The scope of medical education in India has expanded so rapidly that it raises important questions about access to it. The number of seats has nearly tripled in 12 years, thanks in part to the government’s push to improve access to health care, entailing infrastructure upgrades and simplified regulations. However, much of the growth has been happening in the private sector, in addition to new government colleges attached to district hospitals. This year, for the first time, private institutions host more than half of all MBBS seats. Of the roughly 10,000 new seats, 79% are in such institutions, a sign that growth in the near future will remain concentrated thus. The increase in seats is, in and of itself, commendable as India’s students still compete fiercely for MBBS seats even as health-care centres suffer a debilitating shortage of specialist practitioners. Thousands of students also seek education abroad. Therefore, expanding domestic ‘capacity’ is a natural response and the rising number of seats ought to relieve the bottleneck and keep talent at home.

But problems abound. Whereas an MBBS seat in a government college rarely exceeds ₹5 lakh for the full term, that in a private institution can cost 10 times more, sustained in part by the unflagging demand for health care. These institutions’ commercial viability is clustered in specific geographies, especially in tier-I and -II cities in the more prosperous States, where incomes are higher. Unless their students deliberately fan out after graduation, their skills also become concentrated in these clusters, whereas the paucity of health-care providers is felt more keenly in the rural areas farther away. Rapid growth also raises the risk of highly uneven quality, with institutions seeking to secure NMC accreditation with the bare minimum of facilities rather than mindfully addressing local needs. ‘Capitation fees’, which persist despite government bans, create new debt that can influence behaviour after graduation. Finally, sans competitive salaries, housing and schools, and assured career progression, graduates gravitate to private practice or abroad. Paradoxically, then, the surge in private capacity obligates the government to keep adding capacity, including opening new AIIMS-like institutions, so the number of cheap seats also keeps increasing. The NMC’s rule of having half of all private institution seats be charged at government rates should be enforced; the NMC should also embrace mechanisms that support surprise inspections and the ability to inspect records without institutions’ permission. Finally, beyond compelling rural service, governments should reward it, in addition to ensuring that the daily needs of rural health-care workers and their families and of hospitals are both well-met.

Published - August 07, 2026 12:10 am IST