IF feedback is the lifeblood of the columnist, then I have been given a transfusion — appropriately enough, mainly (but not only) by readers from the medical profession. My column "When doctors emigrate" (The Hindu, December 10, 2006) has elicited a flood of responses to the newspaper and to myself, and apparently stimulated a lively debate in the blogosphere, judging by the examples forwarded to me.

Complex issue

As is usually the case, the responses can broadly be divided into two categories: agreement (sometimes enthusiastic) and disagreement (often vehement). But many in both categories of respondents are willing to see some merit in the opposite point of view, which has led to somewhat more nuanced positions than anticipated by blogger Sharath Rao in Pennsylvania, who cheerfully wrote, "I will leave Mr. Tharoor to read his weekly quota of hate mails".

Dr. N.R. Ramesh Masthi, who teaches in a medical college and has served as a doctor in several remote rural areas, "fully agrees" with me, saying that in his experience, "nearly 40 to 50 per cent of the students migrate from every medical college each year". He notes that "90-95 per cent of the students who join medical college are from urban areas, mostly capital cities, and [are] just not interested in working even 30 km from an urban area". Barely two per cent of the students admitted are from rural or government schools. Dr. Masthi says with feeling: "If we cannot retain our doctors, the whole notion of merit in education has no value for people like me who are paying a very high tax to subsidise their education in the hope that they will give back something to the community which sponsored them". He would rather have an average student joining a medical college and staying on to serve India than a bright student who goes abroad, "because ultimately in medicine it is experience and commitment which makes a doctor good".

No longer attractive?

Dr. Vishwa P. Rath from Canada says that medical education is no longer as attractive as it used to be to the younger generation. "The youngsters feel medical studies are time consuming, less-paid, makes one look 30 years older than one's age, and [offers] limited scope". A computer science or technical degree, Dr. Rath says, provides a far better lifestyle. The solution is to offer Indian doctors better financial incentives and more attractive working conditions: "If a patient dies a doctor should not be beaten in the corridor"! The good Dr. Rath adds that "even if 20 per cent of [doctors] emigrate, we still have 80 per cent to serve our nation... Personally, I belong to a family of doctors serving in Indian Air Force, Indian Navy and other Government assignments. Therefore subsidy is essential because for a family like mine, this generous help has contributed seven doctors to our nation."

An NRI blogger named "Seeji" (Dr. C.G. Prasanna) lists "[the] minimal number of post-graduate seats not catering to the thousands of [medical] graduates, illogical reservation system, a very low pay package compared to other professions" amongst the reasons why doctors emigrate. Seeji asks: "How justified it is to blame doctors alone when even IITians and IIM guys have studied with the same taxpayers' money?" But he proposes the passage of a law that would bind graduates to work in India for a specified number of years. "That should be applied to doctors as well as engineers", he suggests. A regular reader, Anju Chandel, agrees that "the Indian government should first ensure a basic level of comfort, safety and salary for young doctors and then enforce mandatory service in medically under-served areas for a stipulated time."

The issue of subsidies for medical education elicits the most informed and contentious debate. Blogger T.A. Abinandan in Bangalore points out that subsidies apply to "everyone — non-medicos or medicos, irrespective of whether they work in India or elsewhere". Noting that tuition fees are a pittance, he states that "such low fees do not allow our colleges and universities to upgrade their infrastructure and hire high quality faculty. On the other hand, making every college student pay — up front — the true cost of higher education may render it inaccessible to the deserving among the poor."

Alternative model

Mr. Abinadan posits an "Australian model", under which every college student (whether in public or private colleges) benefits from a loan from the government which he repays by paying taxes at a higher tax rate. "This additional tax kicks in only when

Source: