Medical Education crisis in India

Dr Sanjay K Bhasin

sanjaybhasin6009@gmail.com

India has crossed a historic milestone in 2026 when across 823 medical colleges when MBBS intake capacity was increased to 1,36,939 per year as per NMC data. At first glance, this looks heartening, hope that more seats, more doctors and best healthcare for 1.4 billion people of this great nation and the ultimate victory. But a closer look at the data tells a different story. The expansion of medical education in India is no longer being driven by public policy or social need. It is being driven by the private sector. And the repercussions of this shift will shape Indian healthcare for the next two decades. Mere increase in number of seats shall not make the dream come true of best healthcare and medical education for socioeconomically disadvantaged lot whose figure after more than seven decades of independence is still whooping high. The following narrative shall tell the real story.

Where the New Seats Are Going

In 2026, NMC added 9,911 new MBBS seats with 7,800 seats (79%) going to private medical colleges. Only 2,111 seats were added in government institutions. Practically it means that 54% of all MBBS seats in India stands earmarked for private colleges and the Government colleges share, once the backbone of affordable medical training, now hold just 46%. It means in clear terms that the majority of India's future doctors will now train in institutions run for profit, not in institutions run for public service.

Expenditure to Become an MBBS Doctor

In order to get an MBBS degree from private vs Government College, the cost difference is staggering. In government medical colleges, tuition remains between 10,000 to 1 lakh per year. A full MBBS degree can be completed for touching 5 lakh, including hostel and other expenses. In private colleges, the picture splits in two. Now only 46% seats are under the "government quota" and cost 6-15 lakh rupees for the entire course. That is still expensive, but manageable with loans and scholarships to a selected lot. The remaining 54% are management and NRI quota seats in private institutions takes from 90 lakh to 1.5 crore rupees for completing MBBS. In some of the top private colleges in south India, the total cost with donations can cross 2 crore. For a middle-class family in Jammu, and other such cities, this is not a fee but generational debt after doing MBBS. The message is brutal but clear: if you miss a government seat, your dream of becoming a doctor now depends on your family's bank balance.

The PG Bottleneck: Trained, But Stuck

India's 1.3 lakh annual MBBS graduates face a grim reality: with only 75,000 to 80,000 post-graduate seats available, over 40% cannot immediately specialise. These graduates must choose between years of NEET-PG preparation, low-paying ad-hoc rural bond service, or corporate hospital jobs offering just ?40,000-?60,000 per month. This creates a severe crisis for middle-class families who take out ?1 crore loans for private medical education. Faced with immense financial pressure and years of uncertainty, graduates are forced to treat medicine purely as a business. Many buy expensive seats in lucrative specialities like radiology, dermatology, or orthopaedics, aiming solely for high-income corporate or private practice to recover their investment. Consequently, vital but lower-paying fields like family medicine and public district hospital service are completely abandoned. Policymakers must urgently re-look at this unsustainable system.

The Big Repercussions

i. Access vs Merit: India's best medical minds are losing out. Wealthier students buy seats with lower ranks, while talented, rural students are outpriced. Affordability is replacing meritocracy.

ii. Urban Bias, Rural Neglect: Debt-burdened doctors cannot afford low-paying rural postings, which often pay less than their loan EMIs. They flock to metros and corporate hospitals. Consequently, rural India-where 30% of doctor vacancies persist-remains critically underserved.

iii. Quality Concerns: The NMC has flagged severe issues in new private colleges, including fake faculty, low patient footfall, and poor clinical exposure. Expanding seats on paper without adequate on-ground training creates under-skilled doctors, directly compromising patient safety.

iv. Commercialisation of Healthcare: When education becomes a business, healthcare follows. Doctors graduating with ?1 crore debts must focus on profit recovery. This shifts medical practice from need-based care to profit-driven diagnostics and expensive procedures, leaving poor patients to suffer the consequences.

The Bigger Question

My argument is not against increasing the number of doctors as India's doctor-patient ratio is still below WHO recommendations. But the question is by increasing the MBBS seats to present level and that to with bigger share to private institutions with space for lucrative capitation fee/annual fee structure, are we:

Are we producing 'competent' doctors with proper clinical training?

Are we producing 'accessible' doctors who will serve where they are needed most?

Are we producing 'ethically trained' doctors who see medicine as a service, not just a business?

As off now and in view of my touching four decades in the profession, my answer to the above question on any forum shall be not in affirmative. Further, I think, whether we are quietly converting medical education into a luxury good available only to the rich?

The Way Forward

Medical bodies and parliamentary committees have flagged these issues for years. Four urgent steps are required:

i. Private College Fee Regulation: Existing state fee committees face political and bureaucratic interference. A transparent, national cap on management quota fees is essential; medical education cannot be left entirely to market forces.

ii. Expand Government PG Seats: The massive MBBS-to-PG gap is the ultimate bottleneck. While DNB programs at district hospitals and rural colleges are expanding, the government must aggressively fill and expand faculty positions. Because MBBS is now just a basic degree, a lack of specialization leaves doctors half-trained.

iii. Stricter Quality Audits: The NMC must look beyond buildings and equipment. True audits of faculty retention, actual patient load, surgery numbers, and graduate outcomes must dictate seat approvals. Quantity without quality remains dangerous in medicine.

iv. Incentives for Rural Service: To counter the severe urban bias driven by education debt, the government should offer robust incentives. Loan waivers, higher stipends, and assured PG seats for doctors serving 3-5 years in rural areas will effectively balance the system.

Conclusion

Unfortunately, the focus today appears to be on quantity rather than quality of medical education. Increasing the number of seats is welcome, but without ensuring affordability, adequate faculty, infrastructure, clinical exposure, and sufficient postgraduate opportunities, we risk compromising the future quality of healthcare.

India's health system cannot be sustained by debt-ridden doctors and unaffordable education. A nation that wants "Healthcare for All" must ensure that "Medical Education for All" comes first. If we continue on the current path, we will have more doctors on paper, but fewer doctors in villages. We will have more graduates, but less trust in the system. The day medical education becomes a privilege, healthcare becomes a privilege too. And in a country like India, that is a price we cannot afford to pay.

(The author is Senior Professor of Surgery National Governing Council Member, ASI)