The disastrous effect of privatisation of medical education on healthcare

By Dr. Sanjeewani Jain, Vice President, Lok Raj Sangathan

The COVID-19 pandemic has brought into sharp focus the need for a strong publicly funded healthcare system. The pandemic has also highlighted the acute shortage of doctors and nurses in the country.  The time has come to demand the reversal of the policy of promotion of private healthcare and private medical education as well. That alone will allow us to successfully face the current and any future similar pandemic and ensure affordable healthcare to all.


The Covid-19 pandemic revealed very starkly the havoc that privatised healthcare has wreaked on the India people. Innumerable people died because they could not afford the treatment while others saw their lives’ savings wiped out due to the greed of profit hungry private hospitals and pharmaceutical companies.

India is among the countries with the lowest per capita government spending on health care, and its public healthcare is among the worst in the world, even taking poorer countries into account. Number of doctors in the country is much less than the norm prescribed by WHO even though a large number of youth are looking for good sources of livelihood. The problem starts at a very basic level, because along with large-scale privatisation healthcare, medical education has also been largely privatised.


Due to privatisation of medical education, students in private medical colleges and their parents have to pay through the nose to meet the costs. It is also true that as in the case of other essential services like transport, electricity, etc. a heavy price is extracted by privatisation from the rest of the society as well.

The shortage of doctors was acutely felt during the Covid pandemic but even in normal times it is getting worse every year and one of the reasons is the way medical education is organised in our country. The government needs to build many more medical colleges to train the requisite number of doctors. However instead of doing that, instead of fulfilling its essential duty of providing medical education in accordance with the needs of the people, it has privatised it to an increasing extent. In other words, medical education has been turned from an essential service into an industry, where profit is all-important. The input costs are cut down to the bare minimum, as low as the promoter can get away with. So we have the horrifying spectacle of medical colleges without the bare infrastructure and equipment necessary, including even attached hospitals! The loop holes in the MCI (Medical Council of India) regulations have made it possible for colleges without proper infrastructure or adequate number of patients to get accreditation. Like any businessman would do, the price of the commodity (medical education in this case) is kept as high as the owner can possibly extract from the buyer, i.e. the doctor-in-making.

But we have gone too far ahead in our story! The travails of a would-be doctor start from a tender age. Those who want to study MBBS have to get a very high rank in the national qualifying exam, NEET. (Those who want to qualify as doctors in Ayurveda, Homeopathy, Siddha or Dentistry also have to qualify through this exam). In 2019, there were 70,978 MBBS seats in 529 colleges in India. Of this, 269 colleges accounting for 35,688 seats are government-run, while the remaining 260 colleges accounting for 35,290 seats are in the private sector. Over 14 lakh students appeared for the NEET exam, which means that only 1 student for every 200 got a seat for MBBS!

Most of these fortunate ones had already spent a lakh of rupees or even as much as five lakhs to get coached for the exams. A very large price had also been extracted at this stage from even the candidates who were not successful, because most of them had also paid for coaching. The competition is so fierce that admission in a government college is well-nigh impossible without the coaching booster dose! So actually, the privatisation of education starts from the pre-medical stage itself. This was true even before NEET was introduced. A difference of 1 mark in the 12th Board exam could mean the difference between jubilation and dejection. So private coaching, either through classes or individually (which is more expensive) had already become almost mandatory for serious aspirants.

It is obvious that ability to pay has become a serious determinant in deciding who can get medical education. Those living in rural areas have a further disadvantage. Grinding poverty for the overwhelming majority, bad schools, frequent power disruption, absence of coaching classes even for those who are relatively better off, all conspire to make the playing field totally uneven. Is it surprising that the lack of doctors in rural areas is even worse?

Once a student gets admission in a government college, her troubles do not end, because government college education everywhere is also not cheap! The annual fees of medical education in India range from Rs. 15,000-80,000 in government colleges and can go up to Rs. 10,00,000 in private medical colleges! Thus at this stage itself, some students end up paying up to 6-7 times more than those who are in government colleges!

India is the only country which authorises the sale of medical seats. Donation based admissions are allowed in private colleges. Many colleges take illegal capitation fees which range anywhere between twenty five lakhs and one crore rupees. How many people in India can afford that? And we haven’t even yet talked about the additional expenses -– books, other equipment, hostel or lodging fees for outstation students, transport costs, and so on.

An MBBS degree takes five years, including study and internship. After that if a doctor wants to do post-graduation and specialise, he or she has to qualify for NEET PG. This exam is also not easy. For NEET PG 2019, a total of 1,43,148 candidates had registered out of which 79,633 candidates qualified. But that does not mean that they got admission! In 2019 there were 10,821 Master of Surgery (MS) seats, 19,953 Doctor of Medicine (MD) seats and 1,979 PG Diploma seats offered by 6,102 government, private, Deemed and Central Universities. These figures add up to 32,753 seats. This works out to less than 25% of those who appeared and only abut half of those who qualified! That is why some doctors take time off just to study. And there are coaching classes for this level as well!

Some doctors who get admission choose not to take it because the difference in fees between government seats and those in the private sector are mind-boggling. They prefer to try again. In government colleges scholarships or stipends are given, whereas in private colleges, as they say, the sky is the limit for extortion!

Believe it or not, in India, in broad daylight, post graduate seats are even auctioned off to the highest bidder! In September 2013, there was a report about such an auction. An MD (Radiology) seat touched Rs. 4 crore in a prominent Chennai college and hovered between Rs. 3 crore and Rs. 3.5 crore in Bangalore colleges. Successful bids for orthopaedics and dermatology varied between one and one and a half crore, while a seat for paediatrics cost Rs. 1.6 crore.

Post graduate (PG) medical students are qualified doctors. They function as “resident doctors” in various hospitals while pursuing their further education. In the recent past their plight became worse.

Resident doctors, in the best of times are grossly overworked and underpaid. They are responsible for tirelessly looking after patients, often forgoing food and sleep. Particularly during the two years of the pandemic, they, along with other medical workers, suffered a lot, having to work continuously without break for as long as 18 hours, and with no proper arrangements for food and drink. During the pandemic many of them received delayed or even reduced salaries! We know that this was despite the fact that the pandemic extracted a huge toll on the entire medical workforce.

To add to their misery, the government entirely botched up the process of admitting first year PG students and more than 50,000 vacancies across the country were not filled for months. Since the first year PG students constitute about a third of the medical workforce, this led to an unbearable increase of the burden on the others.

Several times medical workers across the country including resident doctors had no alternative but to strike work. In fact, resident doctors across India – in Delhi, Rajasthan, UP, Tamil Nadu, Kerala, Karnataka, Andhra Pradesh and Telangana went on a major strike towards the end of last year.


This shows the utter unconcern that the government has towards the medical workforce, including medical students.

Once a person acquires a PG qualification and becomes a specialist, other expenses of setting up his establishments crop up. Since government jobs are not enough, the private healthcare “industry” with its all-important bottom lines becomes an option.

So is it any wonder that medical treatment in India is so outrageously expensive and out of reach of most people? One can only imagine the compulsions on doctors who have acquired their degrees at such costs! Will patients matter to them or money?

Privatisation of medical education in India is not a new phenomenon and has been going on merrily with the blessings of various parties that have come to power at the central and state levels. The first private college was set up in 1953 and the process really speeded up in the nineties with the adoption of the policy of globalisation through liberalisation and privatisation. In the case of education, many bigwigs of big political parties have themselves become “shiksha samrats” or education barons.

When medical education is so expensive in India, is it any surprise that so many would be doctors pursue their education abroad? If they have to anyway take loans in India, they prefer to take loans and go to study abroad where the education and conditions in general may be more conducive. By the year 2014-15, the number of students seeking medical education in US, Canada, UK, Australia, China, New Zealand and Germany had crossed 2.5 lakh! And as is well known, many such doctors are lost to our country and its people! The National Health Service of UK depends heavily on doctors as well as nurses from India and other countries in the subcontinent.

Indian students also go abroad to pursue medical education in Russia, Kyrgyzstan, and Ukraine because it is cheaper there than in India. For the same reason they even go to countries like the Philippines, the Caribbean, Nepal, Bangladesh and Poland.

There are a number of countries in the world where education is free.  The Government of India owes it to our people to provide free education.

The COVID-19 pandemic has brought into sharp focus the need for a strong publicly funded healthcare system. The pandemic has also highlighted the acute shortage of doctors and nurses in the country.  The time has come to demand the reversal of the policy of promotion of private healthcare and medical education. That alone will allow us to successfully face the current and any future similar pandemic and ensure affordable healthcare to all.

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