Can India maintain educational standards and meet healthcare needs?

India’s medical education system has expanded rapidly over the last decade, but this growth has sparked concerns about the quality of training, infrastructure, and shortages in qualified faculty.

Union Health Minister J.P. Nadda recently announced that the number of medical colleges will increase from 706 in 2023-24 to 766 in 2024-25. This 8% rise builds on a decade-long expansion that has seen the number of colleges nearly double, from 387 in 2013-14 to 766 by 2024-25. Of these, 423 are government-run while 343 are privately operated.

In tandem with this growth, the number of MBBS seats is set to rise by 6%, from 1,08,940 in 2023-24 to 1,15,812 in 2024-25. Over the past ten years, MBBS seats have increased by 125%, up from 51,348 in 2013-14. Postgraduate (PG) education has followed a similar trend, with PG seats growing by 127%, from 31,185 to 73,111 by 2024-25.

But while these figures reflect India’s drive to address its healthcare challenges, concerns persist that the quality of medical education has not kept pace with this rapid expansion.

"This growth is crucial for strengthening our healthcare system, but we must ensure that the standards of education and training are maintained across all institutions," Nadda emphasised.

Shortage of Qualified Faculty and infrastructure

One of the primary concerns is the shortage of qualified teaching staff. A 2023 report by the National Medical Commission (NMC) highlighted a significant lack of faculty in key disciplines such as anatomy, pathology, and community medicine. Many institutions are struggling to meet the recommended teacher-student ratios, raising questions about the quality of education being provided.

The issue of "ghost faculty"—where staff are registered but seldom present at colleges—was flagged in a 2022 Parliamentary Standing Committee on Health report, which called for improved oversight to address this problem. "Despite increased public investment, government colleges still face shortages in quality faculty and infrastructure. A policy requiring graduates to serve in the government sector for at least ten years could help address this," said Arup Mitra, Professor of Economics, South Asian University (SAU), New Delhi. 

The rapid expansion of medical institutions has also put a strain on infrastructure. A 2022 assessment by the Ministry of Health revealed that about 40% of newly established medical colleges lack fully functional laboratories, operating theatres, and essential clinical facilities. This shortage of infrastructure is hampering practical training for students, especially in newer institutions.

A study conducted by the Indian Council of Medical Research (ICMR) in 2022 found that more than 30% of surveyed colleges were under-equipped in terms of research and training infrastructure, further fuelling concerns about how prepared graduates will be for medical practice.

Another challenge facing India’s medical education system is the stark urban-rural divide. According to the 2023 Rural Health Statistics report, urban areas in states like Maharashtra, Tamil Nadu, and Uttar Pradesh have benefitted the most from the expansion of medical colleges, while rural regions remain underserved. States such as Bihar and Jharkhand, which already suffer from a shortage of healthcare personnel, have relatively fewer medical institutions compared to wealthier, urbanised states.

Even in states that have seen new colleges, like Rajasthan, rural institutions often struggle with limited resources and skeletal faculty, exacerbating the gap in healthcare services between urban and rural areas.

Private Institutions and Accessibility

The role of private institutions in the expansion of medical education has also been significant, with private colleges now accounting for 55% of all medical institutions in India. However, concerns have been raised about the quality of education provided by some private colleges. A 2023 study published in The Lancet found marked differences in educational standards between private and government-run medical colleges. The lack of stringent oversight in some private institutions has led to disparities in the quality of education.

In addition, the high tuition fees charged by private colleges — often exceeding Rs 20 lakh per year—have made medical education inaccessible to many students from economically disadvantaged backgrounds, despite the government’s efforts to increase seats.

"One major issue with the medical education system is the privatization and significant increase in fees. Students unable to secure seats in government medical colleges often turn to private institutions and adopt a profit-driven mindset. After graduating, many focus on earning money, which affects government college graduates, who also seek lucrative opportunities. This contributes to brain drain and reluctance to work in rural areas," said Mitra.
"Strict regulations should also apply to the private sector to discourage temptation and poaching," said Mitra.

Brain Drain: Retaining Doctors

A further challenge for India is the ongoing "brain drain" of medical professionals. A 2023 report by the Organisation for Economic Co-operation and Development (OECD) noted that India is one of the top countries supplying doctors to developed nations such as the US, UK, and Canada. This exodus of skilled professionals has long been a problem, with many doctors seeking better career opportunities abroad. As a result, while India continues to produce more doctors, it struggles to retain them, particularly in rural and underserved regions where healthcare workers are most needed.

“There have been reports of students complaining about the lack of faculty and good infrastructure at the newly formed medical and dental colleges. While there is certainly a need to increase undergraduate (UG) and postgraduate (PG) seats to cater to India’s rising population, the government must also ensure the maintenance of quality faculty and sufficient infrastructure in these institutions. This is crucial to ensure that doctors graduating from these colleges meet global standards,” said Dr Anil Kumar Chandna, member Delhi Dental Council.