Why are medical graduates not joining the rural services in India

Abstract

There are significant differences in the health parameters between the urban and rural areas of India. While most parameters have reached levels comparable to the developed world in the metropolises, they remain significantly lower in the rural areas of the country. One of the major reasons for this difference is the insufficient deployment of human resources, especially doctors in the health institutions located in rural areas. Physicians are reluctant to take up jobs in rural locations. The government of India estimated in 2010 a short-fall of 10.3% for doctors at primary health centers (PHCs) and 62% for specialists at the secondary level1. The doctor: population ratio is 13: 10000 in the urban areas but only 3: 10000 in the rural areas of the country.2Joining in and adhering to rural health services are often defined by the availability of benefits like financial incentives in the form of loan repayment and scholarships for students willing to serve in rural areas, as in the United States. Monetary incentives along with professional development opportunities are also used for recruiting and retaining physicians to rural areas in several other countries. The government of India provides incentives such as the rural or hardship allowance and reservation of post graduate seats for physicians serving in the rural areas. However, these are not considered enough motivation by the vast majority of medical graduates in India, who take up jobs in city based hospitals, sometimes for lesser remunerations. Professional isolation and lack of infrastructural facilities, less salary, low standard of living and limited exposure as a doctor continue to discourage physicians from joining rural service. This trend is not unique to India and reluctance of medical graduates to set up rural practice or join rural health services have been in seen in countries both from the developing as well as the developed worlds.