Med 2018

TN, 5 others have more doctors than WHO norm of 1:1k people

Despite Good Figures, Rural Areas Remain Underserved

Rema.Nagarajan@timesgroup.com

Even as governments cite shortage of doctors to allow more private medical colleges, six states — Delhi, Karnataka, Kerala, Tamil Nadu, Punjab and Goa — have more doctors than the WHO norm of one for 1,000 people. Yet, some can’t find enough doctors for the rural public health system. Also, most doctors from these states are unwilling to move to states like Bihar or UP that suffer from an acute shortage of doctors. This again raises the question of whether merely producing more doctors can address the shortage in public health and in rural areas.

The density of doctors per 1,000 people in Tamil Nadu is as high as 4, almost at the same level as countries like Norway and Sweden, where it is 4.3 and 4.2 respectively. In Delhi, the density is 3, higher than the UK, US, Canada and Japan, where it ranges from 2.3 to 2.8. In Kerala and Karnataka, the density is about 1.5 and it is about 1.3 in Punjab and Goa.

TOI calculated these densities after deducting 20% from the number of registered doctors, as is done by the Medical Council of India to estimate the number of doctors actually available, since many state councils have not updated their registries. In states that have updated them through periodic reregistration, as in Delhi, the 20% reduction was not applied.

Since India’s doctors are largely concentrated in urban areas, it is possible that even some states with doctor population ratios better than 1:1,000 may have shortages in rural areas. However, Tamil Nadu and Kerala boast that they have no vacancies in their rural public health systems.

According to Dr Prabhakar DN, former president of the Karnataka branch of the Indian Medical Association, 40% of doctors in Karnataka are in Bangalore. “In rural areas, there is still a shortage. Bangalore is totally saturated, even for specialists. So they don’t get jobs. Doctor salaries are coming down. Suppose one hospital is doing well in an area. If three more come up in the same area, they will resort to unethical practices to get more patients. We need to focus on producing doctors for the periphery,” said Dr Prabhakar.

“Unlike engineers, who typically need to find jobs, doctors can be self-employed. If there are too many in a geographical area, they resort to unethical practices on the few patients they get to make ends meet,” said Dr N Sulphi, secretary of the Kerala IMA.

The problem also is that many of the states with high doctor-population ratios have the largest number of MBBS seats. As a result, this ratio tends to just keep getting better as more batches graduate.

Tamil Nadu IMA president Dr J A Jayalal agreed that there was a glut of doctors in cities with even consultants getting low pay. “For one post, more than 10 apply for non-clinical disciplines. In clinical, it is now one is to one. But with every passing year, the numbers are increasing, a cause for concern. Government colleges are increasing seats. Poor quality private colleges will have to shut down,” said Dr Jayalal.