Exorbitant fees in private medical colleges denies access to medical education for less privileged: Economic Survey

Skyrocketing fees for undergraduate medical education remains a considerable challenge that denies the opportunity to make the MBBS degree accessible and affordable for students from less privileged backgrounds, states the Economic Survey 2024-25.

Since financial year 2018-19, the number of medical colleges grew from 499 to 648 in FY 2023 to 780 in FY 2025, during which time the MBBS seats increased from 70,012 to 96,077 in FY 2023 to 1,18,137 in FY 2025 and post-graduate seats increased from 39,583 to 64,059 in FY 2023 to 73,157 in FY 2025.

Despite the National Medical Commission (NMC) issuing guidelines for determination of fees and all other charges in respect of 50% of seats in private medical institutions and deemed to be universities, fees remain high ranging from ₹60 lakh to ₹1 crore or even more in the private sector, which holds 48% of MBBS seats, the survey notes.

The number of candidates aspiring to study MBBS has increased consistently over the years, from around 16 lakh in 2019 to around 24 lakh in 2024.

“The consequence is that every year thousands of students go abroad especially those with lower fees such as China, Russia, Ukraine, Philippines, Bangladesh,” the survey further states.

These aspirants invest multiple years in repeated attempts at exams — the NEET-UG before taking admission, the Foreign Medical Graduates (FMG) Exam on completing the course and then complete compulsory internships of 12 months in India. “FMGs in China (during COVID lockdowns) and Ukraine (as the conflict escalated), had to return to India dropping their education and faced uncertain prospects,” the survey states.

The very low pass percentage of FMGs in the qualifying exam for practising in India (16.65% of 2,02,385 students) indicates sub-par quality of medical education abroad including lack of clinical training. “As policy intervention to dissuade medical education abroad is crafted, keeping costs is India within reasonable limits is essential,” the survey points out.

The availability of opportunities for medical education is geographically skewed, apparent from the fact that 51% of undergraduate seats and 49% of postgraduate seats are in the southern states, the survey says.

There is also a skewed distribution of seats in favour of specialisations like radiology, dermatology, gynaecology, cardiology while specialities like psychiatry, geriatrics, etc., are neglected.

Also, the survey points out that market estimates indicate that remuneration of fresh graduates is around ₹5 lakh per year and senior doctors earn between ₹12.5 and ₹18.4 lakh per annum in cities.

“This is almost similar or lower to the packages that are available to other graduates at the entry level. The attraction towards the medical profession, as seen from the consistently increasing number of aspirants, seems to arise more from the social status attached to it rather than its earning potential,” the survey says.

The survey points out that doctors from India are already migrating to greener pastures. “The OECD countries reported in 2021 that there were close to 19,000 physicians from India in their workforce and migration in 2021 alone was over 2,800 physicians,” the survey says.

The Economic Survey has stated that while the National Medical Commission (NMC) has put in place measures such as CCTV cameras and an Aadhaar-based attendance system in medical colleges, issues like shortage of faculty, ghost faculty, low patient load in hospitals, etc., continue to affect the quality of training.

The survey has stated that there may be a need to revisit the incentive-disincentive and design of regulatory measures to improve compliance, reduce costs and prevent associated rent-seeking, with regards to NMC and revamping the medical education system in India.

“The success of any policy, including regulatory ones, lies in its execution. If outcomes do not align with our goals or if there are unexpected effects, it is essential to take a step back and refine these policies to make them more meaningful and impactful,” the survey states.