My go to answer has always been that we need more colleges. But it was good to see behind the curtains of what is causing the real scarcity of doctors in India.
A layman like me finds our national relationship with foreign countries baffling. I feel emotional about countries but understand the importance of "only permanent interest, no permanent friends and all that". I also understand that there are wheels within wheels, and the whole truth of foreign relations will never come out to layman-public ever.
The voting public cannot understand foreign policy, so the electorate cannot hold the government accountable in any meaningful way. That being the situation, what are the incentives for a democratically elected government to conduct a foreign policy beneficial for the nation? Who should hold the government accountable in matters of foreign policy?
You're right. In policy areas where secrecy is the norm, it is difficult for electoral feedback to operate. Not just in India. You might like this recent new book Public Choice and the Illusion of Grand Strategy which explores the same questions from a US perspective.
Do you have any suggestion for a greater public accountability in matters of foreign-policy? I understand that the US is equally messed-up in this regard. But that is no consolation.
I think for any big nation-state, performance on domestic affairs will vastly outweigh performance on foreign policy affairs in a voters' calculus. Unless there are extraordinary situations like war or crippling sanctions.
Regardless, here are a few things that can improve things at the margin.
1. Better rules on disclosure of official histories of major foreign policy events. It will be post-facto but can provide useful lessons. For instance, the official history of Kargil War is still not made public. Even the Henderson-Brooks report has remained a "state secret" and was never properly debated.
2. We need economists in defence and foreign policy ministries, to bring in the concepts of efficiency, viability at the organisational level etc. In my interaction with defence community, I found this aspect lacking.
3. Probably, strengthening the Standing Committee on External Affairs can help provide better parliamentary accountability.
I used to think that increasing supply was clearly the solution to India's high-demand, low-supply education problems, so I used to be a big advocate for, say, more IITs. But I have since come around to the point of view that this only solves the degree-printing-machine side of the problem. As with engineering, medicine requires teachers with great science knowledge, an ability to be hands on in applying this, and to be willing and able to break this down with effective communication for others to follow. Typically, the demand for such skilled professionals in non-academic settings is so high (and their pay commensurate to that demand), it's much harder to convince them to actually teach for a pay that then struggles to keep up. Sure, that too can be addressed with "right" incentives but that quickly reduces to a "who will bell the cat" situation.
Agree with you. This can't resolve all problems. No one policy instrument can. But increasing the number of healthcare professionals is a necessary and insufficient part of the solution.
Here, I do not see a "who will bell the cat" situation. Privatize and make profit-making legal in education. The market will figure a way out.
Let me blabber some ideas about bringing the cost down while maintaining high quality:
1. Judicious mix of few expert-teachers and a considerable number of less-skilled helper-teachers.
2. Practice using modern virtual-reality based techniques. I can fantasize about a star-trek-holodeck kind of program for skill practice a few years down the line.
3. Pay the expert teachers even higher than the industry because the 'value' the institutes will extract from the expert-teacher will be much more than the salary. It is feasible.
My reference to "bell the cat" was from the perspective that I thought the obvious solution to the problem I posed would be to suggest paying the teachers more. To me, that translates to a substantial increase in investment to start these institutions (in addition to crossing all the hurdles Pranay's excellent article covers). Who will then make this investment in sufficient volume to cover the demand? IMHO, there have barely a handful of private colleges that have made investments that put them even on a comparable to their government counterparts (BITS? Manipal? Ashoka? ISB?). Government institutes (AIIMS, IITs, NITs) come closer to what is required, but are still far below international levels. (Note that good teachers have international demand: US colleges happily import them.)
I think your solutions are interesting, but IMHO, the problem is a lot harder. I'd argue that your first solution is already the current state of affairs in our best institutions where the fundamental sciences, etc., are covered by non-experts (often barely grads themselves). I was a big fan of things like MOOCs (did a couple of courses even :-)), but the expected revolution didn't quite materialize. Seeing MIT videos online are, alas, proved insufficient to make us all MIT engineers :-(. Learning in many of these subjects is driven by hard practice and trial under expert guidance, which often lands us back to the physical domain. But, despite being jaded, I'm still hopeful that there might be innovation here that can help in some way, without quite seeing completely how it will.
India today has a vast supply of (frankly, very) low quality institutions. I'd argue that what makes people go abroad (to even places like Ukraine, to circle back to the starting point of Pranay's article) is not just supply, but supply at the given cost. Take the Rs. 30L/year number that Pranay quotes for private colleges that are often already way off from even their local government counterparts in quality. That's $40k/year, an amount many excellent US colleges will happily accept to give you education. (It's why undergrads are now the majority of the Indian population at US universities once dominated overwhelmingly by grad students.) In other words, what I'm saying is that just increasing (poor quality) supply won't solve this problem effectively for those who can now pay significant amounts (although, yes, it is an important part).
Thanks for going through my comments and writing such a detailed reply.
I am not sure whether BITS/Manipal/Ashoka can make profits without any restriction on fees they can charge. I am not sure whether there is 'true' privatization in any field/stage of education in India.
I keep wondering why the Government does not allow for-profit educational institutes to exist. It will not cost a paisa.
Can you post your sources here? I am working on a whitepaper on Indian medical education and the sources to your figures saves me a lot of trouble. Thanks.
You covered several points. However the malaise goes deeper. There is extensive criticism on private colleges but very minimal scrutiny of government colleges and institutes of national importance. For e.g. how many graduates from these institutions have stayed back in India for starters? How many of those stayed back have worked in tier 2 & tier 3 cities? A significant number of doctors from these institutes take advantage of tax payer funded subsidized education to settle abroad. Is there any discussion on this at all?
My go to answer has always been that we need more colleges. But it was good to see behind the curtains of what is causing the real scarcity of doctors in India.
A layman like me finds our national relationship with foreign countries baffling. I feel emotional about countries but understand the importance of "only permanent interest, no permanent friends and all that". I also understand that there are wheels within wheels, and the whole truth of foreign relations will never come out to layman-public ever.
The voting public cannot understand foreign policy, so the electorate cannot hold the government accountable in any meaningful way. That being the situation, what are the incentives for a democratically elected government to conduct a foreign policy beneficial for the nation? Who should hold the government accountable in matters of foreign policy?
You're right. In policy areas where secrecy is the norm, it is difficult for electoral feedback to operate. Not just in India. You might like this recent new book Public Choice and the Illusion of Grand Strategy which explores the same questions from a US perspective.
Do you have any suggestion for a greater public accountability in matters of foreign-policy? I understand that the US is equally messed-up in this regard. But that is no consolation.
I think for any big nation-state, performance on domestic affairs will vastly outweigh performance on foreign policy affairs in a voters' calculus. Unless there are extraordinary situations like war or crippling sanctions.
Regardless, here are a few things that can improve things at the margin.
1. Better rules on disclosure of official histories of major foreign policy events. It will be post-facto but can provide useful lessons. For instance, the official history of Kargil War is still not made public. Even the Henderson-Brooks report has remained a "state secret" and was never properly debated.
2. We need economists in defence and foreign policy ministries, to bring in the concepts of efficiency, viability at the organisational level etc. In my interaction with defence community, I found this aspect lacking.
3. Probably, strengthening the Standing Committee on External Affairs can help provide better parliamentary accountability.
I used to think that increasing supply was clearly the solution to India's high-demand, low-supply education problems, so I used to be a big advocate for, say, more IITs. But I have since come around to the point of view that this only solves the degree-printing-machine side of the problem. As with engineering, medicine requires teachers with great science knowledge, an ability to be hands on in applying this, and to be willing and able to break this down with effective communication for others to follow. Typically, the demand for such skilled professionals in non-academic settings is so high (and their pay commensurate to that demand), it's much harder to convince them to actually teach for a pay that then struggles to keep up. Sure, that too can be addressed with "right" incentives but that quickly reduces to a "who will bell the cat" situation.
Agree with you. This can't resolve all problems. No one policy instrument can. But increasing the number of healthcare professionals is a necessary and insufficient part of the solution.
Here, I do not see a "who will bell the cat" situation. Privatize and make profit-making legal in education. The market will figure a way out.
Let me blabber some ideas about bringing the cost down while maintaining high quality:
1. Judicious mix of few expert-teachers and a considerable number of less-skilled helper-teachers.
2. Practice using modern virtual-reality based techniques. I can fantasize about a star-trek-holodeck kind of program for skill practice a few years down the line.
3. Pay the expert teachers even higher than the industry because the 'value' the institutes will extract from the expert-teacher will be much more than the salary. It is feasible.
I would like to know your points of disagreement.
My reference to "bell the cat" was from the perspective that I thought the obvious solution to the problem I posed would be to suggest paying the teachers more. To me, that translates to a substantial increase in investment to start these institutions (in addition to crossing all the hurdles Pranay's excellent article covers). Who will then make this investment in sufficient volume to cover the demand? IMHO, there have barely a handful of private colleges that have made investments that put them even on a comparable to their government counterparts (BITS? Manipal? Ashoka? ISB?). Government institutes (AIIMS, IITs, NITs) come closer to what is required, but are still far below international levels. (Note that good teachers have international demand: US colleges happily import them.)
I think your solutions are interesting, but IMHO, the problem is a lot harder. I'd argue that your first solution is already the current state of affairs in our best institutions where the fundamental sciences, etc., are covered by non-experts (often barely grads themselves). I was a big fan of things like MOOCs (did a couple of courses even :-)), but the expected revolution didn't quite materialize. Seeing MIT videos online are, alas, proved insufficient to make us all MIT engineers :-(. Learning in many of these subjects is driven by hard practice and trial under expert guidance, which often lands us back to the physical domain. But, despite being jaded, I'm still hopeful that there might be innovation here that can help in some way, without quite seeing completely how it will.
India today has a vast supply of (frankly, very) low quality institutions. I'd argue that what makes people go abroad (to even places like Ukraine, to circle back to the starting point of Pranay's article) is not just supply, but supply at the given cost. Take the Rs. 30L/year number that Pranay quotes for private colleges that are often already way off from even their local government counterparts in quality. That's $40k/year, an amount many excellent US colleges will happily accept to give you education. (It's why undergrads are now the majority of the Indian population at US universities once dominated overwhelmingly by grad students.) In other words, what I'm saying is that just increasing (poor quality) supply won't solve this problem effectively for those who can now pay significant amounts (although, yes, it is an important part).
Thanks for going through my comments and writing such a detailed reply.
I am not sure whether BITS/Manipal/Ashoka can make profits without any restriction on fees they can charge. I am not sure whether there is 'true' privatization in any field/stage of education in India.
I keep wondering why the Government does not allow for-profit educational institutes to exist. It will not cost a paisa.
A (sort of) related article I just came across on the US doctor supply problem that may serve as a bit of a counterpoint to what I've said above: https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/
Thanks for this article. Many parallels with our system but we are starting from a base that is incomparable with the US.
Can you post your sources here? I am working on a whitepaper on Indian medical education and the sources to your figures saves me a lot of trouble. Thanks.
Sources are hyperlinked in the post already.
You covered several points. However the malaise goes deeper. There is extensive criticism on private colleges but very minimal scrutiny of government colleges and institutes of national importance. For e.g. how many graduates from these institutions have stayed back in India for starters? How many of those stayed back have worked in tier 2 & tier 3 cities? A significant number of doctors from these institutes take advantage of tax payer funded subsidized education to settle abroad. Is there any discussion on this at all?