Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce

ABSTRACT

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India – resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

KEYWORDS:

• Entrance examination
• medical school
• undergraduate medical education
• healthcare equity
• NEET-UG
• NEET-PG
• rural healthcare
• global health

Acknowledgments

The authors wish to thank Prof. Michael McDermott, M.D., Chief Medical Executive of Miami Neuroscience Institute for his thoughtful edits and Prof. Jishnu Das, PhD, Professor at Georgetown University for his feedback during the manuscript revisions.

Consent for publication

All authors provide consent for publication of this manuscript.

Contributorship Statement

All authors approve the manuscript as it is written.

Disclosure statement

Manmeet Singh Ahluwalia: Grants: AstraZeneca, B.M.S., Bayer, Incyte, Pharmacyclics, Novocure, MimiVax, Merck. Consultation: Bayer, Novocure, Kiyatec, Insightec, G.S.K., Xoft, Nuvation, Cellularity, SDP Oncology, Apollomics, Prelude, Janssen, Tocagen, Voyager Therapeutics, Viewray, Caris Lifesciences, Pyramid Biosciences, Varian Medical Systems, Cairn Therapeutics, Anheart Therapeutics, Theraguix. Scientific Advisory Board: Cairn Therapeutics, Pyramid Biosciences, Modifi Biosciences. Stock shareholder: Mimivax, Cytodyn, MedInnovate Advisors. Faique Rahman, Vivek Bhat, Ahmad Ozair, and Manmeet Ahluwalia completed medical school in India. All other authors declare no relevant disclosures.

Authors’ contributions:

FR conceptualized, drafted, edited, and revised the manuscript. VB conceptualized, drafted, edited, and revised the manuscript. AO conceptualized, drafted, edited, revised the manuscript, and corresponded with the journal. DD edited and revised the manuscript. MSA revised the manuscript. All authors reviewed the final version of this manuscript.

Additional information

Funding

This research received no specific grant from any funding agency in the public or commercial sectors.