Medical Students, Doctors Seek Careers Abroad Amid Challenges in India

Medical students and professionals in India no longer see medical education and the profession as lucrative. An increasing number of them are choosing to study abroad. Furthermore, many graduates prefer to pursue their medical careers outside India and also practise overseas. This trend raises concerns about the future of healthcare in India, as the brain drain of talented professionals could increase the existing shortages in the medical field.

Challenges and Aspirations of Medical Students Studying Abroad

Anita Singh (name changed), a third-year MBBS student from Gauhati Medical College and Hospital, shared her aspirations and challenges with The Probe. “I always wanted to pursue a medical career. I gave my NEET exams, but the first attempt did not go well because of Covid-19 in 2020. I attempted again in 2021. Now, I am planning to go abroad. I am preparing for the United States Medical Licensing Examination. It is a three-step exam, and I am planning to take up the first step this year.”

Her primary motivation to go abroad stems from her cousin’s experience in the US. “My cousin pursued his education in the US, and he says it is very good there. In India, there is a heavy load of patients, but in the United States, as far as I have heard, the system is very different. The population is less, and the infrastructural facilities are better,” she explains.

Anita, however, clarifies that she does not intend to settle in the US permanently but definitely wants to study there due to greater opportunities. She believes that significant changes are needed to make Indian medical education and the profession more lucrative in India. “Doctors need to be protected. We are seeing so many cases of violence against doctors, and medical professionals don’t feel safe in India,” she states. “The learning needs to be more structured. Students keep moving from one thing to another in India. The syllabus and the way classes are set up should be more structured. This must be left to the professors and the teaching faculty, but there is no feedback system to understand the pulse of the actual on-ground educationists.”

She continues, “Most of the time, we have our professors telling us that this is not the structure they like to follow but that this is what has been given to them. That is not a very desirable situation. Much needs to change in India to make the medical education and profession more appealing and secure for future doctors.”

We spoke to another Indian student, Chinmay Nirwan, who is currently pursuing his final year of MBBS at the Odessa National Medical University in Odessa, Ukraine. “I gave my NEET exam in 2018. After giving my NEET exams, I did not get any opportunities in Indian government medical colleges. Though I could get admission in a private college, it is very expensive in India, so I decided to go to Ukraine and study,” he explains.

Despite the ongoing war in Ukraine, Chinmay states that the infrastructure there is still good. He expresses a desire to return to India for his internship but wants to keep his options open post that. “I want to learn more languages and then see if I can work abroad after my studies,” he states. “The infrastructure in Ukraine has been conducive to my education, and I hope to leverage that experience, whether I practise in India or elsewhere.”

Challenges and Migration Trends Among Indian Medical Students and Professionals

Dr. R V Asokan, National President of the Indian Medical Association (IMA), states that the phenomenon of Indian medical students going abroad was very rare earlier. “This phenomenon was very rare when there were only government medical colleges, but in the last two decades, we have seen that medical education has been privatised, and now we have more private medical colleges than government ones in the country. Earlier, the medical colleges also had a system in every state for fee regulation, determined at the state level. But now the National Medical Commission (NMC) has come into the picture. Originally, it was stated that 60 percent of the medical seats could be sold in the open market. The IMA objected to this, and the government changed it to 50 percent.”

Dr Asokan adds, “Now, the state-level fee-controlling authority is not there, and the authority lies with the NMC, which regulates the fees for that 50 percent. The cost of education has gone very high because of all these factors. The number of people aspiring to get into medical education face a choice: face tough competition in India or pay more money to join private colleges in the country. Abroad, you may need to pay just 30 to 40 percent of what we pay in India. That is why Indian medical students, if they are borderline and want to continue their education, choose to go abroad.”

Dr. Shalabh Gupta, Chairman of the IMA Medical Students Network states that there are several reasons behind this exodus to foreign countries. “In 2024, around 23.5 lakh students appeared for the MBBS NEET UG examinations. The seats are limited, with only about one lakh nine thousand available. So, where will the rest of the 22 to 23 lakh students go who don’t qualify?” he questions. 

“All the students have very explicit goals to become doctors, which is good, but look at the numbers. In the last 3 to 4 years, the number of aspirants has surged from 3 lakhs to 23 lakhs, but the seats have hardly increased from around 70,000 to 1.09 lakh. I recently met many Indian students in Kazakhstan, and they were all happy. They were not complaining about not getting a seat in India. Students don’t get opportunities in India. Outside, students get better infrastructure,” Dr Gupta notes. 

He also points out that the reservation system is a significant issue contributing to this trend. “The reservation policy in India is too extensive. General candidates have limited seats in government colleges. Of the approximately 58,000 seats in government colleges out of the total 1.09 lakh available seats, around 60 percent are reserved. So, the total number of seats available for general candidates is about 20,000 to 25,000 only. Reservation has actually brought down the number of seats for general candidates. In other countries, we don’t usually see such extensive reservations; only in India do we see this amount of reservation.”

Abroad, there are tremendous opportunities for research, which attract many Indian medical students. In contrast, research opportunities in India are limited, making it difficult for aspiring doctors to pursue their interests and contribute to medical advancements. If a student does not secure a spot in a government college, their only option is to attend a private institution. However, medical education in private colleges in India is prohibitively expensive, often putting it out of reach for many families. The high cost of private medical education adds another layer of difficulty, pushing more students to seek affordable education abroad, where they also benefit from superior infrastructure and resources.

In 2016, the World Health Organisation (WHO) stated, “Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population. It has been estimated, however, in the World Health Report 2006, that countries with fewer than 23 physicians, nurses, and midwives per 10,000 population generally fail to achieve adequate coverage rates for selected primary health care interventions as prioritised by the Millennium Development Goals framework.”

The WHO recommends a doctor-to-population ratio of 1:1000. This year, the Indian Health Minister told Parliament that the doctor-population ratio in the country stands at 1:834, which is better than the WHO standard of 1:1000. However, there is a catch. When the Indian government calculates these figures, they include AYUSH doctors. In reality, practitioners of traditional medicine are usually not included in this global calculation. AYUSH doctors cannot be treated on par with MBBS doctors. This discrepancy paints a misleading picture of the healthcare scenario in India, potentially masking the actual shortage of qualified medical professionals.

Dr. Gupta states that in developed nations, the doctor-to-patient ratios are significantly better. “For instance, in many developed nations like the US or UK, they have approximately one doctor for every 200 patients. We have far fewer,” he states. “Around 70,000 to 90,000 doctors from India are serving abroad. Even if you bring all of them back, the scenario is not going to change much because you need to provide doctors with good standards of living, good salaries, and a proper environment where they are not scared of violence.”

Dr. Gupta emphasises the daily challenges faced by doctors in India. “On a daily basis, we see stories related to violence against doctors. The environment has to be conducive for doctors to practise. Without these essential conditions, it is difficult to retain medical professionals in the country,” he adds.

Growing Exodus of Indian Doctors and Medical Students

Dr. Joyita Bharati, MD, DM, and a Teaching Fellow at the Boston Medical Center, USA, completed her medical school at Madras Medical College in India, her residency at the All India Institute of Medical Sciences, and her nephrology fellowship at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh.

Despite her extensive training in India, she decided to pursue a re-fellowship in the U.S. due to the superior research facilities, better laboratories, and mentoring opportunities available there. Dr. Bharati explains that the ease for a new faculty member to conduct research is significantly greater in the U.S. compared to India.

“There are some challenges in India, such as the non-mandatory adoption of Electronic Medical Records (EMRs). In the U.S., using EMRs is a requirement for practising. Additionally, patients in the U.S. are more aware of their diseases and are willing to discuss them openly, which isn’t as common in India. We still have excellent doctors in India, but I believe we need a better patient-to-doctor ratio and improved research opportunities.”

Dr. Dhruv Chauhan, National Council Coordinator of the Indian Medical Association-Junior Doctors Network (IMA-JDN), notes that a fearful environment against medical professionals has been created in the country. The lack of central laws to protect these professionals is a significant reason why doctors are travelling abroad and choosing to practise elsewhere.

“The doctors feel that they are not respected in the country and hence they lack protection,” he remarks. “Not just in the West, but even in the Middle East, doctors are paid more. Doctors need a chance to practise in a country where they can work with dignity in a conducive environment and are also paid well for the services they render.”

Dr. Chauhan also points out that Indian doctors are overloaded with patients. “The doctors are burdened with treating more and more patients on a daily basis. The health budget of our country is so low considering the population. The facilities are inadequate, and the infrastructure is poor. There is a dearth of medicines. The pay scale of doctors is very low; for instance, in the southern parts of India, doctors in government hospitals are paid as little as 30,000 to 40,000 rupees per month for full-time work, and they are not allowed to do private practice. Then at least pay them well, no?”

He continues, “Everybody shifts to Delhi for treatment, but even in Delhi, the situation is not that great. When good treatment is not given, the blame is often pinned on the doctors. Interns in various medical colleges work without pay. Resident doctors are also paid less and often have to wait for 4 to 5 months for their salaries. This kind of treatment forces many doctors to look for better opportunities abroad and medical students also feel that there are better options outside India.”

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