Decline of medicine as a career prospect

Medical and Paramedical career options.

For long it has been said about the nobility of medical profession. No other career offers its aspirants a chance to do an as noble deed as a medical career. Truly it is a noble profession.

Not too long ago, it dominated the priority lists of the undergraduates. The profession did not just offer a secure income to its aspirants, but a respected position in society as well. Getting their kids an admission secured in a medical field was a dream cherished by most of the parents, not too long ago.

However the scene is undergoing a rapid and drastic change. The sheen and the glitter which has long been associated with the medical profession is fading away fast. There are numerous questions one has to answer before trying to be rational.
Now does the noble intentions can be kept away from the professional aspirations of a medic?
Does the professions commands same respect in the present era?
Is there the same undying enthusiasm still alive in the hearts of the aspirants?
Are there the same number of takers ready to take it up as their profession?

With the IT boom sweeping across the country, With more and more liberalization being introduced in the market, with increased role of private sector in the scheme of things; other career options in IT and BPO sectors are becoming more lucrative.

Whats is the reason behind this change in attitude?
There has been a tremendous increase in the number of medical aspirants in the last few decades.

Drastic rise in registered medical practitioners from 59338 in 1950 to 410875 in 1992 and around 6,40,000 registered doctors today, comparable to the best in the world.
The number of medical colleges in India has grown from 25 in 1947 to 229 in 2005.
The national doctor/population ratio is 1:1916 (1992)
The rural doctor-population ratio happens to be a pathetic 1:25829.
Population with access to improved sanitation (%), 2000 is 28.
According to the most recent government data only 41,191 doctors were employed by all the different government agencies in the country and only 31,480 were in position in rural primary and community health centres. Hardly a drop in the ocean for India’s 72 per cent rural population!
All over rural areas in the country, there is an acute shortage of essential specialists — gynaecologists, paediatricians and surgeons. Around 40 per cent positions of specialists are vacant in public rural health centres.

So where do rural India seek health care from?
Private practitioners who do not possess a formal medical qualification or training — the ones whom the medical community calls `quacks’. However they are the ones who are accessible and available when needed, and provide to their patients a sense of dignity, continuity and community kinships.

This essentially implies that even though the number of medical practitioners in India has drastically increased, they are concentrated in the urbanized india, whereas the rual India is still neglected, depriving it of its basic health care.
This clearly underlines the fact that its not the nobility of the profession but the monetary gains the profession has to offer.
Why do rural and underprivileged urban areas have so few formally qualified providers?
Understandably, questions of livelihood are critical for all graduates, especially after struggling through five and a half years of an expensive medical education. The opportunity costs and social costs of working in rural areas are too high. For those who set up private practice, better off urban areas offer far better markets and facilities. The public sector is equipped to reach skilled and well-trained medical professionals in rural areas, but the hefty wage differential between the public and private sectors does little to attract the best professionals to the public sector.
Socially, a rural posting can be excruciatingly isolating and working conditions quite challenging for someone who has spent long years acquiring knowledge and skills in an urban medical institution. Doctors are extremely reluctant to be posted at PHCs for it is literally a professional dead end. There is a fear of sophisticated skills becoming rusty. Also a fear of an academic fade-out due to absence of the stimulating atmosphere that one finds in city hospitals and urban practice.
Other sore points are the unsatisfactory working conditions, lack of adequate staff and equipment and primitive living quarters.

Now, in the present scenario, even the urban density of the medical practitioners have increaded beyond leaps and bounds.
There is a stiff competition among the fellow medics. After all the Darwin’s theory of Survival of the fittest holds true and is evident on the neckbreak competition the medics have immersed themselves into.

With more and more IT industries taking over the market and BPO dominating the employment columns, students are naturally inclined towards it. Also the amount of inputs in terms of finance and time is lesser as compared to a medical career.
The fee structure and a four year IT course is more lucrative than a five and half year (including internship) MBBS at a steep fee structure. Above all considerations, the salaries now the fresh graduates are offered from these BPO and IT firms far exceed the average monthly income of a medical practitioner in India. The recent strike of the resident doctors and interns are testimonials to the meagre salary and pathetic facilities the medicos of our Country are provided with. Not to forget the battering they got on account of the lathi chage they had to bear in exchange for a peaceful protest. With the low salaries on offer in government institutions, the medicos rely upon the private practice system to make a decent living.
However, another important factor is the cost required to set up a private medical practice. And with the real estate prices shooting up, owning a clinic in the urban India is becoming a distant drream for the average middle class India.
In starking contrast in the high package an IT employees is offered and that too at zero investment.

To improve upon this alarming unsynchronisation, there must be some steps taken.
The goal of medical education needs to be synchronised with public health and not just with the career aspirations of students.
Of all professions, the medical profession is most inseparable from its social objectives. The first call of medical education must be to the health of the nation’s people.
For this the infrastructure governing the medical system in our country needs to re think on reimbursement service being meted out to its medicos, perhaps then, maybe, the old noble profession will take over and reinstate its position in the priority lists of the wanting to be successful Indian youth.