India has more doctors, but poor care. Is relicensing the answer?

A key finding of the recently released The Lancet Commission report on a citizen-centred health system for India is stark: while access to healthcare has improved significantly over the years, the quality of care has failed to keep pace.

The report underlines that uneven quality of care sharply limits the benefits of expanded access, often resulting in low-value or even harmful health services for a large section of the population. In short, getting more people into hospitals has not necessarily translated into better health outcomes.

Expanding on this concern in an interview with India Today, The Lancet’s editor-in-chief Dr Richard Horton pointed to a systemic failure that, he said, contributes directly to preventable deaths across India’s healthcare system.

“Many patients in India die despite reaching a hospital,” Horton said, “because of the wrong diagnosis, wrong treatment, wrong drug, or wrong follow-up.”

‘DOCTORS PRACTICE FOR 40 YEARS WITHOUT OVERSIGHT’

Using doctors as an example, Horton questioned India’s system of lifelong medical licencing.

“Doctors qualify at roughly 25 years of age and then can practise for 40 years,” he said. “And nobody pays attention to what you’re doing. There’s no relicensing, no checking on whether they are practising good or bad medicine.”

Calling this approach “mad,” Horton contrasted it with the UK, where medical regulators introduced reforms after a series of failures.

“Now, every five years, a doctor in the UK has to go through a process called revalidation, where they must prove that they are competent to practise medicine,” he said.

In most developed countries, doctors are required to undergo periodic revalidation that includes annual appraisals, peer and patient feedback, proof of continued medical education, and in some cases, written or practical examinations to demonstrate clinical competence.

Horton cited India’s growing crisis of antimicrobial resistance (AMR) as a telling example of poor clinical oversight. He said that irrational prescribing of antibiotics—often without following established protocols—has played a major role in driving resistance.

The implication was clear: without mechanisms to assess and correct clinical practice over time, poor-quality care becomes entrenched, regardless of how many doctors the system produces.

India has periodically considered introducing a centralised relicensing or revalidation framework but has so far failed to implement one.

Over the past decade, however, several state medical councils have made the accumulation of Continuing Professional Development (CPD) credit points mandatory for doctors.

Yet many public health experts and medical educators argue that while The Lancet Commission and Dr Horton correctly identify the problem, they stop short of diagnosing its deeper causes.

‘POOR QUALITY CARE A SYMPTOM, DISEASE DEEPER’

According to Dr Dilip Mavlankar, former director of the Indian Institute of Public Health, the real issue lies in the structural neglect of public healthcare and the unregulated nature of private healthcare.

“In government hospitals, doctors are forced to see an overwhelming number of patients in severely resource-constrained settings. Mistakes are inevitable,” he said. “In private hospitals, where doctors are often given monthly revenue targets, overtreatment and overdiagnosis are not always accidental.”

Dr Mavlankar stressed that primary and secondary healthcare—meant to form the backbone of the public system—have been systematically neglected for years.

“There has been virtually no meaningful increase in health budget allocation over the past several years,” he said.

In the Union Budget 2026, presented by Finance Minister Nirmala Sitharaman, the Ministry of Health and Family Welfare was allocated Rs 1.05 lakh crore, just 9.2 percent higher than last year’s revised estimate, reinforcing concerns about chronic underfunding.

Echoing this view, Dr Abhay Gadre, a member of the Association of Doctors for Ethical Healthcare (ADEH), said Horton’s remarks highlighted visible symptoms without addressing the systemic disease underneath.

“For decades, the government has starved public hospitals of funds while tacitly encouraging patients to seek specialist care in the private sector—without putting checks, balances, or enforceable treatment protocols in place,” he said.

Dr Gadre, known for whistleblowing on unethical practices in Indian healthcare, argued that medicine has been reduced to a commodity, despite the deep power and knowledge imbalance between doctors and patients.

Patients, he said, often have little choice and even less recourse.

NO ACCOUNTABILITY, NO REDRESSAL

A major concern raised by experts is the lack of accountability mechanisms. According to Dr Gadre, the National Medical Commission (NMC)—India’s apex regulator for medical education and professional conduct—offers patients no effective redressal system for complaints of negligence or unethical treatment.

NMC’s predecessor, Medical Council of India, which was wounded up on the account of being "corrupt" and "inefficient", on the other hand, at least had this provision, many say.

“There is virtually no accountability for anyone,” Dr Gadre said.

Other experts pointed to problems at the very foundation of the system: medical education and clinical training.

Dr Ravi Wankhedkar, former president of the Indian Medical Association (IMA) and a former faculty member at a government medical college in Maharashtra, said poor-quality care was closely linked to how doctors are currently trained.

“The government is allowing medical colleges to open left, right and centre without ensuring adequate infrastructure or faculty,” he said. “Medical education is increasingly geared towards clearing multiple-choice speciality entrance exams, not towards learning clinical medicine.”

India now produces over one lakh MBBS graduates every year from more than 700 medical colleges across states. Nearly half of these graduates come from private colleges, where fees can exceed Rs 1 crore.

Critics argue that such high costs create perverse incentives.

“Doctors who pay these fees are under immense pressure to recover their investment,” said one public health expert, “and patient welfare often takes a back seat.”

“Doctors trained in India were once celebrated globally,” Dr Wankhedkar said. “Today, many new graduates are little more than technicians—treating patients based on investigation reports rather than careful clinical examination.”

While experts agree that relicensing and revalidation are standard in most developed countries, they caution that simply importing these norms into India will not fix a deeply broken system.

Even basic reforms have struggled to take off.

The government has failed to implement the National Exit Test (NEXT)—a common licensing exam for MBBS graduates envisioned under the NMC Act—after facing sustained protests from medical students.