The central argument of this article is that India needs a professional, medically qualified leadership cadre to govern its healthcare system, just as it has specialised administrative services for policing, forests, revenue and other sectors. The argument deserves a serious national debate.

Here is an expanded, polished English version, retaining the forceful, reform-oriented and advocacy-driven tone of the original.

BRING BACK THE INDIAN MEDICAL SERVICE (IMS): WHY INDIA NEEDS DOCTORS TO LEAD ITS HEALTHCARE SYSTEM

Healthcare cannot be governed by bureaucracy alone. It must be led by people who understand medicine, hospitals, patients and the realities of clinical practice.

Imagine a country where the decision to fly an aircraft rests with a trained pilot, where military operations are planned and commanded by experienced generals, and where policing is entrusted to officers specifically trained for law enforcement.

The country has specialised administrative services for almost every important sector:

• IPS – Indian Police Service for policing and internal security.
• IAS – Indian Administrative Service for general administration and governance.
• IFS – Indian Forest Service for forest management and conservation.
• IRS – Indian Revenue Service for taxation and revenue administration.

Yet, when it comes to the health and lives of more than 1.4 billion people, why does India not have a dedicated, professionally trained Indian Medical Service (IMS) to lead healthcare administration?

Why should decisions concerning intensive care units, ventilators, oxygen supply, dialysis facilities, essential medicines, hospital infrastructure and national health programmes be predominantly controlled by administrators who may have excellent general administrative abilities but little or no formal medical or clinical experience?

This is not an argument against civil servants. India needs competent administrators, financial experts, engineers, economists and policy professionals. Their contribution to governance is indispensable.

But healthcare is fundamentally different from many other administrative sectors. It is a complex scientific, technical and human enterprise in which administrative decisions can directly determine whether a patient lives or dies.

The question is not whether doctors should replace administrators. The question is whether healthcare should be administered without doctors having an authoritative role in decision-making.

1. The tyranny of generalist administration over specialist healthcare

A modern hospital is not merely a government building with doctors, nurses and beds. It is a highly sophisticated organisation involving critical care, emergency medicine, surgery, diagnostics, infection control, pharmacology, biomedical engineering, nursing, public health and hospital management.

Consider some routine but crucial administrative decisions:

• How many ICU beds does a district hospital actually require?
• What specifications should a government hospital’s ventilators meet?
• Which antibiotics should be included in essential drug procurement?
• How should dialysis services be expanded?
• What is the appropriate doctor-to-patient ratio in an emergency department?
• How should a hospital respond to a sudden outbreak of an infectious disease?
• How should intensive care facilities be distributed between urban and rural areas?

These are not merely financial or administrative questions. They require an understanding of clinical priorities, medical evidence, patient safety and the practical functioning of healthcare institutions.

An IAS officer may be an outstanding administrator, but administrative seniority cannot automatically substitute for clinical expertise.

A person who has never managed a cardiac arrest, septic shock or acute respiratory failure cannot independently determine the clinical requirements of an emergency department.

Similarly, a bureaucrat may understand the financial implications of purchasing a ventilator but may not necessarily appreciate the clinical differences between equipment specifications, patient-monitoring requirements and the actual needs of an intensive care unit.

Healthcare decisions should therefore be made through a partnership between professional medical leadership and administrative expertise.

The problem arises when administrative authority becomes so dominant that professional medical advice is reduced to a subordinate opinion rather than an essential component of policymaking.

2. The procurement paradox: Administrators make decisions, doctors face the consequences

One of the most disturbing contradictions in India’s public healthcare system is the separation between decision-making authority and accountability for clinical outcomes.

Consider the procurement of essential hospital equipment and medicines.

Decisions concerning budgets, tender specifications, vendor selection, procurement procedures and supply-chain management are often distributed among administrative, financial and technical authorities.

Doctors and hospital administrators may provide clinical requirements, but they do not necessarily exercise final control over procurement.

Now consider the consequences:

• An inadequate supply of oxygen can cripple an intensive care unit.
• Poor-quality or unsuitable ventilators can compromise patient care.
• Delayed procurement of essential medicines can interrupt treatment.
• Expired or improperly stored drugs can endanger patients.
• Insufficient diagnostic facilities can delay life-saving interventions.

When a healthcare system fails, who faces the immediate anger of the public?

The treating doctor.

When a patient dies, the relatives confront the medical team. When an emergency department becomes overcrowded, the resident doctors face the pressure. When a hospital lacks essential facilities, the doctor is often expected to explain and defend the system’s shortcomings.

In extreme cases, doctors and healthcare workers become victims of physical violence.

A young resident doctor, perhaps barely 25 years old, may have worked continuously for 24–36 hours, handling emergencies and critically ill patients. Yet, when an unfortunate death occurs because of systemic deficiencies, that doctor may become the target of public anger and mob violence.

Meanwhile, those who controlled the administrative and financial decisions may remain far removed from the immediate consequences.

This creates a fundamental imbalance:

Those who control the system are often not those who face the consequences of its failures. Those who face the consequences often have little control over the system.

Accountability must follow authority. If doctors are expected to deliver results, they must also have meaningful participation in decisions concerning the resources, infrastructure and working conditions required to deliver those results.

3. The historical irony: India once had an Indian Medical Service

The demand for an Indian Medical Service is not entirely new.

During British rule, the Indian Medical Service (IMS) existed as a specialised professional service. It included medically qualified officers who served in military and civil medical establishments and held important medical administrative responsibilities.

Following Independence, India reorganised its administrative and healthcare structures. The old IMS was discontinued as an imperial service, and the country developed different arrangements for public health administration and medical services.

However, the question of establishing a dedicated professional health administration cadre continued to arise in subsequent policy discussions.

Various committees and policy documents have highlighted the importance of strengthening professional management and leadership in healthcare.

These include:

• Mudaliar Committee (1962): Examined the development and organisation of India’s health services and emphasised strengthening the health infrastructure and public health administration.
• Kartar Singh Committee (1973): Recommended major reforms in the organisation of health services, particularly the integration of healthcare delivery at the grassroots level.
• Bajaj Committee (1986): Examined health manpower planning and the development of human resources for healthcare.
• National Health Policy (2017): Emphasised the need to strengthen health systems, improve management capacities and develop appropriate professional competencies in healthcare administration.

These developments demonstrate that professional health management has long been recognised as an important requirement.

The precise recommendations of these committees and the policy documents should be examined individually rather than assuming that all explicitly proposed an identical IMS structure.

Nevertheless, the larger question remains relevant:

Why has India not developed a strong, nationally coordinated professional leadership service for its healthcare system?

4. Article 312 of the Constitution: Is a new All India Medical Service possible?

The Constitution of India provides a mechanism for creating new All India Services.

Article 312 empowers Parliament to create an All India Service if the Rajya Sabha passes a resolution, supported by not less than two-thirds of the members present and voting, declaring that it is necessary or expedient in the national interest.

Such a resolution enables Parliament to legislate for the creation of the service.

India has already demonstrated that specialised professional services can be organised to meet the requirements of national governance.

The creation of the Indian Railway Management Service (IRMS), for example, reflects the changing approach towards professional integration and specialised management in a major national sector.

Healthcare is arguably an even more compelling area for such an initiative.

India faces enormous challenges:

• A rapidly growing population.
• Unequal distribution of medical professionals.
• Overburdened government hospitals.
• Shortages of specialists in rural and underserved regions.
• Rising costs of medical treatment.
• Increasing prevalence of non-communicable diseases.
• Emerging infectious diseases and pandemic threats.
• Growing requirements for medical technology and digital healthcare.
• The need for stronger public health surveillance and emergency preparedness.

A nationally coordinated professional medical administrative service could help address these challenges through better planning, professional leadership and continuity of healthcare policies.

Article 312 provides a constitutional route. The real question is whether there is sufficient political and administrative commitment to pursue it.

5. Why doctors must participate in policymaking, not merely implement policies

One of the fundamental weaknesses of healthcare governance is the tendency to treat doctors primarily as service providers rather than as professionals who should participate in designing the system.

Doctors are expected to:

• Treat patients.
• Manage emergencies.
• Conduct surgeries.
• Maintain clinical standards.
• Implement government health programmes.
• Participate in disease-control initiatives.
• Work in difficult geographical and infrastructural conditions.

However, when policies are formulated, procurement systems designed, hospital budgets allocated and institutional priorities determined, their professional representation may be inadequate.

This creates a disconnect between policy formulation and ground realities.

A doctor working in a district hospital understands why an emergency department needs additional staff, why a particular diagnostic facility is essential and why certain medicines must remain continuously available.

A specialist working in a tertiary-care hospital understands the technical requirements of advanced critical care.

A public health expert understands disease surveillance, vaccination, epidemiology and population-level health interventions.

These experiences are valuable inputs into national policymaking.

The ideal system should combine:

Medical expertise + Administrative competence + Financial accountability + Scientific evidence.

No single profession possesses all these capabilities.

But no healthcare policy should be formulated without meaningful medical and public health leadership.

6. What should the proposed Indian Medical Service actually do?

The proposed IMS should not become another bureaucratic hierarchy or simply a mechanism for giving doctors administrative posts.

It should be designed as a modern, multidisciplinary professional service with clearly defined responsibilities.

Its officers could be recruited through a transparent national selection process, with appropriate pathways for medical graduates and experienced healthcare professionals.

The service should include or provide specialised pathways in:

1. Hospital Administration: Planning, managing and improving government hospitals, medical colleges and tertiary-care institutions.
2. Public Health Administration: Disease surveillance, epidemic management, vaccination programmes, preventive medicine and national health missions.
3. Health Policy and Planning: Developing evidence-based national and state healthcare policies.
4. Medical Procurement and Technology Assessment: Evaluating medical equipment, medicines, clinical requirements and healthcare technologies with appropriate financial and technical expertise.
5. Healthcare Quality and Patient Safety: Establishing standards, monitoring outcomes and improving patient safety.
6. Medical Education Administration: Strengthening medical education, faculty development, institutional standards and postgraduate training.
7. Emergency and Disaster Medicine: Developing coordinated responses to pandemics, natural disasters, mass casualties and public health emergencies.
8. Rural Healthcare Development: Improving primary healthcare, community health centres, district hospitals and specialist referral systems.
9. Health Economics and Financing: Planning healthcare expenditure, assessing cost-effectiveness and ensuring responsible utilisation of public funds.

The service should also provide structured opportunities for experienced clinicians, public health specialists and hospital administrators to enter leadership positions.

Importantly, medical qualifications alone should not be treated as sufficient preparation for senior administrative positions. Officers must receive rigorous training in management, public finance, law, procurement, governance, leadership and institutional accountability.

7. An important distinction: A doctor is not automatically a good administrator

While advocating IMS, we must avoid creating another professional monopoly.

Being a successful surgeon, physician or professor does not automatically make someone a competent hospital administrator.

Clinical medicine and institutional management are different disciplines.

A good healthcare administrator must understand:

• Financial management.
• Human resource planning.
• Public procurement regulations.
• Institutional governance.
• Labour laws.
• Healthcare economics.
• Data management.
• Public accountability.
• Leadership and conflict resolution.

Therefore, the proposed IMS must be a professionally trained administrative service, not simply a service reserved for doctors by virtue of their medical degrees.

It should encourage interdisciplinary collaboration with economists, statisticians, engineers, management specialists, public health professionals and experienced civil servants.

The objective should not be to replace one form of bureaucracy with another.

It should be to create a system in which professional competence determines leadership responsibilities.

8. Protecting doctors also requires protecting the healthcare system

The demand for IMS is also connected with the increasing vulnerability of doctors working in government hospitals.

Doctors are frequently held responsible for circumstances beyond their control.

A resident doctor cannot manufacture an unavailable medicine, create additional ICU beds overnight, repair a broken ventilator or independently sanction additional hospital staff.

Yet, patients and their relatives often perceive the treating doctor as the face of the entire healthcare system.

This disconnect contributes to frustration, mistrust and, occasionally, violence.

A professional medical administration cadre could help create a more accountable institutional structure in which clinical decisions, resource allocation and administrative responsibilities are clearly defined.

It could also help establish stronger mechanisms for:

• Protecting healthcare workers from violence.
• Ensuring adequate staffing.
• Improving duty-hour management.
• Providing transparent grievance-redressal systems.
• Monitoring hospital infrastructure.
• Ensuring timely procurement.
• Investigating institutional failures objectively.

Doctors should be accountable for negligence and professional misconduct. But they should not become convenient scapegoats for administrative failures.

A healthcare system that demands accountability from doctors must also ensure accountability from those who control its resources and administration.

9. The larger vision: Healthcare is too important to be treated as an ordinary administrative department

India aspires to become a global leader in science, technology, medical education and healthcare delivery.

It has world-class medical institutions, highly skilled doctors, internationally recognised research centres and an expanding healthcare industry.

Yet, the management of public healthcare continues to face significant structural challenges.

A country cannot build a world-class healthcare system merely by constructing hospitals and purchasing expensive equipment.

It needs competent institutional leadership, scientific decision-making, professional management and accountability.

Healthcare is not simply another government department. It is a national responsibility involving human dignity, constitutional commitments, social justice and the right to life.

Article 21 of the Constitution, as interpreted by the Supreme Court, has important implications for access to healthcare and protection of life.

The administration of healthcare must therefore be treated as a specialised national responsibility.

The proposed Indian Medical Service could become an important instrument in achieving this objective.

But its creation must be accompanied by structural reforms, transparent recruitment, professional training, performance evaluation and institutional independence from arbitrary administrative interference.

10. The final question to Parliament and the Government of India

If we accept that policing requires specialised police leadership, forests require specialised forest administration, and taxation requires specialised revenue administration, why should healthcare remain predominantly dependent on a generalist administrative framework?

Why should doctors with decades of clinical and institutional experience remain subordinate in decisions concerning the very hospitals they run and the patients they treat?

Why should a country with one of the world’s largest populations not develop a dedicated professional leadership structure for its healthcare system?

The demand for an Indian Medical Service is not about prestige, promotion or professional supremacy.

It is about putting the right expertise in the right place.

It is about ensuring that decisions concerning patients, hospitals, medicines, medical equipment and public health are informed by scientific knowledge and practical clinical experience.

It is about creating a healthcare administration in which authority and accountability go together.

India does not need a war between doctors and bureaucrats. It needs a partnership in which each profession contributes its strengths.

But the leadership of healthcare must never be disconnected from the science and realities of medicine.

The pilot must understand aviation. The general must understand military strategy. And those entrusted with leading the healthcare system must understand healthcare.

The lives of 1.4 billion Indians cannot be governed by files and financial approvals alone.

They deserve a healthcare administration led by knowledge, competence, compassion and accountability.

OUR DEMAND

BRING BACK THE INDIAN MEDICAL SERVICE (IMS).

Let doctors and public health professionals have a meaningful, institutionalised role in governing India’s healthcare system.

Let clinical expertise become an essential part of national health policymaking.

Let procurement decisions be scientifically informed and financially accountable.

Let hospital administrators be professionally trained.

Let those who make decisions be answerable for the consequences.

Let doctors treat patients without being made scapegoats for failures of governance.

This is not a demand for professional privilege. It is a demand for institutional reform.

Healthcare must be governed by competence, not merely by administrative seniority.

NO MORE DELAY. INDIA NEEDS A PROFESSIONAL HEALTH ADMINISTRATION SERVICE.

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DoctorsMustLeadHealthcare

HealthcareReformsNow

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One important suggestion before publishing

The article will become considerably stronger if it distinguishes three things:

• Historical IMS: The Indian Medical Service that existed during British rule.
• Proposed modern IMS: A new All India Medical Service under Article 312, with an appropriately designed recruitment and training structure.
• Medical leadership versus bureaucratic control: The objective should be professional medical leadership working alongside competent administrators, rather than excluding IAS officers from healthcare administration.

I would particularly recommend a separate, properly sourced historical and constitutional section establishing exactly what the Mudaliar, Kartar Singh and Bajaj committees recommended, and what the National Health Policy 2017 actually states. This will prevent critics from dismissing an otherwise important reform argument on factual or historical grounds.