RURAL vs URBAN Healthcare Jobs: Where are Doctors needed the most?

By Dr. Adeela Anees, MBBS

India’s Healthcare future depends on bridging the gap between Urban and Rural communities through policy changes and smarter workforce planning.

According to a study by the National Health Workforce Account (NHWA 2018), there’s a total population of 5.76 million health workers, which includes allopathic doctors, nurses/midwives, pharmacists, dentists, and traditional medical practitioners. However, the active health workforce size estimated by NSSO (2017–2018) is significantly lower (3.12 million), with allopathic doctors and nurses/midwives estimated at 0.80 million and 1.40 million, respectively.^[1]

The findings revealed a significant imbalance in the distribution of the health workforce between rural and urban areas, as well as within the public and private sectors. India’s Healthcare future depends on bridging the gap between Urban and Rural communities through policy changes and smarter workforce planning.

Total health workforce (NHWA 2018)

Estimated at 5.76 million, including:

• Allopathic Doctors

• Nurses/midwives

• Pharmacists

• Dentists

• Traditional medical practitioners

Active health workforce (NSSO 2017–2018)

Significantly lower at 3.12 million, including:

• 0.80 million allopathic doctors

• 1.40 million nurses/midwives

Workforce density (per 10,000 population)

• NHWA stock figures:

  • Doctors: 8.8

  • Nurses: 17.7

• NSSO active workforce estimates:

  • Doctors: 6.1

  • Nurses: 10.6

• After adjusting for adequate qualifications:

  • Doctors: 5.0

  • Nurses: 6.0

WHO threshold recommendation

• 44.5 doctors, nurses, and midwives per 10,000 people

• India's active and qualified workforce falls well below this standard

Rural vs Urban Healthcare disparity

• Two-thirds of all health workers are based in urban areas
  

• Yet 66% of India’s population lives in rural areas
  

• Rural presence of professionals:
  

  • Doctors: only 27%
    

  • Nurses: only 36%
    

  • Dental workforce: even lower rural presence

State-level disparities

• Acute shortages in less-developed states like:

• Bihar, Jharkhand, Odisha, Rajasthan, Uttar Pradesh

• Indicates a need for region-specific policy interventions

Public vs. private sector imbalance

• A large majority of health workers are employed in the private sector

• Creates challenges for public healthcare delivery, especially in rural areas

India's healthcare system faces an enormous challenge, while rural areas house nearly 65% of the population, they remain underserved by qualified medical professionals. Despite numerous government initiatives, attracting and retaining doctors in these areas continues to be a major problem.

Let's understand the real barriers faced by young doctors, which will help in building a healthcare system that is accessible to all.

Curriculum Gaps and Lack of Rural Relevance

• Medical UG and PG courses lack a specific health context.

• Diseases prevalent in rural India receive minimal coverage in medical education, resulting in doctors being unprepared and disinterested in rural postings.

Inadequate Clinical Training

• Overcrowded hospitals leave students with limited hands-on clinical experience.

• Over-reliance on labs and imaging—resources often unavailable in rural settings.

• Internship is now reduced to a formality due to PG entrance exam pressure, and the 3-month community medicine rotation is poorly implemented.

Forced Rural Service Without Proper Compensation

• State governments use compulsory service bonds to push doctors into rural areas without offering fair salaries, with most states lacking clear policies on integrating bonded doctors into long-term service, with no clarity and guidance on career progression and permanent employment post-bond.

Poor Infrastructure and Working Conditions

• Doctors in PHCs face severe limitations of medications, laboratory and imaging support.

• Remote locations deter young doctors, especially those with families.

• No proper schooling or healthcare access for doctors’ families in rural postings.

Physical and Social Isolation

• Many PHCs are built far from actual villages, often across large tracts of agricultural land.

• Lack of proper internet and connectivity.

To tackle the severe shortage of doctors in rural areas, India’s central and state governments have introduced various policies and incentives designed to attract and retain healthcare professionals in rural areas and strike a balance between urban and rural healthcare.

1) Education-Based Incentives and Inclusion

• Reserved MBBS seats for rural students (district quota).

• Mandatory 3-month rural internships during MBBS.

• Government sponsorship/preference for PG courses linked to rural service.

• Revise the medical curriculum to include rural health challenges and Indian research.

• Inculcating the importance of community medicine during Medical school studies

2) Institutional Expansion

• Expanding Medical Colleges in Districts and rural areas with qualified faculty and facilities

• District hospitals offering DNB training as alternatives to urban programs.

• Utilizing AYUSH graduates to supplement rural health services.

3) Motivation & Environment

• Supportive social environment and living conditions

• Work ethics, respect, mentorship, and promotion opportunities

• Mapping Areas of need and offering career growth opportunities

4) Access to Technology

• Use telemedicine and distance learning for rural doctor support

• Facilitate health education, appointment scheduling, medication reminders, and monitoring chronic conditions via smartphones

• Portable Diagnostic Devices

• Electronic Health Records (EHR)

• AI & Machine Learning

• Solar-Powered Health Facilities

Current government schemes in place to reform and cater to the growing urban and rural healthcare needs:

The National Urban Health Mission (NUHM) is a flagship initiative by the Government of India, launched in 2013 as a sub-mission under the National Health Mission (NHM). Its primary objective is to improve the health status of the urban poor and other vulnerable populations by providing equitable access to quality healthcare services.

As per the mission, it has created a valuable impact in the above sectors:

1) As of 2022,5,000 UPHCs have been established with progress in slum and facility mapping across cities.^[2]

2) Deployment of over 78,000 ASHAs and formation of more than 80,000 MAS to engage communities in health initiatives.

3) Implementation of National Quality Assurance Standards (NQAS), with 150 UPHCs certified as of June 2022.

The above-mentioned efforts have led to improved immunization rates, increased institutional deliveries, and better management of non-communicable diseases in urban areas.

The National Rural Health Mission (NRHM) is an initiative launched by the Government of India in 2005 to provide accessible, affordable, and quality healthcare to the rural population, especially women and children.^[3]

Objectives of NRHM:

1) Reduce maternal and child mortality.

2) Strengthen health systems in rural areas by upgrading Sub-Centres, PHCs, and CHCs across states.

3) Promoting community participation through ASHAs and Village Health Committees

4) Incorporating mainstream AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) into the public health system.

5) Improve nutrition and sanitation in cooperation with other sectors and promote awareness on hygiene, nutrition, and immunization.

The National Rural Health Mission has played a major role in strengthening rural healthcare delivery, making quality health services more accessible and equitable across India.

References:

1. Karan, Anup, Himanshu Negandhi, Suhaib Hussain, Tomas Zapata, Dilip Mairembam, Hilde De Graeve, James Buchan, and Sanjay Zodpey. “Size, Composition and Distribution of Health Workforce in India: Why, and Where to Invest?” Human Resources for Health 19, no. 1 (March 22, 2021): 39. https://doi.org/10.1186/s12960-021-00575-2. Accessed September 1, 2025.

2. National Health Systems Resource Centre (NHSRC), India. “Urban Health (NUHM).” NHSRC. Accessed September 1, 2025. https://www.nhsrcindia.org/practice-areas/kmd/urban-health-nuhm

3. Ministry of Health & Family Welfare (MoHFW), Government of India. “National Urban Health Mission (NUHM).” National Health Mission. Accessed September 1, 2025. https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=969&lid=49

Reviewed by Dr. Sumbul MBBS, MD

_MSM