Doctors For The World: Indian Physician Emigration

Fitzhugh Mullan

Health Affairs. 2006;25(2):380-393. 

In This Article

Returning Home

Some numbers of expatriated Indian physicians do return to India. "No one ever really wants to abandon their country," an oncologist trained in Texas who returned to Chennai told me. "You always leave a little of your heart behind." The number of nonresident Indian (NRI, a term frequently used to characterize Indians who have moved abroad regardless of their precise emigration status) physicians returning is increasing. New proprietary hospitals and high-tech medical centers catering to "medical tourism" have recruited many NRI physicians because the quality and prestige of their international credentials are an important element in the institutions' marketing strategy.

Problems of Resettling

Returning is often not easy, even for those with a strong sense of motivation. "The logistics of resettling are daunting," was the way one recent returnee put it. Although the income of returned physicians might be substantial, adjustment to life in India can be difficult for families. Professional life requires readjustment as well. "Everybody with a laparoscope wants to take out every appendix and gall bladder they see," a successful, British-trained transplant surgeon told me. "You have to compete and market yourself." He also cited omnipresent "civil corruption," the absence of good regulation of hospitals, the lack of credentialing, and the generally " uncontrolled and uncoordinated health care system" as problems for him and others who trained in the West.

Attracting Capital

It is widely believed that NRI physicians, as other NRIs, send considerable amounts of money home, helping India with hard-currency accumulation. Although estimates are available on overall remittances to India, no specific data exist on physicians' remittances. Several observers told me that they did not believe that physicians emigrating to the West, coming as they did from generally wealthier families, sent a great deal of money home.

A new area of financial engagement for NRI physicians, however, is investment in commercial medical enterprises such as hospitals, medical colleges, and medical equipment firms. A variety of economic and immigration policies are being modified explicitly to attract NRI capital back to India.[24] Additionally, the children of Indian expatriate families are returning to India to study medicine, drawn, in part, by private medical colleges whose sizable (by Indian standards) tuitions are nonetheless attractive by U.S. standards. These students then compete for U.S. residency training positions as international medical graduates (IMGs). The Manipal Medical College system, for instance, reserves 30 percent of its seats for NRIs. The SRI Ramachandra Medical College in Chennai has established a relationship with Harvard Medical International, bringing a global educational brand to the school, which presumably helps its competitive position.