Readers’ comments: Unfair to target doctors. Many immigrate due to poor pay, VIP culture

What about engineers, MBA graduates?

Why is the same not expected from engineering students from prestigious institutes like the Indian Institutes of Technology or the graduates of the Indian Institutes of Management (“Harsh Mander: Why India’s doctors leave for foreign shores while Cuba’s serve their poorest”)? Their success is measured in terms of the packages they get – crores per annum – and even appreciated.

Who pays the bills for doctors and their families? Who will fund the education of their education, pay their rent and loan installments? Are doctors supposed to work on meagre wages?

There is so much disparity in India with a government that does not provide any good facilities. Indians, including doctors, are left to fend for themselves. Everyone has the right to live a good, comfortable life and to provide the same for their family after years and years of hard work and struggle, especially when they come in the top 1% of the elite in India. – Shilpi Agarwal

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Why discriminate against the medical profession and not engineers, lawyers, chartered accountants and so many others? When a graduate from an Indian Institute of Technology bags a crore-plus package, it is news but when a doctor does the same, they are called greedy. These are just double standards. – Bhaskar Ghosh

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The same lens must be applied to Indian engineers, a vast majority of whom do not practice engineering, especially in rural areas. With proper housing, water and sanitation, the burden of diseases in the community will drop drastically. – Kushilab Bose

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When candidates from the so-called economically weaker section pay Rs 1 crore to Rs 5 crore as fees for a postgraduate medical education, the reason for the situation described in the article is evident. Moreover, what prevents the government from mandating 10 years of rural service, without any loopholes, from all postgraduate and undergraduate doctors? I served in rural areas and made a difference – I have no regrets. Finally, Cuba is an open air prison and this is not a fair comparison. – Dr DK Samuel

Corruption, business model

A few hard facts before generalising about Indian doctors:

1. Tens of thousands of Indian students go abroad for medical education every year – the total number of Indians studying overseas is in the hundreds of thousands (over a million by counts of the Ministry of External Affairs), and MBBS is a major reason many leave. These are often young people seeking seats, lower fees or quicker paths to practice, and have not “abandoned” India.

2. At the same time, a lot of India-trained doctors actually end up working in richer countries like the UK, US, Canada and Australia, which rely heavily on doctors trained in India. That is partly a policy/market problem, of visa rules, pay, working conditions, and not merely an individual lack of “vocation.” The OECD and national registers show India as a top source of migrant doctors.

3. If you want doctors to stay and serve the poor, you must address the real, structural reasons they leave: toxic workplace cultures, bullying and exploitation of juniors in medical training, and political/VIP interference in hospitals that drains morale. These problems drive people away from public service far more than an abstract “lack of sacrifice”.

4. The private hospital sector in India is increasingly corporatised and run along commercial lines. Many big hospitals are corporate entities where managerial/financial priorities often outweigh professional autonomy. The result is pressure on doctors to meet revenue targets, unequal access for poor patients, and governance that is not physician-led. If we want equitable care we must reckon with corporatisation, not just moral lectures to individuals.

If your argument is that more doctors should serve poorer communities, say that. But don’t ignore why many choose private practice or foreign posts: inadequate public pay and infrastructure, bullying and hierarchical toxicity in training, political interference and a corporatised hospital industry that values profit and VIP access. – Dr Sudha Kumari, serving India and will serve till my last breath

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It was wonderful to read this article but this assessment of the Indian healthcare system is highly flawed. While the author is absolutely right about Indian medical professionals leaving the country for greener pastures, this is just one of the reasons for the plight of Indian doctors.

The Indian healthcare system is notorious for departmental corruption, high burnout rates and more recently the spike of violence and assault on medical professionals. Coupled by the fact that Indian medical professionals earn meagre salaries even after completing their post-graduation,which takes about eight to nine years, one cannot blame them for migrating out to make a better career and future for themselves.

I also absolutely agree that increasing medical seats through privatisation is not the solution for this issue. Better pay, better working conditions and better safety norms should be implemented to address this situation. – Anand Thorat

High cost of education

When candidates from the so-called economically weaker section pay Rs 1 to Rs 5 crore as fees for a postgraduate medical education, the reason for the situation described in the article is evident. Moreover, what prevents the government from mandating 10 years of rural service, without any loopholes, from all postgraduate and undergraduate doctors. I served in rural areas and made a difference – I have no regrets. Finally, Cuba is an open air prison and this is not a fair comparison. – Dr DK Samuel

CMC Vellore an example to learn from

Harsh Mander’s important reflection on the ethical crisis in Indian medical education rightly contrasts India’s profit-driven model with Cuba’s public-spirited approach. Yet I was struck by two notable omissions that would have strengthened his argument and greatly enlightened his readers.

First, in discussing Cuban medical education, he omits Ernesto “Che” Guevara, the doctor-revolutionary whose philosophy of “revolutionary medicine” helped shape Cuba’s ethos of service and solidarity. This moral foundation is inseparable from Cuba’s socialist political economy, which nurtures a distinctive orientation toward preventive medicine and public health.

Second, while analysing India, Mander makes no reference to Ida Scudder and the Christian Medical College, Vellore, one of the few Indian institutions that has consistently formed doctors with a commitment to ethics, preventive care, and service in underserved rural areas. The Christian Medical College has achieved this within a capitalist political economy, demonstrating that mission-driven education can cultivate motivations similar to those found in Cuba.

Given that Mander’s central concern is the contrasting moral orientation of doctors in India and Cuba, these twin silences (or omissions) feel like significant gaps. – John Kurien

‘Mafias’ to blame

The hospital mafia is to blame and pharma mafia. Both are hand in glove. Even the Bharatiya Janata Party government is afraid to tackle both mafias. If the Indian government can bring a strict law, curtail hospital owners and management, and cap hospital charges, things may change. Otherwise nationalise all private hospitals with more than 100 beds for the benefit of the poor and the middle class. There are many things I cannot say. – Jayashankar

Expressed reality

You have expressed the reality of today’s health adversity in our country. I would like to appreciate your article and also your contribution to society. – Jivtesh Bishnoi

Difficult to work in government institutions

Cuba is a wrong country to compare our medical education system with. The country is run entirely on communist principles and healthcare is an important pillar for communist regime policies. It is not easy maintaining a healthcare policy wherein the caregiver and the patient are both taken care of. Imagine where a neurosurgeon gets paid the same as a bell boy or a taxi driver as per an equal wage policy.

I have done my MBBS and MD from top government institutes in India and I do want to be a part of upskilling future medical graduates. But given the how the government runs public health institutions, it discourages doctors, be it the lack of funding and medicines to shortage of ancillary staff like nurses and ward boys, dealing with goons and political “bahubalis” to even facing physical assault and sexual harassment.

1. The government is focused on pumping more doctors into the system without essential staff like nurses, paramedical personnel, lab technicians and wardboys. I had to do a lot of tasks, which wardboys and nurses are supposed to do, instead of patient treatment and medical research. Resident doctors in government hospitals are “white collar slaves”.

2. The government doesn’t finance public health institutions, especially in states as health is a “state subject”. The World Health Organization recommends 6% of gross domestic product spending on healthcare but in India it averages to approximately 2%.

3. There is a pay disparity for doctors in private and public health care institutions, especially in tier 1 and tier 2 cities. Doctors in government institutions are not even paid salary on time.

4. The lack of basic amenities, like hostels and on-call rooms, especially for women doctors, is a serious problem. Having full time security in emergency departments and ICU to protect doctors from violent attacks is a luxury. At least big, private hospitals tend to to provide these facilities. Laws to protect doctors are poorly implemented. Even the nationwide outrage against the RG Kar medical college rape case could not reform laws to protect against doctors.

5. Politicians and the public take the medical profession for granted and doctors are often exploited for political brownie points. Doctors are expected to treat for free, not charge for tests and provide inexpensive medications. There are bad apples everywhere but most doctors have good intentions and even if the cost becomes a hurdle, they try their best to treat patients.

Imagine studying and training in a stressful course for eight to 13 years, compromising health and personal and family life. The least doctors expect is fair monetary compensation. If professionals like lawyers, financial advisers, accountants can charge astronomical rates, why should a doctor earning money from his rightful knowledge and skill be criticised?

It is no surprise that doctors often consider migrating to western countries in view of better labour laws, better rules and regulations, security, better work life balance and fair monetary compensation.

I urge you to review this article and make appropriate changes as it sends a wrong message against Indian doctors. – Dr Ashwin Unni