Salary Trends of Doctors in India, 2016

1. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm Salary Trends of Doctors in India, 2016 A Review by Hi Impact Consultants –India’s Leading Doctor Recruitment Company By: Dr. Tulika Roy & Sunny Sinha For: http://www.hiimpact.in/

2. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm fafa Setting the Context

3. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm H ealthcare sector in India is emerging as one of the largest sectors - both in terms of revenue and employment. The overall sector is pegged at around US$ 100 billion currently and is expected to grow to US$ 280 billion by 2020 at a CAGR of over 22%. With 4% contribution to the country’s GDP, it is the fifth largest employer among all sectors, both in terms of direct and indirect employment. The sector offers direct employment to nearly five million citizens in the country. Strengthened coverage, and increased investments by both public and private players, has empowered the sector, which is expected to generate close to 7.5 million direct opportunities by 2022.[1] Bureau of Labour Statistics (BLS) also expects the total workforce employed by the sector to grow at a CAGR of 19% by 2024, projecting demand of over 2 million health care practitioners, with 50% being offered to Physicians, Specialist Doctors and allied paramedical staff. [2] As per The World Health Report 2000, by World Health Organization, India ranked 112 amongst 190 countries on the overall performance of health system, raising few fundamental questions on the system: [3] How should the country transform its healthcare system? What are the loopholes of the industry? Rise in population (currently pegged at 1,261,527,930) and increasing life expectancy underline the high domestic demand for healthcare services. Even though the nationwide healthcare system is run at both the centre and state levels, but mistrust, low quality services and less penetration in rural regions, have helped establish a supportive private healthcare network. Currently, 70% of those in urban cities and 63% of those in rural areas prefer to access private healthcare services. [4] Currently, India stands at a cross-road of high-end, multi-specialty private healthcare services on one end and lack of doctors, support staff, medicines and facilities at the other. High-end facilities and education platforms are concentrated near metropolitan cities (World Health Organization year 2012 reported that only 26% of healthcare professionals were available to address the needs of 72% of the country’s population). [5] India produces the finest quality of doctors, but unfortunately due to high population rate and doctor deficit, India has a very poor Patient Doctor Ratio of approximately 1:1700, whereas the World Health Organization (WHO) stipulates and recommends a minimum ratio of 1:1000. Hence recruiting doctors is an important & crucial aspect in India. [6] Availability of trained medical practitioners (doctors) is critical for the growth of the industry. So we have attempted to delve little deeper in subjects like challenges associated with recruitment of doctors and the emerging salary trends especially for MBBS, MD/MS, DM/MCh doctors across the country.

4. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm “The healthcare system generates more employment per unit established as compared to other sectors that are given priority and supported by the government in India… …Around 50,000 medical students graduate every year, whereas the number of PG seats are only approx. 15,000 in MD, MS courses. Scarcity of PG seats leads to migration of students opting for higher education, fellowship programmes and job opportunities outside of India” -Sanjeev Priyadershi CEO, Hi Impact Consultants

5. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm According to the Medical Council of India (MCI), over 27,000 medical candidates graduate & take the Hippocratic Oath every year. The budding doctors accordingly opt for employment options, including: (a) Teaching/Research in medical colleges (b) Pursuing higher studies (Masters) MD/MS (c) Associate with a reputed hospital or run an independent practice [7] The Indian government is trying to resolve the high-demand of doctors by opening number of medical colleges and hospitals in both rural and urban areas. Table 1: Year wise growth of Medical Colleges in India (2012-2016) [7] Year Number of Medical Colleges 2012 348 2013 362 2014 387 2015 401 2016 420 The medical colleges in the country have increased at a CAGR of 4.8% in the last 4 years to reach 420 in 2016 & the total medical seats has reached around 54,000 with a similar growth. After successful completion of MBBS not all doctors are available for recruitment, MCI claims a passing out ratio of 85 % in government colleges and a passing out ratio of 66 % in private medical colleges, out of which a majority of them opt for higher education like MD/MS/DNB. [7] After MD/MS/DMB, some of the candidates go on to pursue super specialization courses. Table 2: Post-Graduation Medical Seats (MCI) – 2016 [8] Specialization Number of Seats MD 13,448 MS 6,906 DM 926 DNB 3,828 Table 3: Super-Specialization Medical Seats (MCI) – 2016 [8] Super-Specialization Number of Seats DM 926 MCh. 1,005 HOSPITAL INDUSTRY IN THE COUNTRY Healthcare infrastructure in India is highly underpenetrated. With close to 20% of the global disease burden, country holds only 6% of the global beds and 8% of the total workforce of doctors and nursing staff. Further, India has just 0.9 beds per 1000 people, which are significantly lower than the global median average of 3 beds per 1000 people. We believe that the government spending propelled by private spending on the sector can improve the macros in the space. This also indicates a huge opportunity for private hospital chains to expand capacities, not only in urban areas, but also in the Tier-II and Tier-III cities. [8]

6. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm Table 4: Hospital Infrastructure in the Country Share of global disease burden Share of Doctors/ Nursing staff global 8% Share of India in Global beds Hospitals Sub Centers AYUSH Hospitals Nos / %age 20% 6% 1,96,312 1,56,926 3,601 Healthcare Providers (Hospitals/Medical Colleges) Handling the Current Scenario: Most of the new hospitals are coming up in Tier 1 and Tier 2 cities with a prime focus to set up a world-class infrastructure at locations with large catchment areas. Doctor team forms the nucleus of a hospital set up. Most of these hospitals struggle to get doctors, thereby bleed with low capacity utilization increasing their payback periods. In addition, existing hospitals struggle to get the right doctor mix more so in Tier 2 and Tier 3 cities which struggle to attract quality talent leading to low quality of healthcare services. [9] Tier 2 and Tier 3 cities have good flow of patients but still suffer from dearth of quality doctors because of their preference for Tier 1 cities. This aggravates the cost pressures for a hospital setups combined with low price points in such cities, thus, resulting in losses for such setups. In order to attract doctors, hospitals increasingly pay higher salaries. Because of pressure from both revenue and cost sides, hospitals compromise on the quality standards. Medical colleges face the similar situation & find it difficult to place enough number of doctors/faculties in their system. They further circumvent the guidelines of Medical Council of India pertaining to doctor/faculty requirements, both in terms of quality and quality. Furthermore, government stipulates the focus of upcoming medical colleges on remote locations where healthcare is inaccessible which leads to additional problems. Most medical colleges thus resort to malpractices owing to the problems of high capital investments, government restrictions and inability to command optimal fees. Doctors: Current Scenario: Large numbers of hospitals continue to open in the country owing to the high demand-supply gap, but the demand of healthcare manpower has outpaced its supply, creating a huge gap in quality healthcare manpower that needs to be filled. All this has created a demand for effectively placing doctors to help the entire healthcare ecosystem to function in an efficient manner. Recruitment of doctors these days is focused on online media including web job portals, social media, modern recruiting practices like online/telephonic interviews, which brings a fast and an innovative way of changing the recruitment experiences for both the medical colleges/hospitals and the doctors. Table 5: Availability of Doctor Profiles on Job Portals Job Web portal services Naukri.com Timesjobs.com Number of Doctor registrations Active in last 1 year 1,52,000 39,994 52,306 32,826

7. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm Around 10% of the doctor pool of the country is listed on the online portals pointing towards low adoption of placement model by doctors in the country. Even the fresh candidates, who pass out every year from medical colleges do not actively seek employment through consultants. Out of over 26,000 candidates passing every year, less than 10% list their profiles on the online portals. This makes it challenging for the employers to hire right candidates. This further propels demand for specialist recruitment of doctors. DOCTOR’SRECRUITMENT–ASEASONALDRIVE[10] Doctors’ recruitment tends to show a seasonal spike during June-October period. An effective doctor’s recruitment requires timing, experienced consultant and discovery of vacancies. Placing a quality doctor at right position (specialization) forms the quality of a good recruiter. Hi impact Consultants, a leading player in doctors’ recruitment has observed a clear high tide, in the demand of doctors during the month of June - October. Firm believes the following reasons result in such a trend: (a) Fresh batches of MBBS doctors pass out every year in June, creating excess supply (b) Increased demand for doctors in hospitals during the same period to address the flux of seasonal diseases like Dengue, Malaria, Swine flu etc. (c) Regulatory inspections of medical colleges by MCI During the high tide months, June-October, the recruitment of doctors is fairly high vis-à-vis the period, Jan-May. A variation in the salary trend of the doctors is also observed in this period. The doctors accept lower salaries during the high tide months and the salaries subsequently rise during lean periods. The Company has also observed the following salary trends in the past 5 years while effectively placing the doctors across institutions in the country: Table 6: Salary trends of MBBS candidates (junior residents) with 0-2 years of experience in India (2013-2016) (in INR)[10] Year Tier 1 Cities Tier 2 Cities Tier 3 Cities Tier 4 Cities 2012 30,000 38,000 40,000 40,000 2013 33,000 40,000 45,000 45,000 2014 35,000 40,000 45,000 45,000 2015 35,000 40,000 45,000 45,000 2016 40,000 47,000 50,000 50,000 Table 7: Salary trends of MD/MS candidates (senior residents) with 0-2 years of experience in India (2013-2016) (in INR) [10] Year Tier 1 Cities Tier 2 Cities Tier 3 Cities Tier 4 Cities 2012 60,000 65,000 75,000 - 2013 65,000 65,000 75,000 - 2014 70,000 75,000 80,000 100,000 2015 80,000 85,000 90,000 125,000 2016 85,000-1.0 L 1.0 L- 1.25 L 1.5 L-2.0 L 1.8 L- 2.5 L

8. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm Table 8: Salary trends of DM/MCh candidates (super specialists) with 0-2 years of experience in India (2013-2016) [10] Year Tier 1 Cities Tier 2 Cities Tier 3 Cities Tier 4 Cities 2013 1.6 L 2.0 L 2.5 L - 2014 1.7 L 2.25 L 3.0 L - 2015 1.8 L 2.5 L 3.5 L 4.0 - 4.5 L 2016 2.0 L 2.5-2.75 L 3.5- 4.0 L 5.0 L & above RECENT SALARY TRENDS OF MEDICAL PRACTITIONERS IN HOSPITALS / MEDICAL COLLEGES[11] According to the 7th pay commission of the Government of India, MBBS doctors like EMO (emergency medical officer)/RMO (resident medical officer)/CMO (casualty medical officer) are entitled to Grade Pay band scale 3 while MD/MS Doctors are entitled to Grade pay 4. This portrays that during the pendency of the allowance committee report, NPA shall be continued to be paid at 25% and being included as a part of Basic pay. This further indicates a higher salary for the doctors in the interim period. For instance, a resident doctor employed with a central government hospital, getting INR 104,000 previously can expect salary of INR 112,500. Table 9: Salary Trends in Government hospitals in accordance with 7th Pay Commission, 2016[11] SI. No.Qualification 01 MBBS (Junior Resident) 02 MD/MS/DNB (Senior Resident) Experience (Years) 0-3 0-3 Grade pay (INR) 80,000 – 90,000 103,000 – 120,000 The healthcare industry is heavily dependent on doctors and there is an upswing in their salaries, but the demand, supply gap still persists, even widening in Tier 2 and Tier 3 cities. Doctors spend a substantial part of their life studying Medicine/Surgery, spending around 12-15 years to attain a DM or MCh degree; doctors expect higher salary to compensate for their investment in becoming a qualified medical practitioner. Majority of doctors spoken to would like the salary levels to rise further, however cost pressure of the Private Hospitals has not allowed a faster growth in salary. However, given the demand supply gap, it may not be a surprise if we see higher salary levels for doctors in near future. Government also needs to step in to augment the supply of doctors in the country. One of the key initiatives taken by the Indian government to help decrease the workforce availability is the approval to create around 10,000 MBBS seats. In another positive development, the Medical Council of India (MCI) has approved the establishment of 16 medical colleges. [1]

9. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm IN SUMMATION The Indian healthcare industry, though confronted with many challenges, offers a chance to create millions of job opportunities that can not only support the GDP growth, but also support other sectors of the economy by improving both demand and supply of a productive healthy workforce. The salary trends of doctors in India in the past five years reiterate the dire demand supply gap in the country.

10. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm REFERENCES 1.Healthcare: The neglected GDP driver, KPMG 2.India Brand Equity Foundation (IBEF) Report, 2016 http://www.ibef.org/industry/healthcare-india.aspx 3.WHO World Health Report 2000 http://www.who.int/whr/2000/en/whr00_en.pdf 4.Healthcare Industry in India 2016: Trends, Overview, Analysis http://info.shine.com/industry/healthcare-medical/5.html 5.A Brief Report on Healthcare, Telemedicine & Medical Tourism in India 2015 6.U Anand Kumar et al. The New Indian Express Magazine. Published on 22 September 2013. http://www.newindianexpress.com/magazine/India-has-just-one-doctor-for-every- 1700-people/2013/09/22/article1792010.ece 7.Medical Council of India Report 2016 http://www.mciindia.org/ 8.HDFC Bank Report on Indian Healthcare Industry. Published data on 11 March 2015 https://www.hdfcbank.com/assets/pdf/privatebanking/Sector_Update_Indian_Health_ care_ Industry_March_2015.pdf 9.Chandralekha Mukerji et al. The Economic Times: Real Estate Report published on 21 March 2016 http://economictimes.indiatimes.com/wealth/real-estate/real-estate-here-are-9-smart- indian-cities-to-invest-in/articleshow/51467656.cms 10.Hiimpact Consultants Data Record, 2016 http://www.hiimpact.in/ 11.Industry Insights

11. Salary Trends of Doctors in India, 2016 A Review by Hiimpact Consultants –India’s leading Doctor Recruitment Firm Hi Impact Consultants Pvt. Ltd. Noida 2nd Floor,D-67,Sector-2 Near sector-15 metro station, Noida, Uttar Pradesh, India - 201301 For Jobs : - +91-7503139000-10; 7503111560-79 Contact :- +91 - 120 -4116767/6969, 4210823 Email : doctors@hiimpact.in hi-impact@hiimpact.in Gurgaon Mobile - +91 7503139000 Landline- +91-124 - 3256216 Email : doctors@hiimpact.in / hiimpact@hiimpact.in Patna Mobile - +91-9308578220 Email : doctors@hiimpact.in / hi-impact@hiimpact.in Serving Clients Nationwide