we dont need new medical colleges.India needs highly skilled physicians and physician-scientists and public health workers.

Who recommended the doctors:people ratio? is there any rationality??
Recommendations and other foundations for health services  was laid by  committees ,HLEG groups,planning commission and  WHO about 60 years ago when acute infections dominated the health scenario.

Minimum doctor population ratio of 1:1000 made by originally developed by the Joint Learning Initiative (JLI) and subsequently more or less adopted  by the WHO.

The two parameters used by the JLI to arrive at the concept were, magnitude of coverage of measles immunization and births conducted by skilled attendant. Both of these are low level medical skills that could be easily done by paramedics.

Even with less doctors, India has done wonders!

In INDIA, since independence, infant mortality rate (IMR) has dropped from 150 to 50 (a three-fold reduction), the maternal mortality ratio (MMR) declined 10 folds from 2000 to 200 per 100,000 live births and the life expectancy at birth has gone up from 31 to 65 yr.

Sixty years ago the total number of physicians was 47,524, with doctor population ratio of 1 to 6300. Today, the number of registered medical practitioners is 840,130 (a 17-fold increase).

Despite the population explosion (population has tripled) the overall doctor population ratio is now 1:1800 which reflects a 3·5 fold improvement. Primary Health Centres (PHCs) are the cornerstone of rural health delivery system. The number of PHCs has increased from 77 in the first plan (1955) to 23,887 in 2011, a 300 fold increase.

The number of doctors at the PHCs has increased from 20308 to 26329 (addition of 1,200 doctors per year) in the period 2006-2011. so, If the trend continues, the shortage of doctors in the PHCs could be met in the next few years within the existing system without increasing the number of medical colleges.

Rampant corruption, low level of literacy, especially women literacy, poor road connectivity and high level of poverty are the main causes for poor rural health.

What india really needs ?
Rural India faces severe shortage of specialists doctors. 70% posts of specialists (surgeons, physicians, paediatrics, gynaecologists, etc.) at the Community Health Centers (CHCs), which provide minimum specialist services to villagers, are lying vacant.

the strong burgeoning  25 crore Indian  middle class demands and ready to pay for - high tech medicine such as well equipped ICU, cardiac bypass surgery, organ transplant, advanced imaging technologies (MRI, PET), prenatal diagnosis, neonatal screening, in vitro fertilization (IVF), etc.

India urgently needs Management of lifestyle disorders,which  needs continuous long term interaction of patients with highly skilled trained doctors and not just a primary health worker. 

Medical tourism, currently estimated to be US $ 2 billion industry, has been totally ignored by indian govt. Medical tourism, which needs highly skilled specialists and super-specialists, could be easily a $ 5 billion-industry in the next decade.

India needs, A strong base of  physician-scientists,which will not only promote international collaborative research but could also make India, which is a major manufacturer of generic drugs, a site for new drug development.

 At the time of independence there were only 20 medical colleges admitting about 1500 students. Today, there are some 350 colleges admitting 45,000 students (30-fold increase in enrollment). This fast expansion of medical colleges has resulted in gross shortage of teachers estimated to be currently 40%.

Private sector, which owns 190 of 350 medical colleges, is now the dominant player in medical education.

In view of the changing health scenario, it is time to review the structure of rural health services and tailor medical education to meet their needs.

1.So, The Government should immediately stop the establishment of new  medical colleges.

2.The govt should urgently evolve and  implement  innovative  strategies to deal with acute shortages of specialists and super-specialists especially for rural health services. for example- 

A. postgraduate student should spend six months at a CHC in the second year of his/her training.

B.To get hands-on  training in super specialty procedures ,the PG student should  spend 6months  in the specialty of his/her choice that is available at the host medical college or even at a private tertiary specialty institution.

C. Similarly, rural health service could be made a part of the super-specialty (DM) courses.