An increasingly large number of non-resident Indian doctors is returning home to south India, giving a third leg to the reverse brain drain phenomenon that mostly involved software engineers and corporate scientists.
A trickle of NRI doctors returning home has been there all around the country for decades now (that is how Apollo Hospitals started), but what marks out the present phase is the accelerating pace and the peninsular focus. The latter is only to be expected since more doctors from the south left India in the first place.
"We get enquiries on a daily basis from NRI doctors wanting to come back," says K Hari Prasad, CEO of Apollo Hospitals, Hyderabad.
On an average, Manipal Hospital, Bangalore, gets five to six resumes every week from NRI doctors in the US and UK. Corporate hospitals in Kerala are seeing a similar inflow of applications.
A good 15 per cent of the doctors at the Kerala Institute of Medical Sciences are former NRIs. Wockhardt hospitals have 28 specialists who have returned to India from abroad. Around 15 former NRI specialists are working with Image Hospitals in Hyderabad and they keep receiving enquiries from doctors seeking jobs in the group.
Says A John Punnoose, CEO, Madras Medical Mission, "Around 80 per cent of the doctors at our hospital in Chennai are former NRIs. I receive around two or three applications from NRI doctors every week, which shows that the trend is on the rise."
"Though it is just over a year since Lifeline Hospitals started operations on Chennai's IT corridor,we already have 13 former NRI doctors, making up a good 24 per cent of the total strength," says M Baskaran, chief executive officer, Lifeline Clinics & Multi-Specialty Hospitals.
Why is this happening? There is both a pull and a push factor. Things are changing rapidly for the better in high-value private health care in India and for the worse for doctors in general in the US and NRI doctors in particular in the UK.
As the economy booms, corporate hospitals are mushrooming all over the country. These are bringing in the latest equipment and their practices and standards are increasingly conforming to globally accepted levels, driven partly by the desire to attract medical tourism.
First, the push factor. V K Kamath, CEO, Apollo Hospitals (Bangalore), says the status of doctors in the US is not what it used to be. Doctors, once among the most respected of professionals, are no longer in that category.
The relative salary of doctors in the US today is not very high as compared to the seventies and eighties when, on an average, they earned much more than those in most other professions.
As for the UK, it is the glass ceiling that has prompted many to return to India.
"There is only a certain level to which a non-White can reach in the UK. The glass ceiling starts to act from then on," said Shabeer Ahmed, a laparoscopy surgeon who had been in Britain since the early 1990s and is now with Wockhardt Hospital. "Here I can use my knowledge in laparoscopy to build something big."
Now the pull factor. According to Dr M I Sahadulla, chairman and managing director of Thiruvananthapuram-based Kerala Institute of Medical Sciences, a premier corporate hospital promoted by NRIs based in the Gulf, "In the past, doctors opted to work in UK and US hospitals as they offered better incomes, top-class medical training and greater job satisfaction. With the Indian healthcare scene now ensuring these aspects, NRI doctors are keen to return. The most important phrase for them is job satisfaction, which they know they will get by working in present-day India's healthcare sector."
Dr A Marthanda Pillai, veteran neurosurgeon and chairman of the Thiruvananthapuram-based Ananthapuri Hospitals and Research Institute, also lays emphasis on the job satisfaction aspect.
"Corporate hospitals in India, particularly those in the south, offer quality standards that are better than those of many western hospitals. NRI doctors returning to India today come home to good salaries, better facilities and, most importantly, greater job satisfaction."
What sort of money are they returning to? Prabhakar V Reddy, MD, heading the emergency medicine and trauma care set-up at Wockhardt's Bannerghatta Road facility, who returned after over a decade in the US, feels most of these doctors make a big sacrifice on their pay packages.
"But, it's the job satisfaction that's the key." Kamath is equally categorical. "It is the recognition in society that is a major factor in drawing the expatriate doctors back."
"The quality of professional and personal life has improved dramatically in India in recent times. Doctors who have worked in the US want to return as they feel they have already made enough money and now is the time to return," said R Basil, managing director and CEO, Manipal Health Systems. Dr Sahadulla adds that the respect that doctors get in India is beyond description.
According to C V Rao, chairman and managing director of Image Hospitals, which operates three hospitals in Hyderabad, "Many of these NRIs have already earned a fortune abroad, and are returning as their roots are still in India. Moreover, salaries to specialist doctors too have shot up in India, offering a lifestyle which they could not afford in the US, plus a flexible work environment."
This flexibility offered by hospitals on compensation packages really helps. It could be a "fee-for-service" or a "guarantee money" model.
Doctors have the option of shifting from one format to another. Most often doctors initially opt for guaranteed income and when they realise they have quite a few patients, they shift to fee-for-service.
Who returns? A majority of them are in the age group of 35 to 40 and want to bring up their children in India. This feeling is stronger in the case of those with daughters.
This reverse brain drain has been a windfall for India. "It has helped bridge the gap in specialities in healthcare in the country," said Vishal Bali, CEO, Wockhardt Hospitals.
For example, Manipal Hospital in Bangalore has a few high-end specialists who have returned from the US and elsewhere whose expertise is being used to start new disciplines, like a department of gerontology.
Additional reporting with Praveen Bose, Sanjeev Ramachandran and Vidhya Sivaramakrishnan.