NEW DELHI: Even as governments cite shortage of doctors to allow more private medical colleges, six states — Delhi, Karnataka, Kerala, Tamil Nadu, Punjab and Goa — have more doctors than the WHO norm of one for 1,000 people. Yet, some can’t find enough doctors for rural public health system. Also, most doctors from these states are unwilling to move to states like Bihar or UP that suffer from an acute shortage. This again raises the question of whether merely producing more doctors can address the crunch in public health and in rural areas.The density of doctors per 1,000 people in Tamil Nadu is as high as 4, almost at the same level as countries like Norway and Sweden, where it is 4.3 and 4.2 respectively. In Delhi, the density is 3, higher than the UK, US, Canada and Japan, where it ranges from 2.3 to 2.8. In Kerala and Karnataka, the density is about 1.5 and it is about 1.3 in Punjab and Goa.TOI calculated these densities after deducting 20% from the number of registered doctors, as is done by the Medical Council of India to estimate the number of doctors actually available, since many state councils have not updated their registries. In states that have updated them through periodic reregistration, as in Delhi, the 20% reduction was not applied.Since India’s doctors are largely concentrated in urban areas, it is possible that even some states with doctor population ratios better than 1:1,000 may have shortages in rural areas. However, Tamil Nadu and Kerala boast that they have no vacancies in their rural public health systems.According to Dr Prabhakar DN, former president of the Karnataka branch of the Indian Medical Association, 40% of doctors in Karnataka are in Bangalore. “In rural areas, there is still a shortage. Bangalore is totally saturated, even for specialists. So they don’t get jobs. Doctor salaries are coming down. Suppose one hospital is doing well in an area. If three more come up in the same area, they will resort to unethical practices to get more patients. We need to focus on producing doctors for the periphery. Just producing more doctors won’t work,” said Dr Prabhakar.“Unlike engineers, who typically need to find jobs, doctors can be self-employed. If there are too many in a geographical area, they resort to unethical practices on the few patients they get to make ends meet. That’s why there is a need to calibrate the number being produced. We have told the state government to stop allowing the opening of more private colleges. They should shut down many of those that are in a bad shape, with no patients and no money to pay their faculty. The IMA is having to intervene each time to help them as they are not paid for six to eight months,” said Dr N Sulphi, secretary of the Kerala IMA.The problem also is that many of the states with high doctor-population ratios have the largest number of MBBS seats. As a result, this ratio tends to just keep getting better as more batches graduate. “But they need jobs. Many young doctors are desperate for jobs. They are willing to take up casualty duty, considered among the worst jobs and not even permanent ones. It could be a six-month job paying just Rs 40,000,” explained Dr Sulphi.Tamil Nadu IMA president Dr JA Jayalal agreed that there was a glut of doctors in cities with even consultants getting low pay. “For one post, more than 10 apply for non-clinical disciplines. In clinical, it is now one is to one. But with every passing year, the numbers are increasing, a cause for concern. Government colleges are increasing seats. Poor quality private colleges will have to shut down. That is good,” said Dr Jayalal.