Every now and then in India, education generally and medical education and primary education specially, generate a lot of heated discussion. After a while things go back to their original state as everyone goes off to see a good movie or an IPL match. These two topics, I ought to point out, are at the opposite ends of capital intensity.Primary education requires a teacher, a blackboard and a good shady tree, which is where my own primary education started back in 1956. It was a ramshackle missionary school. My father was the Collector in what was a very small town then.Medical education, on the other hand, requires, about 18 years later, a lot of capital. It takes around ₹400 crore today of initial investment to start a medical college, not to mention the operating costs.People who have their hearts in the right place, if not their brains, are unaware of the most important aspect of all this: the economics. If medical education needs a lot of money, primary education needs a lot of time.It’s as hard to create even an average level doctor as it is to teach a six-year old to read and write, let alone to count. So we come back to the most basic of all questions in economics: time and money. Both are scarce.Scarce money, wasted timeTime is scarce because, if at the end of high school you will be doing what you were doing without that education, you can justifiably ask why should I go through all that trouble and boredom and angst.And money because, unlike time, it’s simply not there to meet the demand for doctors. If we want a doctor for every 1,000 people, we need 700,000 more doctors. This means that we need, at 250 doctors per year from one college, 400 new colleges. 400X400. That means how many crores?Economics calls this the opportunity cost, in this case of education. It’s defined as what you lose when you choose option A over option B.Here’s another problem: without primary education you can’t have a doctor. So where would you rather spend those lakhs of crores? This, too, is a form of opportunity cost.Which leads to two other questions. If you have ₹100 to spend on education, how will you divide it between primary and medical education? And who will bear how much of the cost between States and Centre?India, to its credit, has been grappling with these issues since the mid-1960s. Several reports have been written. Different governments have tried different solutions. Absolutely nothing seems to have worked because need-based demand has far outstripped resources-based supply.Before we start beating ourselves up, remember that all countries are short of domestically trained doctors. That’s why they import doctors and export patients under the misleading name of medical tourism.Import doctorsAlternatively, if you want one doctor for every thousand people the world would need eight million doctors. The current stock of doctors is 14 million but unevenly distributed between rich and poor countries.This suggests that the poor countries should be importing doctors, not exporting them. India currently does not allow the “commercial” importation of doctors. Instead, it imports patients, around 500,000 a year, as if domestic demand for medical services is low.Here I have a confession to make. Back in 1988 I wrote a research paper for ICRIER (unpublished because it was deemed too ‘journalistic’) saying that India should import patients instead of exporting doctors.Now we are doing both, which means we have got one half right. Today it’s the other half, the importation of doctors, which is important. The revenue from the imported patients can pay for the cost of importing doctors.The massive supply-demand gap, meanwhile, explains the high demand for medical education. Currently as many as 25,000 Indians are studying medicine abroad. They spend around ₹7,500 crore each year.This is seen as worthwhile because, apart from the social status a doctor enjoys, the returns over a working life of, say, 45 years are far more than in any other occupation. The average income of a doctor is around ₹7,000 a day.It’s skewed downwards by the less experienced doctors who earn far less than the senior ones. Doctors in government service also skew earnings downwards.If this skew is rectified even a bit, the average daily income of a doctor would be even higher. Is it any wonder that the demand for medical education is so high?Interestingly, not many doctors want to join government service in spite of the non-monetary benefits. It’s too much work for too little money.TailpieceOne final observation about our cockroaches: student movements are transient ab initio because the students soon become mummies and daddies.Published on August 3, 2026