The shortfall has persisted despite India having the most medical schools of any nation. That's because the size of graduating classes is small – typically 100 to 150 students.
Indeed, gaining admission to India's top medical schools is akin to winning the lottery. The All India Institute of Medical Sciences in New Delhi has been rated the best medical school in India Today magazine's past five annual surveys. According to the registrar's office, it takes in only 72 students for its undergraduate course each year out of about 80,000 to 90,000 who apply – an acceptance rate of less than one-tenth of one percent. As in the United Kingdom, most medical school students attend an undergraduate program.
Similarly, Christian Medical College, a top-ranked school in the southern city of Vellore, received 39,974 applications this year for 100 places, according to a school official – an acceptance rate of 0.25 percent. By contrast, the acceptance rate at Harvard Medical School for its entering class in 2014 was 3.5 percent.
Health ministry officials and doctors say India's medical-education system began to falter following a surge in new, private medical colleges that opened across the country during the past few decades, often in remote areas.
In 1980, there were 100 government-run medical schools and 11 private medical colleges. Thirty-five years later, the number of government medical colleges has nearly doubled. The number of private medical schools, meanwhile, has risen nearly twenty-fold, according to the Medical Council of India. There are now 183 government medical colleges and 215 private ones.
'Little better than quacks'
Many of the private colleges have been set up by businessmen and politicians who have no experience operating medical or educational institutions, said MCI officials. Sujatha Rao, who served as India's health secretary from 2009 to 2010, said the boom in private colleges was driven by a change in the law in the early 1990s to make it easier to open new schools because the government was struggling to find the money to build public medical schools.
"The market has been flooded with doctors so poorly trained they are little better than quacks," Rao told Reuters.
Not that a legitimate degree necessarily makes a difference.
A study in India published in 2012 compared doctors holding medical degrees with untrained practitioners. It found "no differences in the likelihood of providers' giving a diagnosis or providing the correct treatment." The study, funded by the Bill & Melinda Gates Foundation, concluded that in India, "training in and of itself is not a guarantor of high quality."
Last year, an individual described as a "concerned" student at a rural government medical college in Ambajogai, in western India, posted a letter online with a litany of allegations about the school, Swami Ramanand Teerth Rural Medical College.
There were professors who existed only on paper, he alleged, and "no clinics and no lectures" for students in the medicine and surgery departments. Conditions were unsanitary at the hospital, and pigs and donkeys roamed the campus, he wrote. The writer also alleged that students had to pay bribes to pass exams.
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"We are not taught in this medical college," the letter stated. Students have graduated "without even attending a single day." The writer said the letter had been sent to various government agencies and health officials.
Records from the Medical Council of India, the body charged with maintaining the country's medical education standards, show that an inspection of the college this January found numerous deficiencies, including a shortage of faculty, residents and lecture theaters.
Dr. Nareshkumar S. Dhaniwala, who served as the principal of the college between 2011 and 2013, said "there is some truth in the letter." Animals, such as pigs and cows, do roam the campus, teachers and students don't turn up for lessons, and there is a scarcity of running water in the dormitories, he said. And before he joined, he said, he heard students had to pay to pass final exams.
"I found the students were not very interested in studying, they don't come to classes, they don't come to clinics," Dhaniwala said. "Medical education has gone downhill all over the country because the teachers are not as devoted as they used to be."
Sudhir Deshmukh, the college's current principal, did not respond to requests for comment.
The Medical Council of India, which was established by the government in 1934 and oversees medical education, has itself been swirling in controversy. Dr. Ketan Desai, the council's former president, faces criminal charges related to his arrest in 2010 for allegedly conspiring to receive a bribe to recommend authorizing a private medical college to accept more students. The case is still pending; Desai has denied the charges.
In interviews, medical school officials complained that the MCI had onerous inspection requirements that were outdated and arbitrary.
"The Medical Council of India is a junk body," said Dr. A. K. Asthana, principal and dean of Subharti Medical College in the northern city of Meerut, which has been accused of demanding illegal fees for admission. Asthana denies the allegations. The council has tried – unsuccessfully so far – to close the school. "I'm totally frustrated with the MCI. Totally frustrated," he said.
Dr. Vedprakash Mishra, the head of MCI's academic committee, told Reuters that the agency has created "discipline and accountability" among medical colleges by imposing fines and, in several cases, prohibiting schools from admitting students for up to two years. "We don't compromise and mitigate on the requirements," he said.
Asked about allegations of corruption within MCI itself, Mishra abruptly ended the interview. "This is not what I want to be discussing," he said.
Under the government's current regulations, private medical colleges generally must have campuses on at least 20 acres of land. Because urban real estate in India is expensive, many schools open in rural areas where recruiting qualified, full-time doctors to teach is difficult because pay scales are low and living conditions are tough.
Interviews and MCI records show that some private colleges solve the problem by cheating – they recruit doctors to pose as full-time faculty members during government inspections. The physicians work there for just a few days or weeks. Two MCI officials estimated that there are several hundred Indian companies involved in recruiting them.
In October, a doctor in New Delhi received an email from a local company called Hi Impact Consultants with the subject line: "Urgent requirement of doctors for MCI Inspection in Ghaziabad"
The email offered up to 20,000 rupees a day (about $310) if the doctor appeared for an inspection at Saraswathi Institute of Medical Sciences in Hapur, east of New Delhi. The doctor, who requested anonymity, has no connection with the college.
"If interested please revert back ASAP," the email concluded. The sender described itself as "a Medical Executive Search firm."
In an interview, Sanjeev Priyadershi, Hi Impact's executive director, confirmed that the firm had tried to recruit doctors to appear during government inspections at medical colleges where they don't normally work.
"My client wanted to hire full-time faculty members for inspection purposes," he said.
Dr. Shailendra K. Vajpeyee, the principal of Saraswathi, said the college is constantly struggling to recruit qualified professors. Vajpeyee said he knew of Hi Impact Consultants, but denied he had employed them during his 18-month tenure.
"I don't know why that email was sent" by the company, he said. He declined to comment further about the matter.
At Muzaffarnagar Medical College, where electrician Dilshad Chaudhry was taken in December, students can read medical journals and books in a sprawling, circular library and take classes in clean and modern lecture halls.
But finding enough patients to provide students with clinical experience at rural, private teaching hospitals like Muzaffarnagar is a challenge. Many people in rural India simply can't afford the cost of treatment.
School principal Agarwal denied the allegations by MCI inspectors that the college's hospital had inflated its number of patients during a 2013 inspection. "Sometimes the inspectors are biased, that is for sure," he said. He also denied the hospital had ever recruited local villagers to pose as patients.
But Dr. Vaibhav Jain, a former student at the college, told Reuters that the hospital would conduct "free check-up camps," to lure rural villagers to the facility on inspection days. He said the hospital sometimes would promise free ultrasounds, but only a small number of people would be tested. Villagers often later complained about it to students at a clinic in Bilaspur where he worked, he said.
"We used to say we can't do anything, the machine was not working," he said.
Medical education is in trouble across India, said Jain. "The truth is that many medical students aren't prepared to be doctors when they finish" college. "And the result is the patient suffers."