Thursday, November 08, 2007

Emigration of doctors trained at AIIMS

Here's an interesting study (pdf) by Manas Kaushik, Abhishek Jaiswal, Naseem Shah and Ajay Mahal, on emigration of AIIMS-trained physicians over the period 1989-2000:

Findings: Nearly 54% of AIIMS graduates during 1989–2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53–2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04–1.76). Multivariate analyses do not change these basic conclusions.

Conclusion: Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.

Among the authors, Jaiswal and Shaw are at AIIMS, while the other two are at Harvard.

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Thanks to Dr. Bruno Mascarenhas for the e-mail pointer.


  1. pradeepkumar pi said...

    Devi Shetty said yesterday ( CNN-IBN) that one of the reasons behind doctors emigration is the lack of post graduate seats in India. Apparently every year 33,000 doctors pass out, however, there is only less than 10,000 PG seats all over India. After
    giving couple of try in the PG entrance, the rest give up and look for opportunities abroad. But I think its not completely true. There are options like DipNB etc are open for Doctors. But I dont know how many DipNB seats are available across country. But more studies like the current one are always welcome.

  2. Anonymous said...

    The study is focused on doctors from premier institutes who migrate due to - limited PG seats, higher aspitations, poor quality of PG education etc. Of late, the trend is seen in other colleges at lower level too. Scores of final year MBBS students are preparing for all kinds of foreign exams, PLAB, USMLE, MCC etc. Not just recent pass outs but doctors with experience are too moving out. This has become a big issue recently in kerala - being hotly debated - that doctors are scouting around for jobs outside india. Earlier the choice was the west and the Gulf countries, now even places like Malaysia, Indonesia, brunei etc. The once famed public health service in kerala is awaiting a near-total collapse. I can think of at least two major reasons:

    (1) primarily lack of PG seats. I doubt that there are even 10000 seats on all-india level. Even if there are, a good no: of them will be non-clinical (anatomy, phys, pharmacol. micro, radiation etc.) the coveted surgical and medicine are really in short supply.

    (2) Most doctors think that the monetary returns are simply not commensurate with the years of effort that goes in. And the gulf is ever widening. 5 1/2 years of MBBS + 2-3 years of PG exam preparation (this again, relates to the seat shortage issue) + 3 years of actual PG = Rs. 12000 p.m at entry level in any major city in India. These days even additional training(called fellowships) for abt 1-2 years over and above PG is a must in big cities. And most govt. hospitals start with the basic salary of Rs. 8000/- pm.

    In spite of this, the fact remains that we have some good candidates willing to be in India - just due to the sheer numbers India procudes. The law of large numbers comes to our rescue!

  3. Anonymous said...

    Isn't the emigration problem applicable in all fields (other than politics)?

  4. Anonymous said...

    Why is it even a problem?

    It's only a problem for the governments point of view, because they think that they're not getting the benefits of offering a subsidized education.

    However, from the point of view of the doctors, it's not a problem at all.

  5. Anonymous said...

    Welfare state(higher ed subsidies) and open borders(immigration and emigration) can't exist together.

    Higher ed fees in India are bound to go up sharply over the coming decades.

  6. Anonymous said...

    //Devi Shetty said yesterday ( CNN-IBN) that one of the reasons behind doctors emigration is the lack of post graduate seats in India.//

    This may be true in some context, but NOT in the case of AIIMS

    Number of UG Seats in AIIMS - 40
    Number of PG Seats in AIIMS - 120

    And there is a bigger comedy (?? tragedy) is that there is something called institute quota in AIIMS and that is 33 %.... This means that EVERY UNDERGRADUATE in AIIMS is assured of a PG Seat in AIIMS itself (Why Youth for equality did not protest against is 33% (33 is more than 27 ) reservation has to be asked to them :) :) :)

    All these doctors from Elite Institution did not migrate "FOR" PG...

    They have migrated "AFTER" PG.

    The HC had found that "AIIMS students, who had secured as low as 14% or 19% or 22% in the (all-India) entrance examination got admission to PG courses while SC or ST candidates could not secure admission in their 15% or 7% quota in PG courses, in spite of having obtained marks far higher than the in-house candidates of the institute." HC had analysed admission data over five years.

    The apex court also agreed with the HC that the "figure of 33% reservation for in-house candidates was statistically so arrived at as to secure 100% reservation for AIIMS students. There were about 40 AIIMS candidates. The PG seats being 120, 33% thereof worked out to be 40." That meant all 40 AIIMS graduates were assured of PG seats.

    Merit here was clearly being sacrificed, the study showed. For instance, in the January 1996 session, an AIIMS student with 46.167% marks - lowest for an AIIMS student that year - got PG admission.

    However, an SC student with the same grades was admitted but denied coveted course such as obstetrics and gynaecology. The SC student got shunted to community while AIIMS students easily won berths in prestigious disciplines.

    Twelve AIIMS candidates were selected even though they got less marks than the SC candidate who secured 60.33% marks. Similarly, 16 AIIMS students got admission to PG courses even though they got less marks than another ST student who got 62.16%.

    AIIMS graduates migrate - There is no doubt regarding that - They have full right to do so - There is no doubt regarding that also - But they should say that they are migrating for the sake of Money - and not for PG Seat - because they have emigrated After finishing their PGs...
    The Emgiration of a AIIMS graduate is vastly different from a guy from a state engineering college who goes and toils in UK for getting his PG. Both are not the same

  7. Anonymous said...

    //The Emgiration of a AIIMS graduate is vastly different from a guy from a state engineering college who goes and toils in UK for getting his PG. Both are not the same//

    The Emgiration of a AIIMS graduate is vastly different from a guy from a state medical college who goes and toils in UK for getting his PG. Both are not the same...

    In many cases, the doctors who are going abroad for PG, do come back after their PG. They are not the cause of concern

  8. anishmohammed said...

    Hi guys,
    I can understand, what this means. I did go a medical school,I left it to do other things. As a matter of fact had to leave the country. I come across quite a few of my classmates, medical education is a long one. Super speciality takes 12 years of your life ( most likely more). The situation in kerala is more aggrevated by families willing to pay hefty sums to send children to med school. So this woudl be case of "return on investment".

  9. Anonymous said...

    Till the quality of training, quality of trainers and work atmosphere is not improved egress of brilliant minds can not be halted. Meager pay scales and caste based reservation have just added to the problem. It is better to live in another country which values your talent than being a second grade citizen in your own country. It is a truth whether you concur with it or not...period.

  10. buddy said...

    yah i completely agree with this after pg migration of aiims pass out.
    and if somebody wud want me to prove it i wud say that make a compulsory criteria for these aiims pass out ,has to be done by govt,
    internal quota student to reside in india only after pg completion thru aiims under internal quota and see the response.
    obviously they wud be agitated and those interna; quota candidates who have plans of going and settling abroad wud think twice to join aiims as they wud be compelled to practise only in india once they have qualified under the internal quota.
    and that wud hence make it obvious and if not so then atleast increase the availability of these highly rated docs in india to serve it.
    gud for govt too!