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Are Indians feeling the shortage of doctors?

April 4, 2008

India is short of 600000 doctors. This works out to be approximately 1 doctor for about 1560 people or 1 doctor for 1,634 people. Other statistics on health workers in India are given at this WHO site. Whichever stats you take, they tell you the same thing – India is short of docs.

Indians are not exactly crazy about allopathic medicine
But the figures given above are for allopathic doctors only. More Indians turn to Alternative Medicine (these systems of medicine are approved by the Indian government and also by the WHO) than to allopathic, and this isn’t just because they can’t find any allopathic doctors. They have faith in Homeopathy and Ayurveda. In rural and semi-urban areas this tendency is more pronounced, compounded by the shortage of allopathic doctors. 65 percent of the rural population in India is believed to use alternative medicine for their primary health care needs.

Alternative medicine rulesimg_2245_1_1.jpg
If you take into account the doctor-per-person ratio of practitioners of both allopathic medicine and alternative medicine, then it’s at 1 doctor to 870 people (Indian government figures). In fact, homeopaths are doing so well in India that the market is expected to increase to over Rs. 26 billion ($650 million) by 2010. Interestingly, alternative medicine is no more the bastion of the east. It is popular in the industrialised nations as well. Here are some interesting faqs from WHO.

  • In China, traditional herbal preparations account for 30 percent – 50 percent of the total medicinal consumption.
  • In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60 percent of children with high fever resulting from malaria is the use of herbal medicines at home.
  • In Europe, North America and other industrialized regions, over 50 percent of the population have used complementary or alternative medicine at least once.
  • 70 percent of the population in Canada have used complementary medicine at least once.
  • In Germany, 90 percent of the population have used a natural remedy at some point in their life. Between 1995 and 2000, the number of doctors who had undergone special training in natural remedy medicine had almost doubled to 10 800.
  • The global market for herbal medicines currently stands at over US $ 60 billion annually and is growing steadily.

If this seems like an article promoting alternative medicine, well no. What I am trying to say is that the shortage of medical personnel is not being felt as acutely by Indians as much as we are given to believe. Alternative systems of medicine are helping to fill the vacuum.

The quacks are the bad news
Unfortunately, quacks are also rushing in to fill the vacuum. Those with fake degrees. All conmen out to make a fast buck. And what’s scary is that there are more fake doctorssign2.jpg in India than genuine ones!

The figures for quacks in just Delhi is estimated to be about 40,000 and I am sure Mumbai beats Delhi due to the sheer volume of its population (13 m at last count, 2001). Many of these ‘doctors’ operate in the slums. They not just misdiagnose, they often prescribe harmful steroids and sell/give away spurious or expired medicine. So if one takes these fake docs into account, then India has plenty of doctors!

Any solutions?
Well, some feel that our doctors should stop migrating to foreign shores but what about those in India who choose to practice in the comfort of the city? Anyway, I don’t blame either of the two groups as it’s human nature to want to lead a more comfortable existence and make money. So no judgments here.

But a way out could be to make a year or two of public service mandatory for those who graduate out of government medical school, after taking advantage of the subsidized education in India. It seems reasonable to me, but apparently not to medical students or their parents or even the government. We are moving in the opposite direction. The Maharashtra government has recently “cut down” on the mandatory rural posting due to strong pressure from students and parents.

So does India simply wait until more medical schools are built? We don’t have a shortage of educated people who want to become docs…the problem is that a huge number of students cannot get into government medical schools because of the nerve racking competition and many others cannot afford the high fees of private schools.

The government has this new idea of recognizing graduate medical degrees from Britain, the United States, Canada, Australia, and New Zealand and allowing them to practice here…but how will that help? How many of these students are likely to work in the rural areas? And that’s what we need isn’t it!

The only other way is to give a year of medical training to interested social workers, train them as para-medics. I had read that the government was thinking of implementing such a programme but apparently this idea has been shot down by the medical council.

I hope the government isn’t simply waiting for the problem to sort itself out…waiting for medical schools to increase and plug the shortage…if that is so we are going to have more quacks in the arena… be prepared!

(Both photos are by me. The second one I made in photoshop)

Related Reading: Growth is not leading to development in India
The health scenario in India and medical tourism
Why medical students don’t like to practice in rural areas
Life expectancy and per capita income in India and the world
Shortage of docs leads to high workload and stress
Britain may not want Indian docs but India does

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24 Comments leave one →
  1. Vivek Khadpekar permalink
    April 4, 2008 8:21 am

    A word of caution regarding alternative medication, both branded and dispensed by the practitioners: I am told that sometimes, in order to enhance its “effectiveness”, non-traditional ingredients are added — such as steroids — the legal use of which in allopathic medicines is subject to rigorous monitoring and contorl.

    Also, an authentic Ayurvedic, Unani, Siddha etc. practitioner is particular about the environmental conditions at the natural source from which [s]he procures the ingredients (e.g. the presence of harmful chemicals in the soil etc.). Such precautions are often given the go-by when it comes to practitioners/manufacturers eager to prove their products in the market.

  2. Vivek Khadpekar permalink
    April 4, 2008 8:32 am

    Nita,

    //…it’s human nature to want to lead a more comfortable existence and make money…//

    Agreed. But then, those who want to follow that path should also bear the ENTIRE expenses of the education that qualifies them to do so. It is a well-known fact that a lot of medical education in India is subsidised by the government out of taxpayers’ money. And it is also a well-known fact that those who get into the good medical schools are largely children of well-to-do parents, who least need the subsidies.

  3. April 4, 2008 9:47 am

    The global market for herbal medicines currently stands at over US $ 60 billion annually and is growing steadily.

    Nita, any breakdown of what type of herbal medicine? I wouldn’t be surprised if a big chunk of that $60 billion is for increasing sexual potency of men.

  4. Vivek Khadpekar permalink
    April 4, 2008 10:15 am

    Amit,

    In response to your comment on the global market for herbal medicines, here’s something that is not entirely off-topic, and somewhat risqué (hoping Nita won’t censor it)🙂 :

    “There is more money being spent on breast implants
    and Viagra today than on Alzheimer’s research. This means that by 2040, there should be a large elderly population with perky boobs and huge erections and absolutely no recollection of what to do with them.”

  5. April 4, 2008 11:01 am

    Vivek,
    You didn’t mention the source for your lines (I don’t mind, its just that we always mention it)

    Nita,
    In rural areas , most of times fake doctors are responsible for increasing the severity of people’s diseases and sometimes death. Can there be (or is there already) any campaign arranged for identifying such doctors?
    Any social worker group or hopefully government initiative will do. Don’t you think so?

  6. Vivek Khadpekar permalink
    April 4, 2008 11:35 am

    Suda, Nita:

    This is one of those things floating around on the net that was forwarded to me without source. I am usually very particular about giving credit, but in this case I genuinely don’t know. That’s why I was particular to use quotation marks. The only improvement I can think of is to add “(Anon.)” at the end.

  7. April 4, 2008 12:05 pm

    Just like Bangalore has an engineering college on every street, we need another city with an equal number of medical colleges 8) My younger sister is studying medicine and we know how worried we were regarding her admission. I was not sure if she would get anywhere! Too many students and too few seats! Luckily, she got into a very good college, else what happens is that most of the parents pay bribes to the tune of Rs. 20 lakhs just to get their kids admitted! And how unethical/shameful is that!

    Funnily, most of the Indians that I meet here are doctors. All of them come from India to seek Residency here, which is a 3 yr program. At the end of their 3 yr residency tenure, they become fully licensed doctors here and earn tons of money. So, I feel that there are not enough medical colleges and on top of that, lots of Indians go abroad to seek better opportunities. This is a double whammy!

  8. April 4, 2008 12:34 pm

    Why not to think other way ? Instead of increasing the number of doctors why not to reduce the number of people falling sick ? The government should think of providing safe drinking water, better sanitation facilities, unadulterated food etc., to everyone.

  9. Vivek Khadpekar permalink
    April 4, 2008 1:09 pm

    OldSailor:

    I totally agree. The emphasis should be on preventive health care, sanitation and hygiene. And a lot of it does not need doctors and medical schools. It should be part of the curriculum right from the primary school level, and parents (especially mothers) should also be reached out to.

  10. April 4, 2008 1:11 pm

    Vivek, yes I have heard that many of these ayurvedic medicines are ayurvedic only in name. In fact some ingredients of Viagra have been discovered in some herbal sex pills and that is what I read here. God alone knows what else they use!!
    However I do not agree that large manufacturers per se indulge in this sort of thing as it is well known that it is large manufacturers who are under the scanner most of the time and are thus more careful. It is the small and medium level guys we need to beware of. At the same time I do agree that some small cos are extremely trustworthy (much like jewelers whom we trust with our gold) but then it becomes difficult to know who for the layman. One has to go by word of mouth of those who have been using a particular doc for years and in a new city this may not be possible.

    Amit, I did try and find out which is the most popular selling herbal drug but didn’t have much luck. I think if sex pills are the highest selling, I won’t be surprised at all. I did find this article which talks of some popular drugs but it looks like Chyawanprash is the most popular. Other popular drugs seem to be cough and cold and digestive medications although one called Aswagandharishta is a neuro-Muscular tonic. I have no idea what it does. I have heard of Shilajit though (I think it is banned now because of high lead content) which was supposed to be a sex pill of some sort and it used to do very well in the Indian market

    Suda, I do wish the Indian govt. and the medical council concentrated on identifying these fake docs, but I don’t think anyone cares. Unless they get a specific complaint they don’t do a thing as far as I know.

    Ruhi, thanks. True, the state India is in now, docs seem to be want to run away to greener pastures. The U.S. is choc-o-bloc with Indian docs…even with the recession coming on there I don’t think the demand for docs in the US, Canada and the UK will reduce. So while execs might find it harder, docs will continue to find plenty of opportunities out there.

    Old Sailor, prevention is better than cure for sure, but even this is a very slow process considering the state India is in now.

  11. April 4, 2008 6:00 pm

    how about having a team of med docs for say a district or 10 subdivisions and having helicopters so that they are more accessible ? this will also help in transporting patients to urban hospitals… .

  12. April 4, 2008 7:13 pm

    Amit, I did try and find out which is the most popular selling herbal drug …

    Nita, thanks. I meant more in the global sense, not just in India. Looks like the system of medicine and times may change, but one idea remains constant (Shilajit, Rhino horn powder, Tiger penis powder, Viagra).🙂

  13. April 4, 2008 8:22 pm

    If the medical education system goes the engineering way….. just if it goes to fill the above mentioned gap, It may just turn out to be another disaster. In Engineering, you always have the option of working in other fields (usually software) eventhough you may not be qualified. Even people who are qualified as software engineers hardly impliment what they learnt in university. The work is totally different from education. Just imagine if we have so many medical schools to fill the gap – what would that do to the quality of medical education and practice ?

    Destination Infinity

    • Dr Mohammed Ali Khan permalink
      August 14, 2009 12:36 am

      Let free markets do the job..
      Simplify and make transparent the procedure to start medical colleges..
      Let people open more medical colleges.. Private that is..
      The number of doctors will definitely increase..
      Of course the doctors will face more competition..
      But we will have the quantity.. Quality will surely come
      Look at the quality of Medical Education imparted in Manipal, Ramachandra Medical college in Chennai.. they are real good

  14. April 5, 2008 2:05 pm

    hey thats a fresh perspective
    very well researched
    yes naturopathy ayurveda and homeopathy are catching on even in cities, as the side effects of alopathy along with the rising cost of medicines and consultation fees effect people.

  15. April 5, 2008 2:07 pm

    Ruhi is correct
    most engineering and medical pvt colleges are owned by big politicians and they don’t want the lucrative source of funding to be hurt , no wonder the consequence is shortage of seats

  16. April 6, 2008 9:22 am

    Nita,
    This is another stigma of the disease that promised a regulated ‘tight-control’, hang-profiteers-from-the-nearest-lamppost, socialistic system. The brain drain is just the superficial reflection of how the society is unable to attract its best to the stench of the rot that it tries to suppress with the deospray of ‘duty’, ‘patriotism’ and ‘selflessness’.
    Vivek:
    The medical education system has always been state-regulated. How can you blame a student for that? And, anyways, as a moral issue, a tax-payer has every right to extract whatever legitimate advantages the system confers on him. why should he lose out?
    That said, one should identify the fact that it is the control society that one flees from. No one wants to run away from free countries. I wonder why. Do you?

  17. April 6, 2008 6:20 pm

    vishesh, a helicopter is something that would not be put into use for public service like this. The state India is in today choppers are to ferry VIPs out of tax payer’s money!

    destinationinfinity, quantity without quality would indeed be disaster. one need to work out both.

    Prax, almost everyone I know has tried natural medicine at some point in their life. I think this belief in traditional medicine is ingrained in us easterners.

    Rdoc, yes something is seriously wrong with our system if it is making people run away. Our country is not able to give an educated person a decent living and few people are altruistic. Inf act I don’t think altruism is part of human nature and I suspect anyone who claims it. Few people will sacrifice personal comfort and life of their families to service towards the country, except in times of emergency like war or a freedom struggle.
    Another point – this so called socialist system which I also hate is one which thought that higher education was elitist and that is why so many controls were put into it. I read this in a editorial by some eminent personality but I forget who! And now because of this so-called control towards “elitist” higher education only the rich can pay donations and get higher education and only the rich can go abraod and get higher education. This stupid policy has bit them right where it hurts. Now they have realised the mistake. Millions of average middle class Indians have no access to higher education as there are no seats in good govt colleges.
    And by the way ther is no such thing as “selflessless” unless someone is Mother Theresa.

  18. April 10, 2008 5:54 pm

    The one year rural service condition laid out by the Government of Maharashtra is a good plot for it to make easy money. Not many fresh MBBS graduates have preferred going to rural areas to work..Those who wished to in hope of learning medical management brass tacks – myself included, some 5 years ago- were refused allotment on grounds of unavailability of slots.(This meant non payment of a mandatory bribe amount, I learnt later!) Those friends of mine who have opted for rural service have regretted it, as wanting to put theory to practice meant rebelling against a well laid out corrupt system and rubbing the ‘permanent’ medical officers the wrong way, which often had odious fall outs. Though I do not have exact figures, I would hazard safely to say that assuming 5% of MBBS graduates did rural service, and the rest paid the ‘bond’ amount to the Government- which it claims to have spent on medical education and hence makes the morally untenable ‘compulsory rural service’ demand-the govt was easily richer by a cool 40 crores in one year. And this is a continuously appreciating fund with higher bond amounts being proposed for later.

    With regards to your comment on traditional medical practitioners, I would like to comment that we live in a world of evidence based medicine. Hence the traditional dichotomy of ‘allopathy’ and anyotherpathy do not apply. The base line is that if something works, and does no harm then it be accepted.Many of the traditional medicine practitioners are in fact akin to the ‘para-medics’ that you allude to, in that a vast part of their curriculum is borrowed from the MBBS curriculum, they prescribe the same pain killers and antibiotics as ‘allopathic’ doctors do. As long as they do toe the line of primum non nocere- first do no harm- I think they do great service in areas where their higher trained counterparts don’t deign to tread foot on.

  19. Dr Mohammed Ali Khan permalink
    August 30, 2009 6:04 pm

    The term ” allopathic” medicine is a misnomer..
    It should actually be called Evidence – based mainstream scientific medicine
    The term ” allopathic” was invented by the Homeopathy people to discredit mainstream scientific medicine
    I suggest a well informed journalist lika nita desist using this term.

    • Naveen permalink
      August 30, 2009 8:41 pm

      Dr. Khan,

      I for myself wouldn’t want to see it made ‘mainstream’ -looking at the direction it is going -showing its back to the fundamental of medicine – ‘Primum non nocere’. A medicine to ‘Acid Reflux’ with side-effects of hypertension and cardiac arrest? I can quote a ton that make no sense at all.

      • vasudev permalink
        August 30, 2009 10:30 pm

        naveen
        what was that? acid reflux with side effects cardiac arrest and hyper tension? could you please give more details? consider that i have a need to know which drug is it? normally gelusil is used for acidity. there are other syrupy stuff for acid reflux which claim to be anaesthetic etc. my personal preference would be a glass of cold refrigerated milk but nowadays taking cold stuff also have added issues which might catch at your throat. for the first time my chidren refused ice-creams!

        • Naveen permalink
          August 31, 2009 1:59 am

          Vasudev,

          Don’t take my advice as medical advice. I worked with some big pharma companies doing biomedical research. I can tell you one thing for sure -do not use acid reflux medicines unless you have tried homeopathy or alternatives(ginger tea etc). Gelusil is an antacid, a temporary relief and that is not a big problem; the biggest side-effect with Gelusil is constipation.

          There are a two classes of Acid-reflux/GERD drugs -‘Proton pump inhibitors’ and ‘H2-receptor antagonists’. The former class was what I was talking about. They generally end as ‘-prazole’. Esomeprazole is the worst among these. The latter class(H2-receptor) could have milder side effects like depression and hallucinations.😉

  20. Vivek Khadpekar permalink
    August 30, 2009 8:13 pm

    Dr Mohammed Ali Khan,

    Your point is well taken, inasmuch as the term “Allopathic” is said to have been coined by Samuel Hahnemann (the founder of Homœopathy) in a pejorative sense applicable to all systems other than his.

    The question is, what would be a simple “postitive” term to use instead? Your suggestion, “Evidence – based mainstream scientific medicine”, is quite a mouthful. Alternatives suggested by various others include “Western medicine, biomedicine, scientific medicine, or modern medicine”. To a layperson, all of these seem ambiguous and open to debate. Is there a single, definitive, unambiguous term?

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