The reason commonly cited for non-availability of the enough doctors for government health care delivery system in India, is that everyone who passes out as a doctor just wants to make money, and thus goes to join the private practice, and consequently government run hospitals are left understaffed. It not only shows that people think that government hospitals are simply waiting for doctors to come and check in but also about the public perception that private practice is as a sure shot way to make easy money.
Out of the total student who join MBBS courses in India, only one fourth to half of the students get admission to a post-graduation course. Now the question is what happens to rest of them who go to the practice (government services, private, institutional) without a post graduate degree? Most of these graduates end up joining the government funded primary and secondary care hospitals. Getting these jobs are not that simple. In most of the northern India states, governments advertise vacancies one 2-4 years and an equal duration is taken to finalize interview, selection and appointment process. And those who are lucky and patient ,get the job, and these are about one fifth to one third of total applicants. Many of those who need the job , could not make it into the list of selected candidates. Many of those who do get selected, fail to join, as they gets some better bargain while waiting for the government to deciding who should be taken and who should be left.
Now what are these so called better bargains which makes a MBBS doctor refuse a government job, which the government desperately wants him/her to join? Is it some six or seven figure salary in some big corporate hospital chain? Of course not. Often these people join some private facility, at half of the salary of what government was offering, just to stay in slightly less rural location as compared to where a usual PHC is located. So that they can stay with or close to their spouse, so that children can go to a decent school and like that.
But this can be said about those who are not specialist. What about those who are post graduate specialist or super specialist? They must be playing in millions.
Even those who do manage to get a post-graduation degree and become so called specialist, they also go through almost same cycle of career options. In cities, medical colleges and upcoming corporate hospitals do offer a reasonable carrier option. A very small subset of who meet requirements like fellowships, publications and connections, could get faculty/consultant positions in these medical college and corporate hospitals. Even their annual remuneration is comparable to any other government employee.
Those who cannot find a place in any of the above, are left with only one option and that is to go to private practice. In most of the case it start with a table and a chair in a rented shop because that’s what a thirty something, freshly passed out, unexperienced , married , broke and so called specialist doctor can afford. Than the daily schedule for next 5-10 years, is to run from one hospital to another, one clinic to another, to make some money, not only to meet his/her monthly expenses but also to pay for 4-5 loans, borrowed for car, house, clinic and equipment etc.
One third of these which survive this ordeal for ten years or so, become the practitioner who are popular in their localities. These are the doctors who have a home bigger that their neighbors, a flashy car and Facebook updates with photos of a foreign tour. They should not mind if they are blamed for lack of doctors in the government health facilities.