Doctors For The World: Indian Physician Emigration

Fitzhugh Mullan

Health Affairs. 2006;25(2):380-393. 

In This Article

Emigration: Pro and Con

Acceptance

The emigration of large numbers of Indian physicians to the West has been taking place for more than a half-century, and acceptance of it (sometimes enthusiastic, often grudging) is the norm. "Building for export" has its proponents, who argue for the brilliance of this strategy, pointing out that India has vast human resources, ambitious people, and excellent professional training capabilities. The export of physicians provides opportunities to the individuals, financial remittances to the country, and the augmentation of NRI communities abroad. The public's acceptance of doctors going abroad is bolstered by a perception in some quarters that "India has enough doctors," or, occasionally, "India has too many doctors."

Concerns

Concerns about health equity, poverty reduction, and the wise use of public resources have led many to skepticism about migration. The use of medical education to leave India and, particularly, the training of health personnel for export at the public expense has evoked consternation in many. A second concern expressed was that the growth of tuition-based private education linked to practice abroad was further skewing the economic profile of physicians toward the wealthy. A third objection to building for export is that it attracts motivated young people who seek careers as health professionals and effectively provides them an immediate passport out of India. This means that their clinical and political energies will never address the improvement of health care in India. In this view, the brain drain serves as a pressure release valve that permits both skills and political energy to escape the task of reform of Indian health care. Moreover, any pronouncements about the "sufficiency" of the Indian health workforce speak to the private sector, which caters primarily to wealthier and urban populations and not the poorly funded, understaffed public sector—or the poor themselves.

What if?

I repeatedly sought opinions on what the several thousand Indian graduates who emigrate every year would do if opportunities abroad diminished and they had to remain in India. Would this create a diffusion of physicians into areas that because of geography or economy had been previously unattended by allopathic physicians, or would this create a competitive glut of physicians in the cities?

Respondents were divided on the question. All agreed that urban-trained, specialty-oriented physicians would not fare well in the poor and rural areas in which physicians are in shortest supply. Nonetheless, many felt that the pressure of competition combined with an improving Indian economy and rural development would make diffusion an important element of future health improvement. Those who felt more strongly about this potentiality agreed that the diminution of emigration and the greater availability of physicians in India would move this process along more quickly.

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