Opinion As young doctors turn away from specialties, a crisis looms over Indian healthcare

Decades ago, most MBBS graduates came from modest economic backgrounds. Their driving force was ambition to build a career, to take up demanding specialties, and to contribute to society while also growing professionally. Today, the scenario is different. Many young graduates come from comparatively secure financial and social circumstances. Their priority is not ambition or professional expansion, but rather peace of mind and work-life balance. This change did not happen by chance.

The new generation of doctors grew up in an age of endless information. They have coaching apps, MCQ banks, video lectures, and online notes. One would imagine that this would make them better prepared. Yet, their learning is shallow. They read widely but skim the surface. They cram for exams but fail to build deep reasoning. Knowledge becomes fragmented, broken into modules and bite-sized notes. The purpose becomes clear: Not learning medicine, but clearing exams.

This comes at a cost. Cognitive fatigue sets in. With too much material to consume, curiosity dies. Passion fades. The joy of learning medicine, which once drove students, is replaced by a mechanical grind.

CBME: Noble in aim, mixed in effect

In 2019, India introduced the Competency-Based Medical Education (CBME) curriculum. It was meant to produce more skilled and patient-ready doctors. The plan was noble. The impact, less so. CBME made learning more structured, but also more mechanical. Students tick boxes in logbooks, complete checklists, and perform fixed competencies. The freedom to explore is lost. Assessments come too often. Documentation is heavy. Instead of inspiring curiosity, it adds stress. Autonomy shrinks. Students feel monitored at every step. The result: Doctors who know protocols, but who lack the inner drive to go beyond them.

Alongside this, India’s health system has changed. The rise of big corporate hospitals has eaten away at independent practice. Once, a young specialist could open a clinic, build trust, and grow. Now, the path is narrow. Corporate hospitals offer jobs, but little room for individuality or entrepreneurship. Doctors feel like employees in a machine, not professionals shaping their own careers. This has dulled ambition further.

The weight of mental health

Mental health looms large over these choices. Suicide rates among doctors are two to three times higher than in the general population. The reasons are well known: Heavy workload, long shifts, constant legal risks. Seniors live this life. Juniors see it. They watch their teachers grow weary from 36-hour duties. They see families strain under the weight of endless emergencies. They hear of colleagues taking their lives.

The message is clear. Do not take on too much. Do not go into branches that demand your whole life. So when it comes to super-specialties, many step back. Why spend years in training only to inherit more duty hours, more risk, and little reward? Here lies another truth. Super-specialty courses like DM and MCh are among the hardest. They demand years of sacrifice. Residents toil in government hospitals with crushing loads.

But when they finish, the pay does not match the effort. A surgical gastroenterologist or cardio-thoracic surgeon may perform very difficult and challenging life saving surgery every day. Yet, in the public system, their salary equals that of a doctor at a primary health care. There is no recognition for the extra years, the higher skill, the constant stress. For many, the decision is rational. Why take a harder path when the end looks the same?

The signs are already here. In Tamil Nadu’s recent super-specialty counselling, more than half the seats went vacant. Among government service doctors in particular, few wanted to step forward. There is a huge shortage of specialists in public sector hospitals. Government hospitals weaken as a result. Students lose teachers. Patients lose advanced care. The poor, who depend on public hospitals, lose most of all.

As specialists vanish from government service, corporate hospitals fill the gap. But treatment there is costly. Complex care becomes unaffordable to the common man.

This is the silent crisis.

What must change

The problem is not the young doctors. Their reluctance is not weakness. It is a rational response to what they see around them. If India wants strong super-specialists in the public sector, the system must change. Financial recognition is key — higher pay scales, allowances, or faster promotions for those who take up super-specialty posts. When it comes to workload management — clear duty hours, adequate support staff, less administrative burden. Counselling, stress management, peer support to prevent burnout are crucial in mental health management. Career flexibility is another aspect; there need to be opportunities for research, academic growth, and even government-sponsored international training. Without these changes, the pipeline of super-specialists will keep drying. Vacant seats will grow. Vacant posts will follow.

The price will be paid not only by doctors, but by millions of patients. This is not just a doctor’s crisis. It is a public health crisis.

Why the change is rational

It is easy to blame young doctors for lack of ambition. But that is too simple.

What they want is not luxury, but sanity. The old guard often speaks of grit. They say, “We worked harder. We faced worse. Why not you?” But the context is different. The earlier generations saw hope. They believed long years would bring prestige, independence, and financial growth. They opened clinics, built hospitals, and rose on their own terms. Today, that path is closed. The corporate model has taken it away. Now, the choice is between being a cog in a large machine or fighting burnout in the government system. Young doctors are not turning away from ambition. They are responding to a system that offers little reward for sacrifice.

The crisis is silent now. But it will not stay silent. It will show in mortality numbers. It will show in the despair of families who wait for a surgery that never comes. It will show in the collapse of trust in public hospitals. This is preventable. Young doctors are not choosing the easy way. They are choosing survival. They are sending a signal. It is time to listen.

Dr Sivabalan is an author, and professor and head, Department of Psychiatry, Sri Lalithambigai Medical College and Hospital, Chennai