacting with the CMO of a district in Rajasthan. He had several vacancies of medical officers lying vacant. Any doctor who wants to join has to just walk-in for the interview to take the appoint letter, with salary of Rs 50,000/- per month. He told me that now doctors do not want to join Govt services as medical officers.
The main reason is that in India, the social status and earnings of a MBBS doctor is much lower than specialist or superspecialist doctor. Patients often ask; which type of doctor you are or what do you treat. They prefer to go to a neurologist for headache, cardiologist for heart problem, endocrinologist of diabetes and thyroid etc. Regular Govt jobs for MBBS doctors are very few as compared to number of medical graduates every year. Most of jobs have been replaced by low paying outsourced jobs. With mushrooming of private hospitals, streams like radiodiagnosis, pathology, gynaecology, orthopedics & super specialties like cardiology, nephrology, neurology etc have gained more importance as they are money churning specialties for the corporate hospitals. We have heard about various unethical practices in these corporate hospitals from time to time. A corporate hospital does not require medical graduates. A graduate is employed only for jobs like night duties in emergency deptt and is paid much lower wages as compared to specialist or superspecialist doctors. Today a fresh MBBS doctor is paid approximately Rs 30,000/- to 40,000/- in pvt hospitals, which is peanuts in comparison to money, time and efforts dedicated to pass an MBBS exam in India. In a pvt medical colleges, the cost of getting a degree varies from 35 to 60 lakhs. In some pvt colleges it may go up to 1.25 crore.
After a PG degree the status and earnings of a doctor improve. Most of them would get a starting salary between ninety thousands to one lakh per month. Clinical specialties may fetch more. So, to improve his social status and earnings, a MBBS graduate has no option but to obtain a post graduate degree (PG degree) at all cost either from Govt medical college or private medical college. To fulfil his aim, a medical graduate starts preparing for NEET PG exam even during internship, neglecting his practical training experience. Out of these 1 lakh graduates, around 74,306 graduates get admission to PG seats (approximately 26,700 in Govt colleges and rest in private medical colleges). Approximately twenty five thousand graduates, who are not able to secure PG seats, keep on preparing for PG and do not enter into work force. Another reason for medical graduates to go for PG may be lack of requisite skills to handle patients independently. Govt colleges have plenty of patients, but large number of Govt medical colleges are grossly deficient of teaching staff. On the other hand, private medical college suffer from both, lack of patients as well as staff. Most of them prefer to stick to bare minimum. Skill training of students is the first casualty.
Today a situation has arisen, where medical workforce is plenty but poorly trained, and not available to society. An adequately skilled medical graduate can tackle 80% of our health problems. I passed out from Armed Forces Medical College Pune (India) in 1988. Majority of our batch joined Army. Soon after graduation we were handling emergencies, as well as routine medical conditions independently, in the combat zones. One of my batchmate performed even a venesection operation to start a intravenous line in a gunshot wound case. Timely action by him saved the life of a soldier. Such types of skills may be rare today.
Transformation of medical profession, to specialization and super specialization, has adversely affected general population as well. Preventive care which should have been central focus of our Govt has been neglected altogether. The cost of treatment has gone up tremendously. The OPDs of specialist or superspecialist have become overloaded with patients and they don’t have adequate time to examine and advise patient. The diagnosis is now based on lab reports and other investigations. If anyone lands up in corporate hospital, he will invariably be subjected to all possible investigation including MRIs (whether indicated or not). Classic teaching of medical science is that investigations are required to help the clinician to confirm or exclude certain conditions. History taking and clinical examination, which has become a rare procedures, were the prime tools of diagnosis and treatment. Now doctors treat the lab reports, not the patients..
Due to wrong policies, lack of foresight, greed of senior medical leaders and professional bodies, the medical professional has unintendedly adopted an approach to benefit drug companies and corporates. The medical professional is turning itself into a scam like situation, where few are benefitted at the cost of majority.
The society requires doctors specially young doctors. As a citizens of country, we want our doctors to be well trained as well as well paid, so that the profession remains attractive. We want that after graduation, most of the doctors should be able to provide good care for majority of diseases under one roof with low cost. We want that our medical graduates should be able to earn and contribute to economy as early as possible and not just linger on with studying more and more in search for better pastures.
If remedial measures are not adopted by leaders of medical profession, the conditions will deteriorate further. As the number of PG seats keeps on increasing without consequent increase in employment, even PG doctors will will be paid less. The specialties which are non clinical or having lesser earning potential will invariably vanish. With neglect of preventive care, the burden of chronic diseases will keep on increasing till the system collapse. Such signs are already started in countries like US. As the people become aware, gradually over years, the entry to profession may decrease and in time to come, medical profession may become so unattractive that we may not have good doctors at all. Its just a question of time when this bubble bursts. To add salt to wounds, AI is already there to replace doctors.
Its high time professional bodies ((Association of physician of India, FOGSI), and Indian Medical Association do some things to improve conditions of our medical graduates, otherwise the health crises will further deteriorate.
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