How Many doctors do we need?

Health manpower planning is an essential activity for any country for achievement of good health. In India there is no consensus about how many doctors we need for our population. Production of Medical graduate is a time consuming and expensive affair. Number of Medical colleges at time of independence was only 19 and now the number has grown to more than 700 at 2023.¹More than 300 are run by private management. India is producing more than 70000 medical graduates in a year. And number is increasing. But when we are considering the manpower requirement, we should consider the Practitioners of Indian system of medicine also. In our country Medical Institution and doctors are concentrated in Urban areas. In rural areas where large number of Indian are residing are mostly depended on Practitioner with less than adequate qualification. In rural areas only small number of medical graduates are employed by Government in government institutions. Very few private Practitioners or private institutions are involved for care of people in rural areas.

As per information provided by National Medical Commission (NMC), there are 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on June, 2022. Assuming 80% availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor- population ratio in the country is 1:834 which is better than the WHO standard of 1:1000. Also, there are 34.33 lakh registered nursing personnel and 13 lakhs Allied Healthcare Professionals in the country. The Government has taken many steps to further increase the availability of graduate of Modern Medicine.² But another report³ by WHO India Office reported acute shortage of Health workforce in India and estimated number of Medical Institutions and investment requirement in the country. They calculated active workforce in a different methodology. They used data from the National Health Workforce Account (NHWA) 2018 and the Periodic Labour Force Survey (PLFS) 2018-2019 conducted by the National Sample Survey organisation (NSSO), government of India. Baseline number at 2020 was arrived and projection was made for considering the goal to achieve different maternal and child health services. They considered net migration, mortality and retirement of the workers for arriving the active workforce. They have also considered those who are engaged in non-human health service and the unemployed. To overcome the deficiency, they estimated the need for opening of large number of new colleges by 2025.

Health system of a country should be such which the country and community can afford. India like to produce large number of medical graduates. Government have taken initiative to covert district hospital to Medical Colleges. In existing medical collages seat are being increased and large number of AIIMS are set up in different states of India. National Medical Commission has relaxed the norms for setting up of New Medical College in terms of requirement for faculty, staff, bed strength and other infrastructure. The age limit for appointment/ extension/ re-employment against posts of teachers in medical colleges have been increased up to 70 years. The tenure of Senior Residency for appointment of Assistant Professor have been reduced from three year to one year.² NMC has rapidly changing the regulation which is creating confusion among the stakeholder of Medical Education. Large number of private medical institution has come up in the country. In management quota seats money get priority over merit. Poor deserving candidate cannot enter into private institutions for monetary problem.

Steps have been taken to rapidly increasing the medical graduate in the country. But Central and State Governments’ budgeted expenditure on the health sector reached only 2.1 per cent of GDP in FY23 (BE).⁴ Each year these large number of medical colleges will produce large number of medical graduates. What will be the fate of these medical graduate in term of employment? What will be their earning after long years of education or hefty investment in private medical colleges? It will be very sad if the precious manpower remains unemployed or under employed or shifted to non-health sector like engineering graduates? In 2021 only 31716 doctors were in position in PHC in rural area of India and only 4405 Specialist in CHC of Rural area of India. Only producing more graduate in the country will not make them available and accessible to the rural people.⁵ Do we have enough income opportunity for them? India is not spending enough money for health care. Health Expenditure as percentage of GDP is miserably low compared to developed countries. Current health expenditure as percentage of gross domestic product (GDP) is 2.96% in India, whereas it is 10.9% in Japan, 11.98% in United Kingdom and 18.92% in United States of America.⁶So, rapid increase in number of doctors without concomitant increase in expenditure in health, especially in preventive and promoting health will not help India to achieve health for all. It will create disappointment among people and health care workers. Proper road map for health manpower production and its utilisation for betterment of health of the people of India is the need of the hour.