Can India's Medical Challenge Be Answered? Docs Quit Govt, Leading To Sinking Public Health Service

The public health service in India has long been in the Intensive Care Unit (ICU).  

A crisis is unfolding in the country’s medical health education, research and tertiary care. All India Institute of Medical Sciences (AIIMS) in the capital along with other reputed hospitals including the 20 AIIMS across the country are witnessing an exodus of doctors.

AIIMS Delhi In Existential Crisis

The Delhi-based AIIMS known for quality tertiary health care services and cutting-edge research, along with a team of doctors who can easily be called the best, is in the throes of an existential crisis due to elevated level of vacancies both in faculty and non-faculty positions. 

Here is the data: 

• Faculty Vacancies: As per data shared by the Centre in August 2025, as many as 462 faculty positions are vacant, while the number of sanctioned posts stands at 1306 – a whopping 35 per cent vacancies. The prevailing conditions continue to worsen by day,  despite efforts by the government to salvage the situation with schemes like hiring retired faculty on a contract basis up to the age of 70 and establishing the system of visiting faculty.
• Non-Faculty Vacancy:  The situation is no better in the non-faculty category, which includes non-teaching doctors and other support staff. AIIMS Delhi reported 22 per cent vacancies – 3,106 out of 13,911 sanctioned non-faculty posts were vacant. This chronic shortage impacts medical, technical, administrative, and support services, seriously impacting efficiency and patient care.

Why It Matters

AIIMS, Delhi is not just another institution. Established as an autonomous institution in 1956  by an Act of Parliament,  it is a unique apex level institute in the country that is widely regarded as the gold standard in medical education, research, and tertiary healthcare provision. Since its inception, AIIMS Delhi has set high benchmarks for healthcare excellence across the country. Here are key contributions of AIIMS Delhi whose legacy is seriously endangered due to growing shortage in faculty and non-faculty positions-

• Producing High Calibre Medical Professionals: It has trained thousands of world class undergraduate and post graduate doctors, nurses, and other health professionals. They have gone to serve in academic and healthcare leadership roles across the country.
• High Quality Medicare: AIIMS boasts of excellence as well as affordable medicare – the premier institute runs one of the busiest out patients’ department (OPD) facilities in the world with 15,000-25,000 daily footfalls. Further with cutting-edge specialised services it attracts lakhs of patients annually requiring  care in various complex speciality illnesses.
• Cutting Edge Research: It is also known for undertaking cutting edge research resulting in pioneering breakthroughs in medicine, public health, and clinical services. Its leadership role during Covid-19 pandemic was acclaimed across the world.
• National Networks: Serving as a National Resource Centre, it supports and mentors over 100 other medical colleges via the National Medical College Network, shaping policy and standards for Indian health care education.

Medical Institutes With National Importance

Let us look at three medical institutes apart from AIIMS that are of national importance and those set up by the Act of Parliament:

The Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh – set up in 1967 

As the vacancy positions are dynamic it is difficult to track all vacancies, but an internal research indicates the following as of August 2025:

1. Faculty Vacancies: Out of sanctioned 732 faculty positions, 131 are vacant
2. Non-Faculty Vacancies: Out of sanctioned 8265 non-faculty positions 1,874 remain vacant.

PGIMER has 18 per cent of vacancies in faculty level positions and 23 percent in non-faculty positions.

Jawaharlal Institute Of Postgraduate Medical Education And Research (JIPMER), Pondicherry:  JIPMER traces its roots back to 1823 under French rule. The prominent hospital was upgraded post-Independence in 1956 and subsequently renamed in 1964 after India’s first Prime Minister Jawaharlal Nehru and declared an institute of national importance in 2008. 

• It has 445 sanctioned faculty posts but 98 are vacant. This includes 33 positions for professors and 42 for assistant professors at the main campus, and three professors plus 20 assistant professors at the Karaikal branch.
• Out of sanctioned clinical 5812 non-faculty positions, 1458 are vacant.

JIPMER has more than 25 per cent vacancy in both faculty and non-faculty positions.

National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru: Set up in 1954 as All India Institute of Mental Health (AIIMH) based on the recommendations of the Bhore and Mudaliar Committee recommendations, it was morphed and rechristened NIMHANS after amalgamation of  Bengaluru Mental Hospital and AIIMH on December 27, 1974. It was declared an institute of national importance in 2012.

Core purpose of NIMHANS is providing quality mental health care (both residential and OPD), churning out desired number of specialists - psychiatrists,  clinical psychologists, psychiatric nurses, and psychiatric social workers among others- and performing cutting edge research. 

From its inception NIMHANS has been facing critical shortage of manpower in all categories- teaching faculties (both psychiatrists and neurologists) and non-teaching members including psychiatrists, neurologists, , anaesthetists,  clinical psychologists, psychiatric nurses, psychiatric social workers, administrative and others staff.

Now let's look at the other AIIMS campuses.

To take quality medicare beyond the capital, the then government led by late Prime Minister Atal Bihari Vajpayee announced six new campuses of AIIMS in 2003. The number of functional AIIMS has since increased to 20 in the country and three more are under construction. Here is the position of vacancies in the functional AIIMS:

1. Out of a total 6,376 faculty positions, 2,561 are vacant- a whopping 40 per cent of the sanctioned positions.
2. There are 58,953 sanctioned in non-faculty positions, of which 19,529 are vacant-33 per cent vacancies Like AIIMS Delhi other AIIMS have also been set up to provide quality tertiary health care services, medical education (as of 2024–2025, there were approximately 2,207 MBBS seats and 1,360 post graduation seats across all functional centres for cutting age research.

The Twin Trauma

Primarily there are twin reasons for this situation:

• Lure Of Switching To Private Hospitals: With the fast proliferation of private sector medicare services in the country, many doctors show an inclination towards joining the private hospitals rather than the  government ones. There has been a shift in mindset and more and more doctors are willing to give up being engaged even with the most prestigious government medical institutes including AIIMS and other institutes of national importance. This was not the case even a decade ago.
• Mass Desertions for Greener Pastures: There are other interesting trends. A large number of senior doctors including faculty members join the premier institutes for experience, which few private hospitals can provide, but quit soon to join the private sector or start on their own practice. Some even opt to join hospitals outside the country.

Data furnished in Parliament reveal that in the past three years alone (from 2022 to 2024) as many as 429 faculties exited AIIMS. The worst impacted was the New Delhi centre– it had the highest number at 52 leaving the most prestigious AIIMS  New Delhi.

Why Are Doctors Quitting Prestigious Institutions 

The exodus stems from multiple factors – better pay outside the government hospital umbrella, increasing opportunities in private hospitals, stressful working conditions, lack of career advancement, and significant work pressures in understaffed government facilities. 

Of these, the most important reason remains the pull factor from the private hospitals that are now desperately hunting for cutting edge senior specialists who have acquired knowledge and experience to handle complex cases in the apex level government medical college hospitals.

Working conditions in premier public health institutions are most often not the best. 

Under the Seventh Schedule of the Constitution, health is a state subject. As such, states have a primary duty to maintain public health and manage health sector infrastructure. 

Number of Medical Colleges: 612 government-run and 291 private medical colleges. 

1. District Hospitals: 764
2. Subdivisional Hospitals: 1,130
3. Community Health Centres: 5,624
4. Sub centers: 1,58,417.
5. Prime Health Centres: 25, 743

Collapsing Backbone

Indian states are facing severe shortage of doctors across the country. And this shortage is across the states, more particularly of specialists’ doctors. The situation is particularly critical in rural and semi urban sectors.

District hospitals and medical college hospitals comprise tertiary care facilities and most patients particularly from rural India are treated at community health centres. 

But how do they fare?

Following is the finding of latest India Health Dynamics report  (2022-23) released by the government in September 2024:

District Hospitals: The report shows that there are 27,304 doctors and specialists employed across 714 district hospitals in the country, against a sanctioned strength of 33,964—which means that 20 per cent of these seats are vacant.

Rural CHC: Only 4,413 specialist doctors of the requisite 21,964 needed  were available in 5491 rural CHCs in 757 districts—a shortfall of 17,551 or 79.9 per cent. In rural CHCs, there was a shortfall of 4,578 surgeons—a shortfall of 83.3 per cent; 4,078 obstetricians and gynaecologists-- 74.2 percent; 4,499 physicians-- 81.9 percent; and 4,425 paediatricians-- 80.5 percent.

Urban CHC: The data also showed that the availability of specialists at 868 CHCs in urban areas was slightly better at 56 percent.

The situation is worse in a few large states such as Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, Gujarat, and Tamil Nadu which have a shortage of 94 per cent, 80.9 percent, 74.4 percent, 80.3 percent, 88.1 percent, and 85.2 percent, respectively.

Time To Act

It is time to roll out adequate effective policies that will arrest the trend. With the uncertainty in the US and confusion over H-1B visa fee hike, it is imperative for the Centre and states to collectively work towards creating a conducive ecosystem for doctors to be interested in serving the country. 

Working conditions must be upgraded, pay scales or incentives relooked so that government hospitals and medical care centres can attract the best talent and even retain them. 

(The writer is a former civil servant. Views are personal)