Overheard : Paging Dr. India

A physician friend from India who is working on the year-end Golden Jubilee celebrations of Bangalore Medical College e-mailed me recently seeking help in contacting the alumni in the US.

He reckons that of the 7,000 medical graduates the school has produced in half-a-century, at least 1,000 are in the US, and perhaps as many as 2,000 are outside India. I was wondering if this is true of other Indian medical schools when I came across an article in the New England Journal of Medicine that provides a startling insight into the flight of doctors from low-income countries, including India.

The biggest beneficiaries of this migration are four rich white countries — the US, Great Britain, Canada and Australia. India has graduated the highest number of doctors in the world (around 504,000) next only to the US (840,000). India is the biggest loser (or "donor," if you wish) of doctors to the four rich countries surveyed (R-4, for purposes of this article).

Some 12% of the half-million Indian medical graduates have migrated to the R-4. As a result, India is the top contributor of doctors to the US (40,839 or almost 5% of the US physicians work force) and to the UK (15,093 or almost 11% of its doctors work force). Indian doctors are the second most numerous in Australia after the locals (2,143 or 4%) and they are third in Canada (1,149 or 2.1%). These four countries alone account for 60,000 Indian physicians. Top six contributors to the US physicians pool besides India at the top spot include Philippines (17,873 doctors), Pakistan (9,667), Canada (8,990), China (6,687), the former USSR (5,060), Egypt (4,593) and Mexico (4,578). While India has lost some 12% of its medical graduates, Pakistan fares no better (lost 12,800 of its 97,000 medical graduates to the R-4). Sri Lanka has lost a staggering 27% (3,000 out of 8,000). Bangladesh, probably because it is a new country, has lost only 5% (1,700 out of 32,000).

But the biggest losers in percentage terms are countries in sub-Saharan Africa and the Caribbean, which produce a small pool of medical graduates, almost half of whom flee to the US.You can see the effect of this migration in the US where one out of every four doctors is a foreign medical graduate. Remember, we are not even counting the children of immigrant physicians who take after the parent and go to medical school.

Thanks to this inflow of foreign doctors, the US has around 35 physicians per 10,000 population. The ratio is even better for UK, Canada and Australia. India has around 5.2 doctors per 10,000 population, or a doctor for every 2,000 people (compared to one for every 280 in the US).

The deleterious effect of this shortage shows in a range of dismal health metrics in India from its high birth rates to high infant mortality rate. For India to produce more doctors than any other nation save the US means the country's leadership laid a pretty solid foundation in medical education. But they did little to retain the talent they nurtured. Today, some 250 Indian medical colleges graduate about 30,000 doctors annually.

So India will likely have a million-plus physicians before 2020. They will saturate the R-4 and discover new pastures. Before long, Indian medical colleges, like the IITs, will be having their alumni meeting in Boston instead of Bangalore, Canberra instead of Chennai, and Manchester instead of Mumbai.

Chidanand Rajghatta

COMMENT : How very prophetic ! See list above.

CREDITS : timesofindia.indiatimes.com/articleshow/1297502.cms