The Impact of Physician Emigration
on
Host Country and Health Care System
1925
1998
SGSMC
MUHS
Dr. Ravindra Bapat
Vice-Chancellor
Maharashtra University of Health Sciences
Nashik ( India)
Policy After Independence
•
To produce ‘Basic Doctors’
• Rural Community
•
Comprehensive Care
 Promotive
 Preventive
 Curative *
 Rehabilitative
“ Basic Springboard to WEST ”
Post Independent Development ?
Committees for Upgradation of Health Sciences Education
1975 : Shrivastava Committee
1983 : Medical Education Review Committee
National Health Policy
1987 : Prof. J.S. Bajaj Committee
1988 : Rais Ahmed Committee
1995 : Dr. A.K. Mukharjee Committee
2002 : National Health Policy
Vision WESTWARDS British Model Continued
Number of Modern Medical Colleges in India
229
250
200
150
100
50
30
0
Pre-independence
Today
“ Aims fulfilled ? ”
Outcome of Medical Graduates
Expected
Present
100
100
70%
80
60
60
40
20
80
20%
10%
50%
40%
40
20
0
10%
0
Super Speciality Speciality Basic Doctors
Super Speciality Speciality Basic Doctors
“ Top Heavy, Bottom Light ”
Can Health Universities Solve the Problem
1. N.T.R. University of Health Sciences, Andhra Pradesh
-1986
2. M.G.R. Health Sciences University, Tamilnadu
-1987
3. Rajiv Gandhi University of Health Sciences, Karnataka -1994
4. Maharashtra University of Health Sciences, Maharashtra-1998
5. Baba Farid University of Health Sciences, Punjab
Politicians handle Finance and Administration !
Mushrooming of Institutions
??? Standards
- 1998
End Result
•
Uncontrolled growth can not fulfill AIMS.
•
Socio-economics & Logistics needs ignored.
•
Cost-intensive western medicine preferred over promotive,
preventive aspects of health
“ Shield or Gun is the Choice ”
Doctors in the Five Blocks in Nashik District
100
87
87
90
80
83
77
71
Percentage
70
60
50
40
29
23
30
20
13
13
17
10
0
Surgana
Peth
Dindori
MBBS
Chandvad
Niphad
Non_MBBS
Source : Economic and Political Weekly Feb. 3-10, 2001 By Dr. Shyam Ashtekar
Urban Education and Rural Deprivation
Rich and Poor both live.
Why the living be cost dependent ?
Are we Unconcerned ?
Maharashtra : An Illustrative Example
Source : 2001 Census
India
- 1069.06 Million
Urban : Rural = 27.78 : 72.22
Maharashtra
- 96.75 Million
Urban : Rural = 42.40 : 57.60
Germany
- 81.84 Million
France
- 60.36 Million
United Kingdom
- 59.76 Million
Australia
- 19.64 Million
Health Care Personnel servicing Population
Allopathic, Ayurvedic, Homeopathic & Unani
Number of Medical Colleges in Maharashtra
50
38
40
30
20
10
0
4
Pre-independence
Today
“ More the Merrier ? ”
Number of Doctors Produced per Year from Maharashtra
5750
+ +
5000
4110
4000
3005
3000
2515
2336
1690
2000
1000
240
0
Medical
Dental
Ayurved
Unani
H’pathy
Allied
No. of Doctors in all faculties = 9860 / Yr
Pride without Prudence
•
After 1980 – Mushrooming of Medical Colleges
•
MBBS Graduates –
80% - P.G.
10% - Foreign
8% - Govt. Services
•
Rural Population Serviced by other pathies.
* Practice Modern Medicine without Training.
* Doctor Population Ratio–
WHO
- 1 : 3500
Medical
- 1 : 1161
All Pathies - 1 : 582
“ Primary Health Care in the hands of other Pathies ”
Privatisation of Higher Education in Maharashtra - 1984
DUC : Deemed University Colleges
Medical
Dental
Ayured
Unani
Homoeopathy
45
43
40
35
Govt / Semi-Govt : 27
32
Pvt / Aided : 134
30
25
20
18 18
16
15
15
10
5
3 4
4
0 0
0
Govt.
(3+1)
4
1
0 0 0
Corporation
1
0 0
0
Aided
0 0 0
DUC
2
Private
“Privatisation of Higher Education is a Policy !”
Suggestions
• Moratorium on New Colleges
• Strengthen the existing
• De-affiliate : less than 50% teachers
• Re-designate the teachers
• Use of Audio-visual aid
• Virtual Classroom
Economics of Medical Education
•
Economics of Medical Education shall play an important
role in providing Parameters A, B & C
•
Monitoring this shall yield better educational standards
•
Private Providers cut corners due to economic stringency
Economics of Medical Education
•
Medical Education differs from other higher education
•
Managing a Medical College is a viable proposition
•
Running a free Hospital is economically demanding
Medical Students learn on patients
Not only on
Books & Instruments
Reality or Fracas
•
Do we have a solution ?
•
Should we increase Medical Colleges & flood the market !
• Empowerment of knowledge to Non-medical practitioners ?
•
Aim is to provide proper Health Care in rural India
“ Modern medicine is Techno-intensive, costintensive with Urban / Semi-urban bias”
Clinical Medicine is Declining
Why Migrate ?
Desire to Migrate
1) For Academic Pursuit
2) To Acquire Advanced Knowledge
3) For Economic Prosperity
4) To Enhance Social Standing
Brain Drain or Economic Gain !
Desire to Migrate
5) For Easy Job Opportunity
6) Craze for Foreign Land
7) Due to Socio Political Reasons
8) Fellowships / Scholarships
Brain Drain or Economic Gain !
Migration for Advancement of Knowledge
• 1900-60 FRCS / MRCP
• 1910-1920 Faculty positions were
given to British Medical Services
• Indians Denied Positions
• Birth of Seth G.S. Medical College - 1925
• Medical Men Loved to come back home
British Degrees Enhanced Professional Standing
Brain Drain or Economic Gain
1960 - 1985
• Exodus to UK / US / CANADA
• Left for Higher Education
• Didn’t pursue the Goal
• Picked what was offered
• Changed the Speciality
• Settled abroad for Economic gain
Knowledge or Money !
Analyze 1960 - 1985 Era
• How many achieved academic excellence?
• Did they alter their basic post-graduate qualification and
took up other speciality like Radiotherapy, Pathology etc.
• They were Post Graduates in Medicine, Surgery , OB & GY,
Pediatrics and Orthopedics
• Waste of National Resources for Education and Training
* Strengthened the Health Care in Chosen Land
Economic Prosperity Blunts Academic Hunger
After 1985
• Flow Diminished
~ Demand Dwindling
• Reforms in UK / US resulted in declining migration
• FMGs from developing countries have to compete
with returning US/UK FMGs educated abroad
• Emigration of FMGs from developed countries
“The trend is to acquire advanced Technology”
Home bound to advanced Urban Centers
Need of Planned Migration
• Fellowships of shorter duration
• Bilateral short term training programme
• Induct fresh Medical Graduates from India to train
in recipient country
• Demand in various Medical Disciplines be assessed
• Supply to be monitored
Manpower Export be Rationalized
Manpower Export
Export potential in order of better opportunity
a) Nursing – Highest demand
b) OT/PT – Excellent opportunity
c) Physicians – depend on need of recipient country
Demand
& Supply Potential
Modern Medical Institutions are flourishing !
Registered Doctors from Maharashtra
Medical Council
As on 31/3/2004
Faculty
166228
10900
Medical / Ayurved / Homoeopathy / Unani
No of
Doctors
Medical
83315
Ayurved
42427
Homoeopathy
37100
Unani
3386
166228
Dental
Dental
10900
Doctor Population Ratio
WHO - 1: 3500
Medical - 1:1161
All Pathies - 1: 582
Medical Colleges
India
Total No = 229
South
Six States = 142
13
38
27
30
South = 62%
20
14
North = 38%
Students Intake Capacity
• All over India : 229 Colleges : 24589
• Colleges in Maharashtra, Andhra
Pradesh, Karnataka,Tamil Nadu,
Gujarat & Kerala : 142 Colleges : 16260
66.12 % intake for only 6 States
Concentration in South Promotes Migration
Consequences
• Surplus in host country
• Reverse flow from foreign countries
• Congestion in Urban and semi-urban areas
• Promotes unhealthy competition, solicitation and
malpractices
Market Philosophy is not applicable
to
Human Professional Product
Migration & Health Care in India
• 10% - Modern Medicine Graduates Migrate
• No impact on Rural Health Care System (RHCS)
• RHCS serviced by other pathies
• Primary Health Care System needs to be empowered
with essential knowledge of Modern Medicine
Health Care Scenario Unaltered
due to
Small Fraction Migrating
Global, Focal or Local
• “India is a global player” – Manmohan Singh (1991)
• 70% population in the rural area Martya
or
Amartya
(Death Prone) (Death do us no Part)
• Their economic subsistence is much below the
poverty line.
Modern Medicine is Techno-intensive, Cost Intensive
Can we serve “Martya” Population ?
The Perils of Globalization of Education
The Impact of Globalization
• Increasing interest of parents to get their children admitted
to foreign educational institution
• Creation of Three different classes of graduates
a) Those educated in foreign Universities
b) Those from costly private domestic institutions
c) Those from economically weaker sections studying
in Government funded institutions
• This will only lead to social tensions
Unkept Promises Lead to Perilous Situation
Question is service to Humanity
A Rural Scene from Ahmednagar District