Empty PG Seats, Missing Doctors

'When young doctors see limited protection, unpredictable careers and an absence of institutional support, they hesitate.'

India continues to face an acute shortage of specialist doctors, particularly in rural areas, even as thousands of postgraduate (PG) medical seats fall vacant each year, exposing deep structural flaws in medical education and workforce planning.

According to the Health Dynamics of India report by the ministry of health and family welfare, community health centres (CHCs) in rural India face an almost 80 per cent shortfall in specialists.

Rural India Faces 80% Specialist Shortage

As of March 2023, just 4,413 specialist doctors were available against a requirement of 21,964 across 5,491 CHCs in 757 districts, each centre serving an average population of nearly 160,000 per centre.

Yet, despite this gap, PG seats for MD and Diplomate of National Board (DNB) courses are going unfilled.

Over 18,000 PG Medical Seats Remain Vacant

"The demand for specialists is real, but secure, well-paid and desirable jobs are unevenly distributed," said Meera (name changed), a 31-year-old NEET-PG (National Eligibility-cum-Entrance Test-Postgraduate) aspirant from Bengaluru.

Uncertainty around employment, she said, makes many young doctors question whether the financial and professional risk is worth it.

"Increasingly, some are choosing alternative careers that allow them to remain connected to healthcare while avoiding clinical exhaustion, while others prepare for international exams or leave clinical medicine altogether," said Ravi Malik, director at Malik Radix Healthcare.

Zero Percentile Cut-Off Sparks Debate

This hesitation persists even as India rapidly expands PG capacity.

The number of PG medical seats rose 157 per cent to 80,291 in 2025 from 31,185 in 2014, with the government planning to add another 2,000-3,000 seats by 2029.

As a result, filling the seats on offer remains a challenge.

After two full rounds of NEET-PG 2025, over 18,000 seats remained vacant, forcing the National Board of Examinations in Medical Sciences (NBEMS) to keep slashing qualifying cut-offs.

High Fees, Low Returns Deter Doctors

This reignited controversy, especially after candidates with zero percentile scores became eligible for counselling in further rounds.

Counselling is the centralised, online process for allocating MD, MS and diploma seats in government medical colleges, managed primarily by the Medical Counselling Committee (MCC).

Zero percentile means candidates who scored the lowest in a test, or that none of the other candidates scored less.

Such relaxations have become routine.

Cut-offs were reduced to zero percentile in 2023, 2024 and, earlier, throughout the Covid years. Experts say this addresses symptoms, not causes.

"Lowering cut-offs may fill seats temporarily, but it does not resolve the uncertainty that deters candidates," said Varun Singh, founder and managing partner at Foresight Law Offices India.

Since all applicants already hold an MBBS degree, and have enough competency, he argued, a purely rank-based counselling system would be more rational than repeated eligibility tweaks.

High Costs, Low Returns

Vacancies are most pronounced in private and deemed universities, which account for nearly 10,000 unfilled seats annually.

"High fees, ranging from Rs 20 lakh to over Rs 1 crore per year, low or irregular stipends, and weaker perceived training value deter candidates," said Deepak Sharma, cofounder and CEO of MedLern.

He added that poor fee regulation in private colleges also acts as a hurdle, making higher learning a high-risk financial bet, particularly for first-generation doctors.

Branch preferences add to the imbalance.

Preferences are strongly shaped by income potential and work-life balance and working condition considerations, with specialities such as cardiology, radiology, gynaecology, orthopaedics, and general surgery traditionally being the most sought after.

Urban Concentration, Rural Healthcare Crisis

On the other hand, seats in non-clinical subjects such as pathology, anatomy and biochemistry have vacancy rates of 50-70 per cent, as many candidates prefer to drop a year rather than opt for these disciplines.

However, doctors say even traditionally sought-after clinical specialities are now seeing gaps.

"These are physically, emotionally and legally high-risk specialties and involve long working hours, high-stakes decision-making, night duties and constant responsibility for life-and-death outcomes.

"The protection and rewards attached to this risk remain inadequate," said Malik of Malik Radix Healthcare.

Mandatory service bonds further discourage uptake.

Several states impose compulsory service with penalties ranging from Rs 30 lakh to over Rs 50 lakh for non-compliance, with terms varying widely across states.

A Delhi-based gynaecologist told Business Standard that divergent bond conditions across states, uneven training quality and regional imbalances in seat distribution continue to influence candidates' choices more than eligibility thresholds.

"There is an urgent need for a uniform national bond framework with reasonable caps," she said, noting that the Supreme Court had flagged the issue as early as 2019.

'In India, doctors frequently face verbal abuse, threats, unrealistic expectations'

The Economic Survey 2024 highlighted that nearly half of India's PG seats are concentrated in southern states, alongside a stark urban-rural doctor density gap of 3.8:1.

While private and even large government hospitals in cities approach saturation point, rural and small-town facilities struggle to attract specialists due to poor infrastructure, pay and working conditions.

"The postings feel punitive rather than purposeful," a gynaecologist said.

Doctors also point to declining professional dignity, workplace violence and medico-legal vulnerability as deterrents.

"In India, doctors frequently face verbal abuse, threats during emergencies, unrealistic expectations of instant cures, and blame for systemic failures such as shortages of beds, medicines or staff," Malik said.

A doctor at the All India Institute of Medical Sciences (AIIMS), New Delhi, said the fear of violence, legal exposure and weak institutional backing make these branches increasingly unattractive to a generation seeking both professional fulfilment and personal safety.

"When young doctors see limited protection, unpredictable careers and an absence of institutional support, they hesitate," he said.

Sanjeev Singh of the Amrita Institute of Medical Sciences in Kochi added that vacancies also need to be seen in light of how quickly the medical education system has grown in the last several years.

The issue is not just poor seat utilisation, Singh added, but also undergraduate (UG) output and PG expansion not happening at the same time.

India generates over 123,000 MBBS graduates per year. At the same time, the number of PG seats has grown to around 78,000 to 80,000 in a short amount of time.

"One can only go for PG once they finish their MBBS and internship, which means a waiting period of five to six years.

"So, it will take time for the UG pipeline to fill the new PG seats that have been added," he said.

Doctors warn that unless PG training is aligned with affordability, job security, safety and health system needs, repeated cut-off relaxations risk becoming an administrative reflex.

"The real issue is not just filling seats," Meera said, "but ensuring that specialist training leads to viable, dignified careers where doctors are actually needed."

Feature Presentation: Ashish Narsale/Rediff