Doctors For The World: Indian Physician Emigration

Fitzhugh Mullan

Health Affairs. 2006;25(2):380-393. 

In This Article

Abstract and Introduction

Abstract

Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia—a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.

Introduction

It is an understatement to say that India is a country of contrasts and complexities. Occupying 2.4 percent of the world's land mass, it is home to one billion people—more than 15 percent of the world's population. Twenty-two languages (not including English) are recognized in the Indian Constitution. Although 80 percent of the people are Hindu, India is the home of more than 120 million Muslims (making it the third-largest Muslim nation in the world) and 100 million Christians, Sikhs, Jains, Buddhists, and Parsis. Bombay has been long known for its urbanity, Bangalore for high-tech prowess, and Calcutta for sheer population density, yet three-quarters of India's people live in rural areas, where conditions resemble the nineteenth century more than the twenty-first. Information technology (IT), business outsourcing, and "medical tourism" are hallmarks of a country with a 6.2 percent gross domestic product (GDP) growth rate (compared with 4.4 percent for the United States and 2.4 percent for the European Union) and a burgeoning middle class. At the same time, India's life expectancy of sixty-two years and its infant mortality rate of sixty per 1,000 births place the country well down the list of developing countries, and its annual per capita income of $470 is 161st in the world. There are many Indias within India.

Medicine and the "Brain Drain"

The British brought European medicine to India in the nineteenth century; today allopathic medicine is a popular and revered profession. During the latter half of the twentieth century, large numbers of Indian physicians traveled to the United States, the United Kingdom, Canada, and Australia in pursuit of residency training and practice positions. The total number of graduates of Indian medical colleges now practicing in these four countries is 59,095—a workforce equivalent to 10.1 percent of the 592,215 physicians registered by the Medical Council of India.[1] From the perspective of the recipient countries, Indian medical immigration has brought enormous talent to the medical workplace and helped buffer physician shortages in these countries. From the Indian perspective, the benefit/loss analysis is more complicated. The expatriation of so many Indian physicians is a straightforward loss and a preeminent example of "brain drain."

Mitigating Factors

However, some elements of emigration mitigate this loss. The most frequently cited is the hard currency returned as remittances to family members by Indian physicians working in the United States and elsewhere. Also cited are the benefits of the technology transfer provided by Indian physicians returning home and the professional opportunities afforded physicians who feel that their financial or technological expectations would not be met in India.[2]

Outlook for the Near Future

Although Indian physicians are the world's most frequent medical expatriates, the emigration of physicians from developing countries to the West is a global phenomenon, and emerging shortages in many developed countries promise to increase the lure of emigration in the immediate future.[3] At the same time, growing global concern with the adequacy of national physician workforces to combat HIV/AIDS and assist in meeting development goals has raised questions that give new importance to understanding emigration.[4] To gain a better understanding of physician emigration, I spent July 2004 in India exploring Indian perspectives on these questions. I visited four major cities noted for medical innovation and medical education (Bangalore, Chennai [Madras], Delhi, and Mumbai [Bombay], and I interviewed more than forty practitioners, medical educators, economists, and public officials about the health care sector and medical migration.

Despite its well-established history and certain obvious motivators, physician emigration is a complicated event influenced by educational experiences and practice prospects. To assess the impact of emigration on India, one must understand the medical culture in which the émigré trains and from which he or she departs. In this essay I describe current medical practice and education in India before discussing my observations on emigration. I conclude with a set of policy recommendations based on those observations.

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