From brain-drain to Exorbitant MBBS Fee: 10 key takeaways from Economic Survey 2024-25 on India's Medical Education

As per the survey, while strides in India's medical education system are evident, significant hurdles persist. Strategic government initiatives are crucial for expanding access to medical training and improving educational quality, aiming to create a more equitable healthcare landscape.

The survey highlighted the growth of the medical education sector with a significant increase in the number of MBBS and PG medical seats corresponding to the rise in the number of medical colleges in the country.

In its observations, the survey hinted that the availability of physicians is set to improve significantly, with projections suggesting that India may achieve the World Health Organization’s recommended ratio of one doctor per 1,000 people by 2030. This optimistic forecast hinges on the annual addition of 50,000 licensed doctors, addressing the pressing need for a robust healthcare workforce.

However, the rising costs of medical education remain a considerable barrier, particularly in the private sector where fees range from ₹60 lakh to over one crore for approximately 48% of MBBS seats. This economic burden poses substantial challenges for underprivileged students, highlighting a pressing need for initiatives aimed at enhancing accessibility and affordability, as per the economic survey.

The phenomenon of brain drain further complicates the issue, as many Indian students are opting to study abroad in countries like China, Russia, and Ukraine, enticed by lower tuition costs. This trend raises concerns about the loss of talent and highlights deficiencies in the quality of training abroad, as evidenced by the low pass rates (16.65%) of Foreign Medical Graduates (FMGs) in qualifying exams.

Geographically, the landscape of medical education remains uneven, with a disproportionate concentration of MBBS and PG medical seats in southern states, leading to a disparity in access for students from rural regions. Furthermore, there is a growing preference for certain medical specialities, such as radiology and dermatology, while crucial areas like psychiatry suffer from a lack of interest.

As per the survey, addressing these disparities requires strategic initiatives to enhance rural healthcare distribution, including better infrastructure, incentives, and professional development.

While salaries for fresh medical graduates start at around ₹5 lakh, and senior doctors earn between ₹12.5 lakh and ₹18.4 lakh annually, these figures do not equate to the financial rewards seen in other professions. Many aspiring doctors enter the field for the societal prestige associated with the profession rather than financial incentives.

It was noted that the government is actively promoting the expansion of medical colleges and postgraduate infrastructure through centrally sponsored schemes and the implementation of regulations by the National Medical Commission (NMC) to elevate educational standards. With continued investment and a focus on accessibility, the potential for future growth in India's medical education landscape remains vast, positioning it as a pivotal area for policy development.

Here are the key takeaways:

Status of medical colleges and MBBS, PG medical seats:

Since 2019, the number of medical colleges grew from 499 to 648 in 2023 to 780 in 2025, during which time the MBBS seats increased from 70,012 to 96,077 in 2023 to 1,18,137 in 2025 and post-graduate seats increased from 39,583 to 64,059 in 2023 to 73,157 in 2025, the survey noted.

"The medical education ecosystem in the country has made significant strides, with notable achievements that lay a strong foundation for future growth. However, there are exciting opportunities to further enhance the system and ensure it fully aligns with broader policy objectives. While the regulatory framework has made progress, there is an opportunity to evolve and keep pace with the dynamic needs of the healthcare sector," it said.

"The number of candidates aspiring to study MBBS has increased consistently over the years, from around 16 lakh in 2019 to around 24 lakh in 2024. The National Eligibility cum Entrance Test – Under Graduate (NEET-UG) is the single mode of entry through which students enter into medical education, MBBS courses in India and abroad. There has been a sustained increase in the number of opportunities available for medical education in the previous ten years. Since FY19, the number of medical colleges grew from 499 to 648 in FY23 to 780 in FY25, during which time the MBBS seats increased from 70,012 to 96,077 in FY23 to 1,18,137 in FY25 and post graduate seats increased from 39,583 to 64,059 in FY2378 to 73,157 in FY25," the survey report further mentioned.

Doctor shortage- still a concern?

Saying that the shortage of doctors in the country is no longer a primary concern, the survey mentioned that the WHO norm of 1:1000 can be achieved by 2030 with 50,000 doctors being licensed every year. 

"There are 13.86 lakh practitioners of modern medicine registered as of July, 2024,79 which converts into current availability for the whole population of the country in the ratio of 1:1263.80 The WHO standard norm of 1:1000 seems to be attainable by 2030 with a conservative 50,000 doctors being licensed every year till 2030. Thus, numerical shortage of physician availability in India is perhaps no longer a primary concern," the survey said.

Exorbitant MBBS Fees:

It was observed that the fees for medical courses remain high – at ₹60 lakh to one crore or more in the private sector which holds 48 per cent of MBBS seats. 

"Unlike other professional education streams, fees for medical education is highly regulated. In case of government medical colleges, the respective state governments are responsible for fixation of fees. In the case of private unaided medical colleges, the fee structure is decided by a committee set up by the respective state government under the chairmanship of a retired High Court Judge in pursuance of the directions of the Hon’ble Supreme Court of India. The National Medical Commission (NMC) has issued guidelines for determination of fees and all other charges in respect of 50 per cent of seats in private medical institutions and deemed to be universities. Despite such measures, fees remain high – at ₹60 lakh to one crore or more in the private sector which holds 48 per cent of MBBS seats. This highlights the opportunity to make medical education more accessible and affordable for all, particularly for those from less privileged backgrounds. By reducing the cost of medical education, for those from less privileged backgrounds. By reducing the cost of medical education, we can contribute to lowering healthcare service costs. If universal coverage is the goal, prioritising cost and equity in medical education will be key to achieving it," the survey report stated.

Brain drain:

The survey took serious cognizance of the issue of brain drain in the country. It noted, "The consequence is that every year thousands of students go abroad to around 50 countries especially those with lower fees such as China, Russia, Ukraine, Philippines, Bangladesh. Medical education abroad entails hardships of studying abroad and productive years of youth invested in repeated attempts at exams - the NEET-UG before taking admission, the Foreign Medical Graduates (FMG) Exam on completing the course and then complete compulsory internships of 12 months in India."

Low quality of medical education abroad:

The very low pass percentage of FMGs in the qualifying exam (16.65 per cent in 202385) indicates the sub-par quality of medical education abroad including lack of clinical training.

The economic survey further said, "FMGs in China (during COVID lockdowns) and Ukraine (as the conflict escalated), had to return to India dropping their education and faced uncertain prospect. The subsequent regulatory issues in addressing the difficulties faced by FMGs and the need to maintain standards in allowing them to practice in India has been a challenge and has required interventions of the courts in more than one occasion. The very low pass percentage of FMGs in the qualifying exam (16.65 per cent in 202385) indicates sub-par quality of medical education abroad including lack of clinical training. As policy intervention to dissuade medical education abroad is crafted, keeping costs is India within reasonable limits is essential."

Disproportionate seat distribution:

"The availability of opportunities for medical education appears to be geographically skewed, apparent from the fact that 51 per cent of undergraduate seats and 49 per cent of postgraduate seats are in the southern states... There is also a skewed distribution of seats in favour of specialisations like radiology, dermatology, gynaecology, cardiology while specialities like psychiatry, geriatrics etc., are neglected," the survey pointed out.

Doctors' service in rural areas:

Noting that doctors are hesitant towards serving in the rural areas, the survey recommended that by offering incentives, improving infrastructure, and fostering professional growth in these regions, "we can attract and retain healthcare professionals, ensuring a more balanced and equitable distribution of doctors to strengthen public healthcare services nationwide."

"The growth in the number of medical practitioners offers a prospect to improve the distribution of healthcare professionals across regions. While many graduates and specialists prefer to practice in their home states or in major cities due to better amenities and professional opportunities, this presents a chance to enhance healthcare access in rural and underserved areas," it said.

The imbalance in distribution can be attributed to the state/region level of economic development, demand for and expansion of healthcare services, and increasing market for medical value travel, the survey mentioned, adding that the availability is skewed in favour of urban areas with the urban to rural doctor density ratio being 3.8:1."These patterns tend to follow the pattern in availability of healthcare services in general. It has been estimated that 75 per cent of dispensaries and 60 per cent of hospitals are in urban areas, where 80 per cent of doctors serve," it read.

On the shortage of specialists, the survey said, "The current shortage of specialists across specialities will further aggravate in streams that are currently not preferred but will be required in the future. Demand for post graduate education is not restricted by the need for clinical practitioners, these doctors form the resource pool for research and development in advanced fields of medicine, pharmaceuticals, biotechnology etc. They are also crucial as faculty and trainers of the next generation. While we focus on increasing facilities for specialisations it is also necessary to maintain distribution across geographies and streams."

Unattractive payscale:

As per the survey, the remuneration of fresh MBBS graduates is around Rs 5 lakh and senior doctors earn between Rs 12.5 -18.4 lakh per annum in cities- almost similar or lower to the packages that are available to other graduates at the entry level. On this, the authorities noticed migration ratio and further observed that the attraction towards the medical profession, as seen from the consistently increasing number of aspirants, seems to arise more from the social status attached to it rather than its earning potential.

"Market estimates indicate that remuneration of fresh graduates is around ₹ 5 lakh and senior doctors earn between ₹12.5 -18.4 lakh per annum in cities.90 This is almost similar or lower to the packages that are available to other graduates at the entry level. The attraction towards the medical profession, as seen from the consistently increasing number of aspirants, seems to arise more from the social status attached to it rather than its earning potential. This may mean that the availability of meaningful work and commensurate remuneration may reduce with increase in the number of doctors available in the future. This would reinforce the already occurring migration of doctors from India into greener pastures. The OECD countries reported in 2021 that there were close to 19,000 physicians from India in their workforce and migration in 2021 alone was over 2800 physicians. Increased public and private sector investments into medical education is in effect creating a global health workforce. The trends in migration need to be factored while incentives for service in public health system are calibrated to ensure availability of doctors in rural areas," the economic survey pointed out.

Quality of education relates to faculty, clinical exposure:

The quality of medical education is directly related to the availability of qualified and experienced faculty and clinical exposure at the hospital, the survey noted and said, "Regulatory requirements in terms of both are robust. Non-compliance carries penalties including the cancellation of recognition of courses. The NMC is empowered to monitor and penalise such non-compliance. Measures such as CCTV cameras and an Aadhaar based attendance system which are centrally monitored by the national regulator have been put in place. The granularity of regulations may appear necessary given that medical profession deserves to be of the highest quality possible but also seem overbearing in terms of associated compliance and monitoring costs. Despite the elaborate regulations and monitoring, issues like shortage of faculty, ghost faculty, low patient load in hospitals etc., continue to affect the quality of training."

The economic survey called for the need to revisit the incentive-disincentive and design of regulatory measures to improve compliance, reduce costs and prevent associated rent-seeking.

What are regulatory bodies doing?

The success of any policy, including regulatory ones, lies in its execution. If outcomes do not align with our goals or if there are unexpected effects, it is essential to take a step back and refine these policies to make them more meaningful and impactful.

"To address the uneven distribution of seats and to expand the availability of seats, the central government is supporting the states through three centrally sponsored schemes, viz., the construction of new medical colleges, creation of infrastructure for the expansion of MBBS and post-graduate seats. The regulatory reform process started with the setting up of the NMC in 2019. NMC has since brought into effect broad-based regulations specifying minimum standards for the establishment of colleges, increasing number of seats, opening new courses, introducing of a competency-based curriculum, minimum qualification, and training of teachers etc. In collaboration with the Quality Council of India, a rating and accreditation system for medical colleges has also been proposed," the survey concluded.

"With all these efforts being made and the private sector remaining an active participant, the medical education landscape presents large opportunities for the future and presents a bigger challenge to policymakers than any other field of professional education does," it said.

Medical Dialogues has been extensively reporting about the regulatory framework being brought by the apex medical regulator in India, the National Medical Commission (NMC) ranging from Minimum standards for imparting MBBS, PG medical, and Super speciality courses to hiring medical teachers at institutions across the country, aiming at reforming the health and medical education sector.