Should the Indian Government continue to subsidise medical education?
Dec 10, 2006 at 03:24 PM ET
AS an Indian who, without actually emigrating, has found himself working abroad all his adult life, I have always had some sympathy for my fellow NRIs. The argument that Indians who work abroad are doing a disservice to their country seems to me misplaced, especially in recent years as Indians abroad have given so much more back to their homeland than they could ever have contributed while staying there. The old fears of a "brain drain" seemed to me to have been supplanted by hopes of a "brain gain", as desi software designers and high-tech gurus from Silicon Valley have opened thriving firms in India, employing their countrymen and women, increasing the country's export revenues and pumping up the national GDP. Indians going abroad after their studies have done a great deal to benefit the Indians who stayed at home.
But one category of Indian professional who emigrates still troubles me. I know it's unfair, but while I am unfazed by the expatriation of our engineers and economists, our scientists and scholars, it still bothers me when I see an Indian doctor settle abroad.
Vital knowledge
Don't get me wrong. Some of my best friends in the U.S. are Indian doctors, and I feel no personal desire to uproot them from their lives here and send them back. But whereas our country is so abundantly supplied with talent that few of us living abroad can truly claim that our absence from our native shores makes any negative difference to India, doctors strike me as a different case. Mainly for two reasons: they possess knowledge and training that is still in short supply in our country; and the Government of India, through its generous subsidies for higher education, has spent a large sum of money helping them to acquire the skills they are taking abroad.
The problem came back to me when I read that Indian doctors in the U.S. are discovering a new means of staying on legally in America. They are serving the poor.
Under U.S. immigration rules, a foreign doctor — even if he completes his medical schooling in the U.S., or does an internship or residency at an American hospital — is obliged to return to his homeland for a period of at least two years before he can seek employment in the U.S. There is, however, an exception built into the law. The U.S. Federal Government has designated 2100 areas, mostly impoverished districts at the nadir of the economic recession, as "medically under-served". If a foreign doctor agrees to work in one of these areas, the standard requirement, of two years outside the U.S. before working here, is lifted. The much sought-after "green card", entitling the doctor to permanent residence in the U.S., is just a few prescriptions away.
As a result, the brain drain of doctors from developing countries continues, while ensuring Americans get medical care even in areas where American doctors wouldn't want to work. There are some 6,00,000 licensed medical practitioners in the U.S., of whom about 1,20,000 are foreigners. The largest single group of foreign doctors is, of course, from India — no fewer than 25,000. The irony of Indian doctors, who have no lack of poor patients needing their medical skills in their own country, coming to help the American underclass, is considerable.
Easy route
Few American doctors want to build a practice or make a home in some of the places that Indians are prepared to serve in. I remember one New York Times piece years ago about one such "medically under-served" area, the town of Welch, West Virginia. The journalist described Welch, a remote outpost in the Appalachian mountains, as "an economic sinkhole whose coal-mining jobs have been vanishing". Towns like Welch, populated largely by the very poor and the often sick, have little appeal for American doctors whose principal objective is to earn back the quarter of a million dollars they have spent on their medical education. Even graduates of West Virginian medical schools refuse to work at the local hospital. So Welch has made use of its Federal designation to import its doctors. Fifteen of the 19 doctors in the town hospital were from abroad, including India.
Other incentives
As with lesser professions, from janitors to cab drivers, immigrants are always willing to do the jobs the locals consider beneath them. The easier route to a green card may not, however, be the only incentive for the foreign doctors. The New York Times wrote that many found greater professional opportunity in these blighted rural communities, less professional discrimination — and greater material comforts. Typical earnings, the newspaper reported, ranged from $80,000 to $2,00,000 a year. Only in America can you make that much by serving the poor.
No wonder Indian doctors prefer to work in Welch than in Warangal or Wardha. But must the Indian taxpayer subsidise them for seven years to do so? That's the question on which I'd welcome readers' views.
