Many of the states that have extremely low availability of doctors for their population are also the ones with the lowest number of medical colleges andMBBS seats . Further, in most of these, like in the rest of the country, doctors and medical colleges are concentrated in urban areas leaving large swathes of rural areas underserved or with no doctors at all barring the few who serve in the public health system.In some of these states, like Uttar Pradesh, a large number of medical colleges have been opened in the last decade. However, most were private colleges where the tuition fees alone (not including fees for library, laboratory, building, advanced training and development) ranged from Rs 10 lakh to Rs 17 lakh per year, thus ensuring that only the very rich get admission. This is despite the central and state governments knowing fully well that students who pay from half a crore to a crore of rupees to do an MBBS are unlikely to serve in rural areas where the shortage is most acute.Jharkhand, the worst off with just one doctor for every 8,000 people also happens to be the state with the least number of medical colleges, just three government colleges with 300 seats. This is barely more than the number of doctors being produced annually in several of the bigger colleges in India.Of the seven government colleges in Chhattisgarh, six were opened since 2000, two in the last five years. Of the three private colleges established in the state in the last five years, none have been allowed to take in new students for the current year, because the Medical Council of India inspection found them not up to the mark.In a bid to ensure rural students get admission in medical colleges, state governments have been trying to encourage colleges in underserved districts. Tamil Nadu, which has the highest doctor density in the country, has a medical college in 21 out of 32 districts. Kerala, with a density of one doctor per 535 persons, has just one of its 14 districts without a medical college. Andhra Pradesh has a medical college in every district.Yet, many of these are private colleges, typically beyond the reach of most middle class and poor students. For instance, there are just 10 governmentcolleges in Kerala but 14 districts and Tamil Nadu has just 25 government colleges but 32 districts. And these are the better off states in terms of the geographical spread of medical colleges.According to a WHO report on healthcare personnel, 80% of doctors in India are concentrated in urban areas leaving just 20% to serve the countryside, where over 65% of the population lives. Even developed countries like the US, Canada and Australia with high doctor-population ratios have found having more doctors does not automatically mean having enough in rural areas.