Brain drain

Dr. Animesh, a young medico puts forth his concerns on the rising ‘brain-drain’ in the medical profession in India, the challenges young medicos face, and possible solutions to overcome them.

The year 2019 was marked as one of the most strenuous years for medical postgraduate aspirants. We are aware of the term “Brain drain”, and it is especially not new to the Indian media and to medical professionals. The Medical Council of India (MCI) along with other platforms have displayed statistics stating that doctors are one of the most ‘likely to emigrate’ professionals in India.

The most evident reason for this is the cast-based reservation of medical postgraduation seats along with rising competition every following year. The demand is ever-rising, and the WHO-proven, deteriorating doctor-patient ratio answers the question of why there is much burden on the medical community in India. While the WHO recommends a doctor-patient ratio of 1:1000, a recent study shows that there is a shortage of 6,00,000 doctors, i.e., that there is one government doctor for every 10,189 patients. Unfortunately, the case with the paramedical staff is equally tragic.

Until a few years ago, the state of Tamil Nadu stood first offering 69% reservation, comprising of various local minorities for postgraduation studies.

In June 2019, the Bombay High Court approved bills and allowed seat allocation to three new sub-categories of postgraduation aspirants, leaving a total of 25% seats for the general category students. The unfair reservation distribution goes like this: SC -13%; ST-7%; OBC-19%; SBC-2%; SEBC13%; EWS-10%; NT-11%. When a state fixates such stringent rules over a section of the population which has the potential to change the course of a nation’s healthcare, there begins ‘Brain Drain’.

Deviation of time, money and resources of young doctors and investing in protests and regular visits to the court, with no positive outcome and just blatant remorse, has already led to many doctors going into depression and turning their back towards serving in the government medical sector.

A primitive, single-paper, objective-patterned, entrance test with non-clinical based questions along with sky-rocketing cut-offs at individual institutions provides obvious incentive for students who know that their clinical acumen and research information would be better tested and complemented in the western world.

You would expect the government to take bold steps to avoid this, but sadly, the Indian government continues to fail; as if chosing to be in denial to such a high emigration rate of young physicians and medical students.

The average allowance – comprising of financial aid, job opportunities and seat allocation – to a reserved community in today’s India is more than a massive 50% of the entire participating population. The recent, meagre appraisal by 50% of the stipend given to the young interns for the unforgivable number of hours they spend working at a hospital after frequent and lengthy silent protests and strikes, offers less hope to the politically-unrelated, young medical fraternity.

The rising brain-drain persuaded the Indian government to set up a few policies, many of them being irrational and peremptory in nature, not to mention, one-sided.

1 For a doctor to secure a job in the US for residency, the health ministry has stopped issuing ‘no obligation to return to India’ (NORI), which is pertinent in cases where doctors want to settle in other countries, noticeably USA.

2 The government has enforced affiliated rural bonds for one year, failing which MBBS students must pay a penalty of Rs. 10 lakhs, PG doctors- Rs. 50 lakhs, and super-specialty doctors- Rs. 2 crores.

3 Lastly, a disappointing approach most stated by doctors is the implementation of Section 32 of the new legislation, which allows 3.5 lakh unqualified non-medical practitioners to practice modern medicine. Never mind that most of them may not know the first thing about diagnosis and prognosis. Section 32 also holds the power to initiate a National Exit exam (NEXT) for all the postgraduates looking to receive their practicing license and a screening test for foreign medical graduates.

Taking such unnecessary, evidently futile steps, where the government yearns to bridge this liability-personified-gap (more than a responsibility) in India’s healthcare system, often leaves a young doctor clueless. The converted cynics and the pessimists of this nation believe that there would be increasing number of deaths due to the poor healthcare system and only when the plummeting mortality rate becomes evident enough to be a mere statistical entity; only at that moment, the merit of this nation, then flourishing in the western world would be seen as a sore mistake to be lost upon.

Possible solutions

The government should openly interact with young physician representatives and various medical students to look out for better and sustainable steps in the right direction. To name a few, increasing postgraduation seats, scrapping off caste-based reservation in postgraduation, improving infrastructure, providing loans and tax breaks for setting up high-end infrastructure are some of the minor, yet decisive initiatives that could bring a massive change. 

Disclaimer- The views and opinions expressed in this article are those of the author’s and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Animesh Upadhyay is a young MBBS graduate from a government medical college affiliated with the Maharashtra University of Health Sciences and is currently preparing for his postgraduation in medicine in the USA.

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