India has proportionally fewer doctors than even Pakistan, which in turn is below the world average in this department. Nothing here to thump your chest over.

Personally, I think US and Canada will continue to rely on International Medical Graduates whose education is for the most part subsidized by other governments. So, personally, I believe some sort of partnership and exchange between educational institutions (even if they are for-profit institutions) in countries like India will minimize the crisis to health human resource in other countries. Partnership will also ensure that North American standards of accreditation can be met and students’ future and career (read ‘repatriation’) need not be left to chance alone. With its huge population base, Indian institutions have access to people seeking primary or tertiary healthcare.

Malathi, Tell me which school does NOT feel strained? Moreover, tell me which corporation, businessmen, scientist, truck-driver, etc. who doesn’t feel that they need more resources. It’s simply human nature to not think that you have enough, or that you need more.

The medical schools in the USA are no different than any other organization in that they don’t feel they can’t find enough good people and funding. Absolutely every organization would feel the same, I’m sure. If the medical schools are cramped and under-resourced here, than I’m sure that the situation is 5 times worse in the Caribbeans or India, where many of our finest comes from.

While the AAMC has called for a 15-20% increase in current numbers of graduating physicians in the US, there are considerable challenges in carrying out this task. My university is in the midst of one such expansion and every teaching and learning resource at every level of the medical education process is strained (e.g, skilled human resources, support staff, clerkship (clinical) placements, physical space especially for small-group sessions, lab space, clinical case:student ratio, clinical preceptor:student ratio, etc.) To add to the challenge is the looming strict accreditation process…

It seems like, here too, India is seizing the day.

The AUA College of Medicine offers a further opportunity to expand a candidate’s worldwide education by way of its affiliation with the Kasturba Medical College in Manipal, India. Candidates have the option of enrolling at either the Basic Science Campus in Antigua or the Kasturba Basic Science Campus in Manipal. Kasturba is one of the top three medical schools in India.

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In a 2003 study Dean Baker, who is co-director of the Center for Economic and Policy Research, estimates that by adding roughly 100,000 physicians to our current pool of about 760,000, we could pull doctors’ salaries down from an average of $203,000 to somewhere between $74,000 and $126,000. For the average middle-class American family of four he reckons that would lead to savings of $2,200 to $3,700 per year

One argument against increasing the number of MDs in the USA is this: The USA (~2.0 MDs per 1000 people) has more MDs per capita than other developed nations, like Japan (~2.5/1000) and UK (~2.3/1000). However, even these 2 countries have shortages of MDs! By suggesting that we’re better off than the Japanese is like a lung cancer patient bragging to a pancreatic cancer patient that he/she is healthier than the pancreatic patient ,when in fact, they BOTH are sick! Moreover, about 25% of our MDs are foreign born. This means that we really only PRODUCE 1.87 MDs per 1000 people, which is much less than Japan (which doesn’t ‘import’ MDs) and UK (which does ‘import’ them).

I should have gone for law.

In the US, it always felt like I was dealing with a nameless, faceless system that didn’t understand a word that came out of my mouth.

So why not look for ways to decentralize health insurance & make it more entrepreneural? For starters, it’s current tax law that makes health insurance a B2B market (e.g. something your employer buys for you) rather than a B2C market (something you buy for yourself like car insurance). You don’t worry about losing your auto insurance when you lose your job…

Health insurance is a market failure. You’re never going to see decentralized or entrepreneurial delivery systems because most people can’t afford to pay out of pocket for the latest medical care. You need a risk pooling mechanism to create a market for new products. Even now the US healthcare system is dominated by just a handful of insurance companies. That is neither decentralized nor entrepreneurial. There is no extra virtue in centralizing something under a corporate bureaucracy rather than a governmental one.

The only reason India can get away with making the delivery cheaper is because Americans are subsidizing the R&D on the front end to create the new products in the first place. The Euros get the best of both worlds. Good access to care through a universal system AND good access to new technology through American incentive structures.