Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges of India

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Barriers to Recruitment,
Onboarding and Retention of
Faculty in Government Medical
Colleges of India



Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
CONFIDENTIAL
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DISCLAIMER:
SahaManthran Private Limited, New Delhi, has received the financial assistance under the Research Scheme of NITI Aayog
(RSNA) to prepare this report/research work. While due care has been exercised to prepare the report/research work using
the data from various sources, NITI Aayog does not confirm the authenticity of data and accuracy of the methodology to
prepare the report/ research work. NITI Aayog shall not be held responsible for findings or opinions expressed in the
document. This responsibility completely rests with SahaManthran Private Limited.



Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Acknowledgement

This study was carried out with the financial support of NITI Aayog, Government
of India and conducted by SahaManthran Private Limited, New Delhi.
We are especially grateful to:
1. Dr. Vinod K. Paul, Member NITI Aayog
2. Dr. Rakesh Sarwal, Additional Secretary, NITI Aayog
3. Dr. K Madan Gopal, Senior Consultant (Health), NITI Aayog
4. Brig. Dr Venkatnarayan Kannan, Officer on Special Duty, NITI Aayog
for their constant support, and invaluable contributions in giving guidance and
directions to the research and bigger policy implications inherent in this study.
We could not have completed this study without the assistance of the Deans and
Directors of various state Medical Colleges, Director Generals at the Directorate
of Medical Education & Trainings in the study states. And last but not the least
all the other respondents who spared their valuable time in sharing their views
on this important subject.



Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Table of Contents
Acknowledgement .................................................................................................................................. 2
Table of Contents .................................................................................................................................... 3
List of Tables ........................................................................................................................................... 4
List of Figures .......................................................................................................................................... 4
List of Abbreviations ............................................................................................................................... 5
Executive Summary ................................................................................................................................. 7
Chapter 1 – Introduction & Study Design ............................................................................................. 14
1.1. Purpose of the Study ................................................................................................. 15
1.2. Pilot Study Findings ................................................................................................... 17
1.3. Study Objectives........................................................................................................ 18
1.4. Study Approach & Methodology .............................................................................. 18
Chapter 2 – Study Findings ................................................................................................................... 23
2.1. Overall Existing Vacancy Status ................................................................................ 24
2.2. Vacancy Status of Study Colleges .............................................................................. 25
2.3. Vacancy Status by Departments/ Speciality in Study Institutes ............................... 28
2.4. Vacancy Status by Faculty Cadre in Study Institutes ................................................ 29
2.5. Planning for New Positions ....................................................................................... 31
2.6. Barriers to Recruitment & Onboarding ..................................................................... 35
2.7. Barriers to Recruitment of Regular Faculty .............................................................. 40
2.8. Onboarding Challenges of Faculty ............................................................................ 42
2.9. Retention Challenges ................................................................................................ 42
2.10. Management Perspective on Faculty Retention ....................................................... 46
2.11. Lack of Facility for Academics and Research in Medical Colleges ............................ 48
2.12. Quality and Effectiveness of the Current Medical Education System ...................... 48
2.13. Role of institutions in regulation and governance of medical education ................. 52
Chapter 3 – Analysis & Recommendation ............................................................................................ 55
3.1. Key Recommendation Emerging from a Lifecycle Approach to Medical Education . 56
3.2. Talent Planning ......................................................................................................... 57
3.3. Talent Retention: Creating an Ecosystem ................................................................. 63
3.4. Creating a Career Path for Faculty ............................................................................ 65
3.5. Creating an Ecosystem for Medical Research ........................................................... 67
3.6. Creating an Ecosystem – Strengthening Governance ............................................... 68
3.7. Summary of Recommendation ................................................................................. 70
3.8. Summary of Policy Interventions .............................................................................. 72
Annexures ............................................................................................................................................. 73
4.1. Annexure 1 – Primary Data Collected from Colleges ................................................ 74
4.2. Annexure 2 – Questionnaires .................................................................................... 78
4.3. Annexure 3 – Legal Cases .......................................................................................... 99
4.4. Annexure 4 – National Institutional Ranking Framework (NIRF) ............................ 105


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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List of Tables
Table 1 - Medical Colleges Selected for Survey ..................................................................................................... 19
Table 2 - Sample Size for Primary Survey with Stakeholders ................................................................................ 20
Table 3 - Estimation of Total Number of Medical Teacher Requirement in India ................................................. 24
Table 4 – AIIMS, New Delhi Vacancy Position ....................................................................................................... 24
Table 5 – PGIMER, Chandigarh Vacancy Position ................................................................................................. 24
Table 6 - Vacancy Status in Study Institutes ......................................................................................................... 25
Table 7 – Vacancy* Status in Study Institutes based on Management Feedback ................................................ 26
Table 8 - Department Wise Vacancy Status in Study Institutes ............................................................................ 28
Table 9 – Select Cadre-wise Vacancy Status in Study Institutes across UG & PG Seats ........................................ 29
Table 10 – Overall Cadre-wise Faculty Vacancy Status for MBBS Seats at SMS Jaipur ........................................ 30
Table 11 - NMC Teacher-Student Ratio Guideline for Medical Colleges ............................................................... 32
Table 12 - Faculty Teaching Load ......................................................................................................................... 33
Table 13 - Clinical Load per Faculty – based on standard assumptions ................................................................ 33
Table 14 - Clinical Load per Faculty – based on actual numbers .......................................................................... 34
Table 15 - State-wise variation in recruitment timelines ...................................................................................... 39
Table 16 – Faculty feedback on barriers to smooth recruitment experience ........................................................ 41
Table 17 - Reasons for Faculty Attrition*.............................................................................................................. 43
Table 18 - Factors influencing Faculty to join Medical College ............................................................................. 44
Table 19- Lack of Performance based Financial Incentives................................................................................... 45
Table 20 - Lack of Incentives for Research & Other Academic Activities .............................................................. 45
Table 21 - Research out of India as % of medical research ................................................................................... 48
Table 22: First preference (career) of medical students in % ................................................................................ 49
Table 23: First preference (job location) of medical students in % ....................................................................... 49
Table 24 - Student Satisfaction with respect to type of faculty (regular vs contractual) ...................................... 51
Table 25 - Establishing relationship between private practice and compromised medical education ................. 52

List of Figures
Figure 1 - Profile of respondents ........................................................................................................................... 21
Figure 2 - Reasons for non-closure of existing vacancies in the study institutes for last 3 yrs.............................. 30
Figure 3 - Evidence of approval of BOG to increase EWS seats and increased seats in PGIMS, Rohtak ............... 35
Figure 4 - Typical Recruitment Process in States .................................................................................................. 36
Figure 5 – Overall Time Taken for Recruitment Process (Regular Faculty) ........................................................... 38
Figure 6 – Median of Time taken in days for each step in the Regular Recruitment Process ............................... 38
Figure 7 - % Faculty NOT satisfied with following components of work environment in medical college ............ 44
Figure 9 - Faculty retention and years of service of regular faculty in medical college in % ................................ 45
Figure 9 - Faculty retention and years of service of contractual faculty in medical college in % .......................... 45
Figure 10 - Management feedback on faculty retention in % .............................................................................. 46
Figure 11 - Current level of dissatisfaction among students with the college in % ............................................... 50
Figure 12 - Lifecycle of a Medical Faculty Professional ......................................................................................... 56
Figure 13 - Framework for Talent Management .................................................................................................. 57
Figure 14 - End-to-end Talent Sourcing ................................................................................................................ 60
Figure 15 - Defining Roles of Stakeholders - Brazilian Best Practice ..................................................................... 69


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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List of Abbreviations
ACR Annual Confidential Reports
AETCOM Attitude, Ethics Communication
AICTE All India Council of Technical Education
AIIMS All India Institute of Medical Sciences
AMC Vizag Andhra Medical College
AP Andhra Pradesh
BJMC Ahmedabad B J Medical College Ahmedabad
CIMS Bilaspur Chhattisgarh Institute of Medical Sciences, Bilaspur
CISP Curriculum Implementation Support Program
CU Central University
DGME Directorate General of Medical Education
DMC Dibrugarh Dibrugarh Medical College, Dibrugarh
DoHFW Department of Health and Family Welfare
DPC Departmental Promotion Committee
EDL Essential Drugs List
GMC Government Medical College, General Medical Council
GMC Haldwani Government Medical College Haldwani
GMC Tanda Dr. Rajendra Prasad Government Medical College, Tanda
GMC Villupuram Government Medical College Villupuram
HP Himachal Pradesh
IDI In-depth Interviews
IIM Indian Institution of Management
IIT Indian Institute of Technology
ILBS Institute of Liver and Biliary Sciences
IMS Indian Medical Services
INI Institutes of National Importance
KPI Key Performance Indicators
LLRM Meerut Lala Lajpat Rai Memorial Medical College, Meerut
MAMC Delhi Maulana Azad Medical College, Delhi
MC Medical College
MCI Medical Council of India
MMC Mysore Mysore Medical College and Research Institute, Mysore
MoHFW Ministry of Health and Family Welfare
MRB Medical Services Recruitment Board
NFDP National Family Development Program
NIRF National Institutional Ranking Framework
NITI Aayog National Institution for Transforming India
NMC National Medical Commission
NPA Non-Practicing Allowance
OPD Out-patient Department
PG Post-Graduate
PGIMER Postgraduate Institute of Medical Education & Research


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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PGIMS Rohtak Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak
RBCW Revised Basic Course Workshop
SMS Jaipur Sawai Man Singh Medical College, Jaipur
SPSC State Public Services Commission
TN Tamil Nadu
UGC University Grant Commission
UKD Uttarakhand
UP Uttar Pradesh
UPSC Union Public Service Commission
VSS Burla Veer Surendra Sai Institute of Medical Sciences and Research, Burla
WHO World Health Organisation




Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Executive Summary
As per the prevailing National Medical Council (NMC) norms, India should have 1,38,028 faculty in
existing 602 medical colleges. However, the actual number of faculty registered with the NMC are
96,649 (inclusive of regular and contract faculty), resulting in a vacancy or possible shortage of 29.98%.
The present study examines the challenges of the availability of qualified medical faculty in India
through the lens of existing and potential medical faculty.
Therefore, the NITI Aayog conceived this study with an aim to “Study the barriers to recruitment, on-
boarding and retention of faculty in medical colleges; to suggest improvements for streamlining
processes, and inform policy.” The objectives included – (a) study of the barriers to recruitment and
onboarding of faculty in medical colleges; (b) understand the perception of stakeholders as regards to
recruitment, onboarding and retention of faculty.
A mix of twelve old and new Government Medical Colleges, representing North, South, East, West,
Central, and North-East regions, were recruited into the study. The sample included a total of 654
participants across stakeholders – Faculty, College and State level Management, and Students from
the twelve colleges. The sample maintained the requisite mix of specialists and super-specialists across
clinical, para-clinical & pre-clinical departments.
Study Findings
The Management from the study institutes reported an overall vacancy of over 10-20% after
accounting for contractual staff. Only, Sawai Man Singh Medical College, Jaipur (0%); Mysore Medical
College and Research Institute, Karnataka (0%); Government Medical College, Villupuram, Tamilnadu
(4%); Government Medical College, Tanda, UKD (10%), and Veer Surendra Sai Medical College, Burla,
Odisha(10%); reported under 10% vacancy. No separate disaggregated data on contractual versus
regular vacancy was shared by the colleges/ states, except for that from TN and Chattisgarh.

Highest vacancies were reported in super specialities and surgical specialities (5-15%) and in pre-
clinical specialities like anatomy and forensic medicine (1.5-6%). The commonest reasons for such
vacancy was attributed to:
a) recruitment process delays, sometimes as high as 2-4 years, especially from
sanctioning to advertisement of positions,
b) high paying jobs in private sector for surgery and super-specialities,
c) preference for postings in metros or home locations,
d) change in NMC guidelines (2019) to disallow recuitment of Postgraduates in Basic
Sciences, and allow recuitment of only MBBS students as faculty. This inflexibility to
fill vacancies in pre and para-clinical specialities only with medical graduates.

With respect to cadres, analysis of data from the study colleges shows a 35-45% shortage, at the level
of Associate and Assistant Professor, with over-filling at Associate Professor (18-40%) and Professor
(10-20%) cadre/s. The policy of assured career progression without an objective appraisal system, has
created a top-heavy ‘inverse pyramid’ organisational structure in all the study college/s. Further, the
lack of a well-developed pipeline for career progression for Professors in the college/s has led to


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Professors working at the same job responsibilities as that of Assistant Professors, resulting in
dissatisfaction around individual career growth, irrespective of the financial security for the cadre.
Two thirds of the Management respondents felt that the permission to hire contractual faculty has
improved the overall shortage by 5-20% in the last three years. Factors contributing to unfilled
positions and persisting faculty shortage was attributed it to:
a. transfers to other colleges to meet NMC norms before inspection/s,
b. assured promotions leaving vacancies at lower cadres,
c. contractual faculty leaving upon contract closure or for better opportunities,
d. delays in faculty recruitment at state commission/s affecting vacancies and HR planning,
e. majority college officials (94%) preferring not to recruit ‘Visiting Faculty’ because of their non-
inclusion in faculty head count by NMC, and their general inability to enforce accountability
amongst such recruits.
f. lack of pre-emptive sanctioning of positions based on analytics of potential vacancies, resulting
in recruitment delays
g. insufficient rollout period for colleges to make provisions for adequate faculty and
infrastructure to cater to State Orders for additional MBBS seats.
Faculty and college management informed that states did not pay heed to the high student/teacher
ratio and low doctor/patient ratio prevalent in their institutions, but only sanctioned/ fulfilled
positions based on basic minimal requirements as per NMC guidelines. The adequacy of this ratio
was analysed using faculty’s primary workload around academics and secondary workload around
patient care against NMC norm and current data of patient workload in study colleges. The academic
workload was well within reasonable expectations. For calculating patient load, we have used actual
faculty numbers belonging to clinical specialties, who are involved in patient care in OPD, IPD and
Emergency. The calculations revealed that the overall patient care workload is of the of magnitude
3-4 times higher than reasonable limits of 20 patients/day/faculty. This is in line with the feedback
from management and faculty that heavy patient workload is a hindrance to honouring their
teaching responsibilities. Therefore, it is necessitated to dynamically assess faculty work load across
cadres for assessing the faculty requirement and use contractual hiring to support the increasing
workload as a top-gap for the recruitment process time.
Recruitment Challenges
State Level recruitment is typically conducted by the State Public Services Commissions (“SPSCs”) or
Medical Recruitment Board (MRB) in select states. Although, the hiring time varies substantially across
recruitment steps in the states, 51.4% faculty informed that the average time taken for completion of
one recruitment (from advertisement of vacancy, to issue of offer letter) cycle was about 7months
(203 days) for regular positions, and 3months (94 days) for contractual positions. While sanctioning of
a position itself typically takes 2-3 months, the biggest bottleneck to recruitment by SPSC is the step
from sanction to advertisement, which sometimes takes 2 to 4 years in select states. The challenge
is the uncertainty of timeline for this leg of the process, for approval and constitution of the Board for
selection. Post approval/ sanction the recruitment of vacant positions is fairly streamlined. However,
states (Uttarakhand, TN, Odisha, Karnataka, AP) with a separate MRB are more effective with
predictable timelines, leading to fewer vacancies.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Over 70% of the faculty responded that there is no prescribed annual hiring cycle for regular faculty;
and the hiring of contractual faculty happens on a need-basis, which is continual. Only 16.2% (n=179)
of the participants responded that the process-time for regular recruitment is more than one year.
The most challenging barriers to recruitment as expressed by the faculty and management, were:
• Lack of Access to Information on Vacancy Status (61%)-no database on vacancies/ filled status;
• No contact point in college or DME to seek clarification (61.5%);
• Lack of information around terms and conditions of employment; such as transfers, difficult
area postings, recruitment & promotion rules, leaves, roles and responsibilities etc.
Other barriers as cited by management respondents as barriers to faculty recruitment were –
• Non-cancellation of an unfilled vacancy for 5 years,
• Process delays on complaint resolution within the government setup,
• 70% of management respondents iterated that at least 20-25 Court cases each year pertaining
to non-transparency in recruitment and retention (DPCs) is usual in all states, which bars
regular recruitment for these unresolved position/s pending court decision. For instance, in
Uttarakhand out of the 312 recruitments done in the last 2 years, only 70-80 joined. 128 cases
of recruitment remain pending since 2018 due to:
o Difference in eligibility criteria for contractual and regular hirings.
o Issues related to regularization of contractual positions/ change in policy.
A deep dive of select court cases around terms and conditions of employment shows that
some of the key processes that were challenged in the court of law were related to –
o Ambiguity on the requisite qualification,
o Non-adherence to selection process,
o Eligibility criteria overlooked during selection,

Retention Challenges
The retention challenges are a factor of student and faculty aspirations of a career in the field of
medicine and the extent to which these aspirations were met. 234 medical faculty across specialities
and cadre (Senior Residents, Assistant Professors, Associate Professors, Professors) at different stages
of their careers were interviewed on their career aspirations and its fulfilment. Survey indicated that
the overall the faculty are self-motivated in the beginning of their career for a career in medicine
(89%); because of passion for the subject (94%), service to the needy (80%), prestige associated with
being professor (87.5%), greater exposure to scientific challenges in patientcare (86.4%). However,
commercial considerations and desire to have a better quality of life, make them change the course
of their career, primarily towards private practice in a clinic or hospital. Location also happens to be a
significant influencer in the decision to join a medical college as faculty. Most respondents (71.4%)
were inclined to be in a Metro or Tier-1 cities, and 36% preferred a work location near their home.
Survey indicates that the faculty haven’t been overtly enthusiastic about realisation of their
aspirations after joining the medical college. More than half of the respondents shared that their
expectations for most components of their work environment were not met. However, none of the
reasons were critical enough to leave a government job. Overall attrition across study states is less
than 5%. Most of the attrition was attributed amongst other factors, to:
• Contractual staff leaving at the end of contract or getting regularized;


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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• Staff (including contractual) leaving for better opportunities especially with upcoming AIIMS
in each state.
The feedback from most faculty respondents’ point to the following as primary grievance:
• While regular annual increments are always available, there was no performance-based
incentive within the defined role (87.6%). There are no incentives to promote good
performance and no disincentive for a non-performer, resulting in a lack of accountability.
• The management across colleges pointed out that there’s no system of monitoring workload
(71.4%) or measuring accountability (80%).
• Lack of mentoring into a new role, especially managerial (68.4%);
• Lack of transparency in tenures/ promotions and transfers (62.2%).
Further, training of faculty, which could have been used for personal career growth within the
specialty, were restricted to NMC mandate on limited topics - teaching techniques, research methods.
Most faculty in management roles are grappling to lead in an administrative role; but there are no
specific trainings to help faculty to transition into management roles.
Quality and effectiveness of student education
Effectiveness of education is one of the crucial outcomes of barriers to recruitment and retention of
faculty in medical colleges. The study revealed that over 88% students prefer studying in a government
medical college, for greater opportunity to learn (85%) and see more patients (82.3%). In terms of
career aspiration, the preference to become a professor (40.3%) follows closely next to providing
patient care (54.7%) for the students. Another 22.5% students expressed interest in Hospital
Management & Research, and thus are equally potential candidate as far as seeking job in medical
colleges is concerned.
The satisfaction levels of students with regards to quality of teaching changed with growing breadth
and depth of involvement in clinical practice, academics and research. The dissatisfaction levels have
grown progressively from clinical years of studentship (40-50%) into internship (65-70%) and stabilized
during post-graduation at 55%, as students realised the need to take personal initiative into academics
and research in their pursuit to seek excellence. The topmost reason for dissatisfaction were: lack of
time for research or bedside teaching (70.6%), disparity in infrastructure across specialty (64.7%),
backdated syllabus & teaching style (55.9%), lack of clinical or research skills being imparted (67.6%),
lack of role models (61.8%), lack of quality teaching staff (67.6%), among other variables. The students
informed on the systems that are in place and those not in place, shown as under:
Students’ feedback on compliance to
guidelines
Students’ feedback on non-compliance to
guidelines
• 91.3% of the scheduled classes are
conducted (n=303). Of which
o 39.9% are taken by senior residents
(n=264),
o 48.4% are allocated to tutor/assistant
professor (n=263), and
o 44.9% classes are allocated to
associate/ professors (n=256)
• Students informed that following are not held
every day
o 37.8% clinical rounds not held (n=312)
o 56.9% evening rounds not held (n=209)
o 41.7% bedside teaching not held (n=218)
• 57.3% informed that no system to provide
feedback on quality of teaching (n=314)



Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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The analysis of student satisfaction around academics (clinical bedside teaching, evening rounds,
clinical grand rounds) with availability of regular and contractual faculty, revealed that student
satisfaction levels were higher in colleges (n=4) with higher percentage of regular faculty @85-100%
as against 35-50% in colleges with over 30-50% of contractual staff (n=3). The Chi-square test
revealed strong relationship between private practice and compromised medical education with p-
value less than 0.05.
A deep dive into the reasons for dissatisfaction as expressed by the students and faculty, reports
almost non-existent research ecosystem. Over 90% faculty reported on inadequacy and
inappropriateness of both hard and soft infrastructure to foster academics and research.
Role of Institutions in Regulation & Governance of Medical Education
Secondary research in select countries (US, UK, Brazil among others) indicated that one of the reasons
for challenges to recruitment and retention could be attributed to the lack of role clarity between the
agencies regulating, governing and managing the medical education in the states. The role of NMC is
clearly regulatory - to lay down policies and regulations to maintain standard and quality of medical
education; and that of medical colleges is that of an implementor of decisions. However, the role of
DMET is unclear and seems to be overlapping between regulatory and executive functions. Ideally the
regulatory roles between NMC and DMET are shared by the federal and state/provincial councils.
Of the sample states, only a few have documented the emphasis on imparting quality medical
education (AP, Assam, TN) as a part of their charter. To strike a balance between academics, research
and patient care in medical colleges, Brazil has defined and shifted the role of each stakeholder from
a teacher-centred and hospital-based approach to student-centred and community-based
education, to use each bed as a teaching bed across the system.
Recommendations
The lifecycle of a medical graduate in academia traverses through three stages:- The career aspirations
of a budding medical graduate develops primarily from past experiences of their seniors; that gets
rationalised when the aspiring student faces the challenges of job market. The aspirations finally get
aligned with the organization that matches closest to their expectations, resulting in retention of the
individual within the select organization or medical college. A system’s framework was therefore
considered to analyse and find solutions for Talent Management: The Talent Management
Framework (TMF), in 3 phases of Talent Planning, Talent Acquisition and Talent Retention.
A. Talent Planning
The key challenge to planning as evidenced in the study is lack of reliable data on exact number of
faculty or even practicing doctors in each state and each medical college across the country. Based on
the study findings, it is recommended that:
• Each student (potential faculty) entering medical education should be provided with a unique
pan-India ID number, so that lifecycle of an individual as a medical professional is tracked.
This will avoid duplication and provide reliable data on pool of doctors across career streams.
• To begin with, a centralized registry of faculty qualified to teach could be maintained by
NMC, and made publicly available; to avoid duplication of faculty across colleges in India.
• A real time data base of faculty pool on a digitized platform will facilitate regular cycle of
faculty planning and recruitment, and offer visibility around promotions and superannuation.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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B. Talent Acquisition (Recruitment)
• To address the talent requirements of critical service like the health service as well as
medical education, MRB has emerged as an effective solution.
• Most advanced practice of recruitment is capturing students through campus selection and
recruit the students before they start exploring alternate career streams/ post-graduation.
Current survey indicates that nearly 44% of the respondents, at various levels of their student
life, do prefer to join as a faculty, or a potential career in medical education system. One of
the ways to take care of this talent pool is to engage with them early (as in TNMSC model).
Capturing the aspiring undergraduate through campus selection, from a larger and better
talent pool, helps to remove uncertainty from a student’s career and showcases a clear time-
bound path to an academic career.
• The Tamilnadu Medical Systems Corporation, Counselling Transfer and Promotional (TNMSC
CTP) Policy with an end-to-end HR thinking. An integrated institutional structure for campus
recruitment and career path was created for the entire medical workforce in the public
healthcare delivery system, not just medical colleges. So, state level recruitment decisions
are made based on not just students in their final year undergrad courses, but also existing
pool of faculty and practitioners across the state public health system. The system allows
flexibility for inter cadre deputation, if a person has the requisite eligibility.
• The TNMSC CTP Policy captures the talent early on in their final year (campus hires) through
counselling and creating awareness around career path across the state health service in
public health, teaching, hospital management basis their choice of post-graduation, and
preferred postings. Students after their postgraduation and a mandatory one-year
probation, are hired at an Assistant Professor level. The decadal learning and success of
TNMSC CTP in the Tamil Nadu medical education system, is worth emulating in other states.
• Lateral entry of mid-career practitioners (clinical practitioners, academicians, and
researchers), distinguished professionals at a senior Associate Professor/ Professor level – as
“Professor of Practice (PoP)” in medical colleges can be explored with separate clinical and
academic career paths. However certain aspects must be considered before institutionalizing
the practice in medical education, that such faculty are hired with the same degree of rigor as
adopted for full-time faculty so that the right type of candidate is identified, and mandatory
participation in teacher training programs, prior to joining as a faculty.

C. Talent Retention:
The study revealed that the Annual Confidential Reports (ACRs) were never a reliable or
comprehensive performance management system, since faculty and management reported that
colleagues generally do not write adverse or objective comments. Management respondents from
AIIMS Delhi, PGI Chandigarh, IIT Delhi, IIM Indore suggested two workarounds to this cultural aspect
around an objective performance appraisal system – to segregate the annual appraisal system from
the promotion appraisal system:
• Creating an objective Promotional Appraisal System with external members in selection
committee, such as in AIIMS, New Delhi and PGI, Chandigarh - all the positions to be open
positions after Associate professor level, allowing inhouse prospective faculty compete with
other potential faculty from all over the country.


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• In this assessment, all possible inputs including academic performance, research output, clinical
performance, annual appraisal ratings, personality assessment, are taken into consideration
during the interviews. The signalling effect of this assessment process is that promotions to
the next level are not automatic and is eventually dependent on the merit of the candidate,
irrespective of annual appraisal cycles.
• Longer duration of regularised contract, like Liver and Biliary Sciences (ILBS) and Rajiv Gandhi
Cancer Institute, on regular contract of 4 year period each, with appraisal by an institute
committee and external subject matter experts to decide on extension for next 4 year period.
Creating an objective performance appraisal system with a set of outcome-based key performance
indicators (KPI), including indicators for (a) teaching and learning outcomes, (b) research outcomes,
(c) healthcare delivery outcomes; aligned with the state’s broader education goals or that of the
medical colleges will be a great system to be explored.
“Pay-4-Performance”, such as in TNMSC and ILBS model wherein the faculty is allowed to take a
portion (approx. 10- 25%) of the OPD/ IPD fees they consult, over and above their salary, has served
well to incentivise the faculty.
D. Development of Career Path
• Create a separate professionally trained administrative cadre for managing the college
administration and hospital operations of the institute. A professional team to ensure
implementation of administrative decisions taken by the technical heads of the institution (dean
and medical director), will free up the administrative time spent by otherwise busy faculty for
teaching and research.
• Recognizing that each position of hospital administrator, dean, director an executive position
and requires full time dedication for the particular role Plan the career path for a pool of senior
faculty interested in administrative positions of Dean (academics or research or examination)
and Medical Director with management development program (MDP) before getting posted
to such positions.
• Dedicated HR team within each medical college would to address this creation of admin cadre
and manage career pathways for individual faculty members.

E. Creating an Ecosystem for Medical Research
• Engineering and Medical education are applied sciences and institutes therefore should be
expected to prioritize applied research with a direct bearing on a product and/or process
development of a commercial nature. So, it makes the current line of thinking of basic research
resulting in publishing papers, is shifted towards a better industry-academia induced
translational research. Creation of state-of-art hard and soft infrastructure to carry out high
end medical research calls for Industry funding for setting up research Centre of excellence.
• Dedicated institutional budget to stimulate research activities similar to that in AIIMS/ PGIMER.
• Creation of a critical number of Medical Institutes of Excellence (beyond the known INIs) by
designating and developing one Medical College in each state as a Center of Excellence. This
COE would act as a pivot for the network of hospitals within the state.




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Chapter 1 – Introduction
& Study Design


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1.1. Purpose of the Study

Only eleven among India’s 36 states and union territories meet the WHO recommendation of 1:1000
doctor to population ratio, while none in the public healthcare sector manage to make the cut. As of
2019, the public healthcare system operates at a ratio of 0.93 (allopathic) doctors for 1000 people.
1

The states with the highest shortfall of doctors – Uttar Pradesh, Chhattisgarh, Odisha, and Madhya
Pradesh – house a huge share of India’s rural population of more than 0.8 billion.
2

Currently, India has 602 medical colleges, producing 90,825 MBBS graduates every year, of which 269
(44.4%) are in private sector.
3
The government intends to add at least one medical college in each
district of the country in phased manner under the scheme “Establishment of new Medical Colleges
attached with existing district/referral hospitals”, by – (a) establishment of new Medical Colleges
attached with existing district/referral hospitals, (b) upgradation of existing State Government/Central
Government medical colleges to increase MBBS seats in the country and, (c) strengthening and
upgradation of State Government Medical colleges for starting new PG disciplines and increasing PG
seats. Under three phases of the scheme, 157 new medical colleges have been approved, out of which
63 medical colleges are already functional.
4
With the proposed sharp increase in the number of
medical colleges, the demand for medical faculty is set to rise. However medical colleges in India are
grappling with the issue of unavailability of appropriately trained adequate number of medical faculty.
As per the prevailing NMC norms, India should have 1,38,028 medical faculty nationally. However, the
actual number of medical faculty registered with the NMC is 96,649, inclusive of both regular and
contract faculty (since NMC considers contract faculty in the count for college’ faculty strength at any
given point of time); resulting in a vacancy of 29.9%.
• This vacancy levels remain in spite of the fact that on an average, each vacancy attracts
at least 50-60 candidates across our study states;
• A total of 166 doctors’ posts vacant in 4 teaching hospitals under Delhi govt was reported
in 2016. Highest vacancy of 83 posts in Maulana Azad Medical College;
• UCMS, Delhi associated with GTB Hospital had 43 vacancies; GB Pant Institute of PGMER,
associated with super specialty hospital had 36 vacancies in neurosurgery, neurology,
gastroenterology, and cardiology.
• Punjab’s functioning private medical colleges reported a shortage of at least 100
members of teaching faculty (Deswal BS et al).
• Dr BR Ambedkar State Institute of Medical Sciences, Mohali, remained a non-starter for
the academic year 2020-21 despite an extension from Supreme Court to grant extension
for permission; as faculty complement required couldn’t be recruited. Reason was the
failure of the government to complete the process of faculty recruitment for the
college.
5


1
https://data.worldbank.org/indicator/SH.MED.PHYS.ZS; As per latest available National Health Profile India 2019, the
number of doctors possessing recognised medical qualifications (Under I.M.C Act) in India at the end of 2018, was 11,54,686.
This doesn’t include Ayush doctors who also serve the same public health system, if included the doctor patient ratio would
be better than required 1:1000. As per Census 2011, the total population of India is 1210.8 million.
2
National Health Profile, India 2019;
3
NMC Website at https://www.nmc.org.in/information-desk/college-and-course-search, accessed on 22 Feb, 2022.
4
https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1766061, accessed on 12 April, 2022.
5
https://www.tribuneindia.com/news/chandigarh/staff-hiring-incomplete-mohali-medical-college-yet-to-begin-
operations-138320


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The vacancy in turn, can potentially have effect on
a. Quality of medical education,
b. Ability to increased post graduate courses in the existing colleges,
c. Increased strain on existing teaching staff.
Therefore, the NITI Aayog, has conceived the present study to examine the challenges around
availability of medical faculty in India through the lens of existing and potential availability of medical
faculty.
The reasons for acute teaching faculty shortage in many states has been attributed to:
• Delays in faculty recruitment process (Rajiv Gandhi Institute of Medical Sciences,
Telangana), as authorities were in a bind over vast difference in salaries (almost 50 %)
between the existing contract faculty and the proposed new contract recruitments.
6

• The Federation of Resident Doctors Associations in Delhi highlighted that poor doctor to
patient ratio led to long working hours stretching to 36–48-hour work days in hospitals. In
super-specialized disciplines, such as neurosurgery in GB Pant, limited OPDs and long
waiting for surgery stretching over months was attributed to shortage of doctors.
• Despite increasing hospital beds from 41,706 in 2010 to 48,096 in 2014, an increase in bed
to population ratio from 2.54 to 2.71, recruitment of faculty had not kept pace, said
officials.
• To tide over the faculty shortage, the Delhi govt advised deans to directly appoint Senior
Resident doctors (SRs) as Associate Professors (AP) after 3 years of training, to address the
delays of Union Public Service Commission (UPSC).
7

Abbas et al (2017) in their study on motivation and satisfaction level among medical teachers in the
hospital managed by Employee State Insurance Corporation (ESIC) of India found that about 60% of
teachers were satisfied with their jobs but reported the lack of performance-based incentives by the
institute being one area of dissatisfaction.
8
Jaiswal et al (2015) studied job satisfaction of doctors, and
all medical staff in the RML hospital through self-reporting. They found that only about half of the
doctors were satisfied with their jobs in the medical college.
9
Lack of motivation for a career in
academia is seen to be a global issue in the field of medicine.
10
However, studies that focus on the
factors influencing career choices of medical professionals as well as their experience in medical
education in India are far and few.
11



6
https://www.thehansindia.com/posts/index/Telangana/2018-08-20/Faculty-recruitment-drive-at-RIMS-put-on-
hold/406576
7
https://indianexpress.com/article/cities/delhi/shortage-of-doctors-in-teaching-posts-citing-upsc-delays-delhi-govt-
advises-deans-to-use-senior-residents/2016
8
Motivational and Satisfaction Level Among Medical Teachers in India: A Questionnaire Based Survey at
http://ijcrr.com/uploads/2333_pdf.pdf, accessed on 22 June, 2021
9
Jaiswal, Poonam & Gadpayle, Adesh & Modi, Rajesh Kumar & Padaria, Rabindra & Singhal, Ashok K Sachdeva, Sandeep &
Vajala, Ravi. (2015). Job satisfaction among hospital staff working in a government teaching hospital of India. Medical
Journal of Dr. D.Y. Patil University. 8. 131. 10.4103/0975-2870.153136.
10
Reck SJ, Stratman EJ, Vogel C, Mukesh BN: Assessment of residents' loss of interest in academic careers and
identification of correctable factors at https://jamanetwork.com/journals/jamadermatology/fullarticle/406556
11
Ryan C, Ward E, Jones M. Recruitment and retention of trainee physicians: a retrospective analysis of the motivations
and influences on career choice of trainee physicians. QJM. 2018 May 1;111(5):313-318. doi: 10.1093/qjmed/hcy032.
PMID: 29452409.


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1.2. Pilot Study Findings
Therefore, to understand the issues on ground, a pilot study was carried out in Delhi, Haryana and
Uttar Pradesh. The pilot study of interviews with faculty and college management revealed that:
a. 50-60 candidates apply for each vacancy;
• But 60% reservation reduces seats for general candidates;
• Shortage of medical faculty is more in clinical sciences and super specialties, as compared to
pre/paraclinical area;
• The delay in receipt of job offers subsequent to selection, results in loss of potential medical
faculty to private job or practice;
• SC/ST vacant positions cannot be swapped, resulting in expiration of the position after 5 years;
• The reserved candidates too leave for better postings in large Urban localities, due to
availability of wider choice and do not prefer rural postings;
• Those who join, leave within 6 months, as there are no employment bonds;
• Unfilled reserved seats are not set free for general candidates, so departmental shortage
continues.
b. State-specific issues
• NMC recommends 1 yr. Senior Residency (SR) for entry into Assistant Professor (AP) level.
However, Maulana Azad Medical College, Delhi requires 3yrs of Senior Residency for AP,
pushing the faculties in Delhi down by 3 yrs. than their counterparts in other states;
• All Departments considered together as single unit for recruitment in UP. As a result,
department starting with alphabet with ‘अ’ (in Hindi), such as Orthopedics gets the first
chance to fill its vacancies. By the time the hiring opportunity arises for Medicine/ Surgery/
OBG etc., the aspirants join elsewhere.
c. Issues around financial and non-financial incentives
• No incentives schemes/ options for posting couple-doctors together: in same institution or
location;
• ‘Disparities in salaries between Govt. and Private is a cause for early ejection from the system’;
• NHM has streamlined contractual appointments, allowing SRs to be hired on a higher package
@ INR 1 lakh than that of a regular Assistant Professor joinee (Rs 80,000/-), triggering inter
and intra departmental dissatisfaction;
• Salary inadequate, and not respectable to support a decent living for medical faculty;
• Financial incentives for specialists are inadequate to attract them to teaching, and to offset
the opportunity cost of earning in private practice, especially in surgical specialties;
• Salary structure not at par across states and cadres;
• No incentives to carry out administrative work, alongside patient care and academics;
• Doctors may join anywhere in the country in their initial years but prefer a transfer to their
local/ home or state positions later on, resulting in vacancies in their earlier positions;
• Non-Practicing Allowance (“NPA”) and other incentives (difficult area posting or hardship risk
allowance) are miniscule and non-attractive compared to clinicians doing private practice;
• Eligibility criteria: Minimum criteria prescribed by NMC (around senior residency, publication
requirements, etc.,) renders interested industry experts, practicing clinician’s ineligible to
serve as faculty.


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1.3. Study Objectives

The aim of the study was to: “Study the Barriers to timely recruitment, on-boarding and retention of
faculty in medical colleges and make recommendations to streamline the processes and undertake
informed policy interventions.” The objectives included:
1. “Study the Barriers to Recruitment & Onboarding of Faculty in Medical Colleges”;
2. “To understand the perception of stakeholders as regards to recruitment, onboarding and
retention”.
For the purposes of the study, following definitions were used:
• “Retention”– as faculty staying in the same medical college for over 5 years
• “Stakeholder” categories include; Faculty (Senior Resident, Assistant Professor, Associate Professor, Additional
Professor, Professor); Deans, Medical Directors, In charge Medical Establishment, Director General Medical
Education, Students (Section 1.3.2).
1.4. Study Approach & Methodology

1.3.1. Research Approach
Given the aim and objectives of the study, a mixed method of both qualitative and quantitative survey
was adopted. Further, this being a qualitative assessment, it was critical to assess different category
of stakeholders, rather than collecting data to ascertain statistical significance of the challenges
witnessed.
a. Primary Objective: Study the barriers to recruitment & onboarding of faculty in medical colleges
• Review secondary data on faculty vacancies—national & selected government medical
colleges
• Desk review on trend of faculty vacancies in last 2 years in selected medical colleges & data in
public domain
• Primary survey with administrative department in the selected medical colleges to understand
the life cycle of faculty recruitment and on-boarding process.
• Primary survey with administrative department and Dean’s office in the selected medical
colleges to understand the barriers to recruitment, on-boarding and retention of faculty in
these medical colleges
• Primary survey with officer in charge recruitment and approvals at Directorate of State
Medical Education on barriers to recruitment and retention at the level of the directorate
b. Secondary Objective: Understand the perception of faculty as regards recruitment, onboarding,
and retention
• Primary survey with faculty of different cadres across clinical and paraclinical departments to
understand barriers to recruitment, onboarding and retention
• Primary survey with students on perceived quality of teaching
Secondary review of literature was undertaken to explore the possible best practices nationally and
internationally for recruitment and retention of faculty in medical colleges.
Interviews were held at Institute of National Importance (INIs) with Deans, Directors of, such as the
All India Institute of Medical Sciences (AIIMS), New Delhi; Post Graduate Institute of Medical Education
and Research (PGIMER), Chandigarh; Indian Institute of Technology (IIT) Delhi; Indian Institute of
Management (IIM) Indore to understand their practices that have been able to:
• Facilitate development of an academic and research & development ecosystem


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• Facilitate recruitment and retention of faculty
• Streamline performance appraisal and career growth of faculty
• Establish processes to draw feedback and improve effectiveness of education
1.3.2. Study Design and Sample Size
Inclusion criteria: A total of twelve Government Medical Colleges from twelve states were recruited
for the study, in consultation with the NITI Aayog. The colleges and the states were representative of
North, South, East, West, Central, and North-East regions of India. The colleges chosen were a mix of
old (incorporated before year 1990) and new colleges (incorporated after year 1990).
Exclusion criteria: Only those government medical colleges that were commissioned before 2014
were chosen, as colleges commissioned after 2014, would either not have, or would have just
completed 5 years of operations – one full cycle of MBBS education, and would not be able to
comment substantially on the study subject. Care was also taken to not choose Institutes of National
Importance (INIs), as the comparisons and analysis would get affected. Non-governmental (private
and/ or trust) medical colleges were not included.
The representative sample of medical colleges recruited for the study is given below in Table 1.
Table 1 - Medical Colleges Selected for Survey
State
Institution &
Location
Year of
Inception
Annual
Intake
Status of MCI Registration
Andhra
Pradesh
Andhra Medical
College,
Visakhapatnam
1923 200
Permitted for increase of seats from 200
to 250 under EWS quota (103rd
constitution amendment) for 2019-20.
Chhattisgarh
Chhattisgarh Institute
of Medical Sciences,
Bilaspur
2001 100
Renewal of recognition with increase in
seats from 100 to 150 granted when
degree awarded on or after 2020-21.
Gujarat
B J Medical College,
Ahmedabad
1946 250
Permission for admitting 250 students
granted for 2021-22.
Haryana
Pt. B D Sharma
Postgraduate
Institute of Medical
Sciences, Rohtak
1960 200
Permitted for increase of seats from 200
to 250 under EWS quota (103rd
constitution amendment) for 2019-20.
Himachal
Pradesh
Dr. Rajendra Prasad
Government Medical
College, Tanda
1996 120
Renewal of permission for admission of
120 seats (including EWS quota) granted
for 2021-2022.
Karnataka
Mysore Medical
College and Research
Institute, Mysore
1924 150
Permission granted for 150 seats for 2021
- 22.
Assam
Assam Medical
College, Dibrugarh
1947 200
Permitted for increase of seats from 170
to 200 under EWS quota (103rd
constitution amendment) till 2021-22.
Odisha
Veer Surendra Sai
Institute of Medical
Sciences and
Research, Sambalpur
1959 150
Permission for admitting 200 students
renewed till 2021-22.
Rajasthan
SMS Medical College,
Jaipur
1947 250
Recognised for increase of seats from 150
to 250 on or after February 2018.


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Tamil Nadu
Government
Villupuram Medical
College,
Villupuram
2010 100
Recognized when degree granted on or
after February, 2015
Uttar Pradesh
LLRM Medical
College, Meerut
1966 150 Recognized for 150 seats. Source.
Uttarakhand
Government Medical
College, Haldwani
2001 125
Permitted for increase of seats from 100
to 125 under EWS quota (103rd
constitution amendment) for 2019-20.
Delhi
Maulana Azad
Medical College,
Delhi
1958 250
Permission for annual intake of 250 seats
granted for 2021-22.
Source: As per NMC Data as on 25-10-2021 18:16; https://www.nmc.org.in/information-desk/college-and-course-search/
Table 2 gives the sample size chosen for each of the stakeholders:
Table 2 - Sample Size for Primary Survey with Stakeholders
Stakeholders
Sample
Size
defined
Sample
Collected
Sampling Method
Desk Review 26 5
Data sheets to be filled out by DGME and Medical College Offices
Dean/College
Management
39 23
At least 3 officials from MC (Dean/ Medical Director/ Director
Administration (HR)/ Director Research/ Medical
Superintendent)
DGME 13 6 Secretary/ DG Medical Education
Faculty 234 251
At least 18 faculty interviews were planned from each MC. 1
junior, 1 senior per department, 1 at assistant/associate level,
and one Additional/Professor or Head of the of Department.
Students 104 360
At least 7-8 students per MC, covering all the five years, including
interns and post graduate students were interviewed.
Total 416 645
Details of the data collected in each college is Annexed as
Annexure 1
Note: IDIs were also undertaken with management of AIIMS, Delhi; PGI Chandigarh; IIT Delhi; IIM, Indore to understand good
practice.
While recruiting the faculty for the survey, it was ensured that the sample is a mix of the twelve
specialties and the sample adequately represented clinical, para-clinical & super-specialties cadres.
These twelve specialties included - Medicine, Surgery, Pediatrics, OBG, Orthopedics, Anatomy/
Physiology, Pharmacology, Microbiology, Pathology, Urology, GI Surgery, and Cardiology. If any of the
twelve specialties was not available in a given medical college, a parallel category was considered.
Apart from the planned numbers of face-to-face interviews, efforts were made to reach out to a larger
set of stakeholders, using online tools. The snapshot of the profile of our survey respondents is shown
in Figure-1.


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1.3.3. Study Limitations
Out of the 12 medical colleges recruited for the study, the faculty and students of 2 medical colleges
(Dr. Rajendra Prasad Government Medical College, Tanda and Pt. B D Sharma Postgraduate Institute
of Medical Sciences, Rohtak) were unable to participate in the study, even as the state cooperated to
share the relevant information and facilitated management interviews. However, the study overall
ensured that the break-up of sample across the categories of stakeholders is maintained.

Due to the COVID-19 restrictions, 100% field survey was not conducted physically. The desk-research
at the medical colleges and at the department of medical education, including 65% faculty and 19%
student interviews were undertaken physically offline. Remaining 35% faculty and 81% student opted
to fill the online form. However, all the college management and the state level interviews were
undertaken through a video conferencing, except for INIs, where we could undertake face-to-face
interviews.

Since the sample size is only 12 medical colleges, and the recommendations stand relevant; the
findings cannot be directly extrapolated to all medical colleges across the states.
The study was substantially handicapped because of lack of access to data, for various reasons.
Therefore, some critical analysis couldn’t be undertaken because of non-availability of granular level
data at the source itself:
• Data for Desktop Review was not readily available at the colleges and DMET (except in
Chhattisgarh, Delhi, TN, Uttarakhand),
• Even in these states, data wasn’t readily available; DMET had to contact the colleges to collect
information,
• Colleges informed of being bound only by RTI to get information,
• Colleges uploaded data only during NMC visit, after NMC visit data gets archived, which is not
accessible to researchers or academicians.

1.3.4. Study Instruments, and Training of Investigators
Questionnaires
Separate set of questionnaires were designed for different stakeholders and modifications were
included to bring in further clarity in research questions, after the pilot study (Annexure 2).
Figure 1 - Profile of respondents


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Engagement of Appropriate Survey team
Since, this was a specialized study that required in-depth understanding of the medical education,
senior staff of SahaManthran that constituted of doctors, educationists, human resource experts, and
social researchers conducted all the online/offline meetings with the DGME, Dean, Faculty and
Students to assure impactful probing to elicit the requisite clarity. Further, the faculty and students
were encouraged to self-fill the online tool (Annexure-1) with support of our medical researcher on
the ground where possible.
Training of Survey team
Since, this was more of a qualitative study all the state level medical researchers were trained on the
art of probing.
1.3.5. Data collection and management
A web-based Computer-assisted personal interviewing (CAPI) tool was developed using Kobo Collect,
which is based on Open Data Kit (ODK) platform for the data collection. The collected data were
regularly monitored by the M & Experts using a standard data viewing and editing dashboard. Data
raw data were exported in STATA (Quantitative) and Atlas.ti (Qualitative) for analysis.
Qualitative data management
The data dictionary/ codebook was developed to define column attributes, specify the range of
allowable values, and standardize data coding (e.g., yes = 1, no = 0). Data entry errors were minimized
by using a pre-developed web-based data collection tool. Additional cleaning and editing of data for
outliers and inconsistencies were performed regularly during data collection, and finally, the data was
cleaned and coded using Atlas.ti.
Quantitative Data Management
All the quantitative data was collected in a web-based Kobo Collect application. Some data were
collected using the printed version of the same questionnaire and were entered on the same tool
immediately after quality and consistency checking. Monitoring and Evaluation (M&E) experts
reviewed and cleaned all the data during data collection to minimize inconsistency.
Cleaning of Raw Data
Before exporting the raw data to STATA format, for analysis, data validation, filtering & cleaning was
undertaken. All plausibility and data consistency checks were undertaken.
Transcribing and checking
All IDIs were recorded with due consent of the respondent/s and transcribed verbatim before
uploading the data on the statistical tools.
Security and Confidentiality
All data was stored under a password-protected secure cloud server, and only authorized personnel
had access to extract the requisite data for analysis.


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1. .











Chapter 2 – Study
Findings


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2.1. Overall Existing Vacancy Status
As per the prevailing NMC norms, India should have 1,38,028 medical faculty nationally (detailed in
Table 3). However, the actual number of medical faculty registered with the NMC is 96,649 inclusive
of regular and contract faculty as NMC considers contractual faculties in the head count for institute’
faculty strength at any given point of time, resulting in a vacancy of 29.9%, (total vacancy-41,379).
12

Table 3 - Estimation of Total Number of Medical Teacher Requirement in India
Maximum
Permissible Seats
Number of
Colleges
Faculty Requirement per
Institute as per NMC Norms
Faculty Requirement as per
NMC Norms
50 13 148 1,924
100 137 178 24,386
150 307 219 67,233
200 75 287 21,525
250 70 328 22,960
TOTAL 602 1,38,028
Source: NMC college and course search and NMC procedure to start a new college standard;
https://www.nmc.org.in/information-desk/faculty-medical-students-information/
The faculty shortage across cadre is evidenced even with the Institutes of National Importance (INIs)
such as the All-India Institute of Medical Sciences (AIIMS), New Delhi and Postgraduate Institute of
Medical Education and Research Chandigarh, India (PGIMER). Even as AIIMS and PGIMER were set up
as autonomous medical colleges by the federal government under the special Act of Parliament in
1956 with autonomy to recruit faculty within the ambit of Government Financial Rules (GFR) and
decide beyond the NMC norms; shortage is a realty for them too. For instance, AIIMS reported the
following staff shortage (refer Table-4). Similarly, PGIMER had about 23% faculty shortage as against
sanctioned strength in 2019-20 (refer Table-5).
Table 4 – AIIMS, New Delhi Vacancy Position
Description Sanctioned Filled Vacancy
Number of Teaching Departments – 42; Number of Teaching Centres – 7
Faculty members 1,095 759 27.4 %
Non-faculty staff 12,318 10,189 17.3 %
Source: AIIMS Annual Report 2019-20
Table 5 – PGIMER, Chandigarh Vacancy Position
Description Sanctioned Filled Vacancy
Group A – Faculty 728 565 22.4%
Group A - Non-faculty 1,535 1,495 2.6%
Group B 3,974 3,549 10.7%
Group C 2,339 1,565 33.1%
Source: PGI Annual Report 2019-20

12
College and state-wise disaggregated data on actual number varies constantly. Therefore, consolidated the total


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Our interviews with the Deans and Directors of AIIMS and PGIMER clarified that their faculty estimates
were based on overall workload per faculty with regards to teaching, research, and patient load,
cumulatively making their requirements greater than NMC’s prescribed norms. Further, the INIs, as a
practice hire faculty with attitudes aligned across levels for teaching and research, and do not merely
fill a position for the sake of regulatory compliance. The AIIMS discussion clarified that there was no
genuine crisis of faculties, and the vacancies prevail because of inability to find the right candidates.
Contrary to the INIs, the vacancy challenges in state medical colleges were more systemic in nature.
Therefore, for the purposes of the study to estimate the breadth and depth of the problem, following
definitions were used:
• “Vacancy”has been defined-- as positions remaining vacant for over 1yr;
• “Shortage”— as faculty vacancy greater than 10% remaining open beyond 6 months (because
NMC allows 10% shortfall with warning, and beond 6months the continuation of shortage
draws de-licensing as penalty); and
• “Retention”– as faculty staying in the same medical college for over 5 years
2.2. Vacancy Status of Study Colleges
The disaggregated data on vacancy status in the public domain (Institutes updated their portals only
prior to NMC visit) was available only from 8 colleges (See Table 6). Desktop research data was made
available only by 4 study colleges (in Tamil Nadu, Chhattisgarh, Uttarakhand and Rajasthan). Other
study colleges could not furnish despite repeated reminders, NITI letter and our team member
standing on ground in the state DMEs and colleges. Colleges and DMEs both acknowledged that they
didn’t have the latest data. None of the DMEs had readily available updated consolidated data for all
the state medical colleges, except for Chhattisgarh and Tamil Nādu.
Table 6 - Vacancy Status in Study Institutes
College
NMC
approved
seats
Faculty
required
as per
NMC
norms
Faculty
sanctioned
by states
Faculty
filled
Vacancy
against
sanctioned/
norm
Vacancy in
percentage
Status as on
date
Dr Rajendra
Prasad GMC
120 219 NA 123 96 44%
19/02/2021,
as per site
Lala Lajpat
Rai Memorial
Medical
College
150 219 NA 128 91 42%
23/9/21-as
per site
Govt. Medical
College,
Haldwani
150 219 NA 127 92 42%
07/09/2020-
as per site
Chhattisgarh
Institute of
Medical
Sciences
180 287 335 217 118 35%
Sept/2021-
as per Data
Sheet
Mysore
Medical
College
150 219 309 200 109 35%
Sept/2021
As per data
sheet


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Assam
Medical
College &
Hospital
200 287 311 259 52 17%
11/03/2020,
as per site
Sawai Man
Singh Medical
College
250 328 613 604 9 1%
Sept/2021-
as per Data
Sheet
Villupuram
Medical
College,
Villupuram
100 178 198 179 19 10%
Oct 2021-
Data sheet
Note: Vacancy against sanctioned position always supersedes vacancy against a norm here. The above data pertains to
overall vacancy staus – including both Contract and Regular faculty.
Source:
https://cimsbilaspur.ac.in/MCI_Data/Teaching_NonTeaching_Staff/faculty_list_25feb2019.pdf,
http://rpgmc.ac.in/clause-info/, http://rpgmc.ac.in//wp-content/uploads/2020/05/Teaching-Staff.pdf,
http://dgmeup.in/docs/staffdetail.pdf, https://amch.edu.in/pages/about/annual+report,
http://www.vimsar.ac.in/upload/List-of-Teaching-Staffs.pdf,
https://education.rajasthan.gov.in/content/raj/education/medical-education-
department/en/administrative_reports/administrative_report.html,
http://www.vmcvpm.ac.in/vmcvpm/content_page.jsp?sq1=facultydetails1743&sqf=2985, https://gmchld.org/wp-
content/uploads/2020/07/faculty-09-July2020.pdf
The vacancy status in study institutes (Table-6) reflects that older institutes like SMS Jaipur, VMC
Villupuram, are able to ensure lower vacancy without resorting to hiring of contractual faculty.
However, the newer colleges or those which are remotely located, like CMC Chhatisgarh, GMC
Haldwani, RP GMC, have depended on contractual recruitment for maintaining faculty requirements.
Management of most study institutes reported total vacancy of over 10% after accounting for
contractual staff, except for Rajasthan (0%), Karnataka (0%), TN (4%), DDN Medical College
Uttarakhand (10%), and Odisha (10%). No Separate disaggregated data on contractual versus regular
vacancy was shared by the colleges/ states, except those from TN and Chattisgarh. TN reported zero
percent contractual staff. Based on management feedback from the study states, following were the
key highlights regarding the vacancy status in the colleges (Table 7).
Table 7 – Vacancy* Status in Study Institutes based on Management Feedback
College Vacancy status in colleges and their reasons, as per management KII
Assam Medical
College & Hospital
Varies month to month because of transfers between medical colleges within Assam.
Vacancies are filled within short periods by recruitment board. 100% regular
employment.
Chhattisgarh
Institute of Medical
Sciences
Overall, 40% vacancy, despite the contractual hiring - 8% deficiency in professors,
18% deficiency Associate Prof.; maximum vacancy in Asst. Prof. of 66% by sanctioned
posts and 46% by NMC norms. 50% deficiency in Radiodiagnosis and another 50% in
biochemistry and forensic medicine.
Maulana Azad
Medical College
Vacancy of 30-40% across most departments.
PGIMS Rohtak Approximately 30% in total, 15% due to reserved categories as no suitable
candidates available; remaining in Nephrology and paraclinical specialities.
Approximately 70% of total (of 410) are regular positions.
BJ Medical College 15-16% vacancies in the last three years. In 2021 - 6%. Approximately 60% are
permanent and 40% contractual faculty.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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27
Dr. Rajendra Prasad
Medical College
Overall vacancy of 15-20%.
Rajiv Gandhi Medical
College
Overall vacancy of 5-20%
Veer Surendra Sai
Medical College
Overall vacancy of 10%. There are no super speciality departments. Shortage mostly
in paraclinical-No MBBS opting for paraclinical PGs.
Mysore Medical
College
No vacancy in the college. With increase in student intake at UG level, 48 APs will
have to be recruited; possibly take walk-in interviews and get them approved on the
go. Over 38% vacancy in administrative posts - out of 367 sanctioned posts there are
139 vacancies.
Sawai Man Singh
Medical College
No vacancy in SMS. Reputation of hospital and legal permission to private practice,
makes SMS the institute of choice. In the general departments and specialist
department - there are no vacant positions - no sanctioned positions are ever vacant.
Villupuram Medical
College
Overall vacancy of 4%.
Govt. Medical
College, Haldwani
Overall vacancy of 10%.
Source: Primary survey in study colleges
* Please note that the “vacancy” status referred to by the college management is with reference to the
“minimal requirements” to meet the basic norms prescribed by NMC. They are NOT based on patient load in
the respective hospitals.
Chattisgarh MC, LLRM MC, Rajendra Prasad MC reported the vacancy status was over 35-45%, because
of non-fulfilment of reserved seats (information from management interview) after inclusion of
contractual appointees. Except for the Chattisgarh MC, at Raipur where the contractual faculty
constitute only 4% of total faculty strength, remaining 4 government colleges of Chattisgarh have over
45-60% as contractual staff.
Further, 94% Management Officials were aware of provision to recruit ‘Visiting Faculty’ under NMC.
However, they prefer not to recruit visiting faculties, because of their non-inclusion in faculty head
count by NMC; secondly, the general inability to enforce accountability amongst visiting faculty for
teaching out of respect for their seniority, as they are usually retired senior professors from within the
same system.

QUICK FACTS
NMC Guideline on Visiting Faculty
The NMC under its Board of Governors (under NMC Act 2019, 13th Oct, 2020) had also allowed hiring of
‘visiting faculty’ by medical colleges with an idea to ‘enhance the comprehensiveness and quality of
teaching of undergraduate students in pre-clinical, para-clinical and clinical departments. Medical
Colleges/Medical Institutions can appoint additional faculty members on part-time basis who shall be
known as “Visiting Faculty”. Their qualification requirements will be as per that prescribed in “Minimum
Qualifications for Teachers in Medical Institutions” regulations. In case a medical college is unable to
provide full time faculty beyond the minimum prescribed, the minimum visiting faculty to be appointed
shall be at least 20% of the prescribed faculty. It is worth noting that the visiting faculty is over and
above the Minimum faculty prescribed, and thus is not counted within the minimum faculty prescribed
by NMC.


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28
2.3. Vacancy Status by Departments/ Speciality in Study Institutes
From the eight study institutes that shared disaggregated data we analysed the departmentwise
vacancies (refer Table 8).
13

Table 8 - Department Wise Vacancy Status in Study Institutes
Departments Vacancy
Para-Clinical and Pre-clinical Departments
Physical Medicine & Rehabilitation 6.1%
Microbiology 3.7%
Pathology 2.1%
Forensic Medicine and Toxicology 1.8%
Anatomy 1.5%
Pharmacology 1.2%
Biochemistry 0.6%
Clinical Departments
General Surgery 14.4%
General Medicine 11.6%
Orthopaedics 11.6%
Anaesthesiology 9.2%
Paediatrics 7.3%
Radiodiagnosis 6.7%
OBGYN 6.1%
Radiotherapy 5.2%
Pulmonary Medicine & TB 3.4%
Community Medicine 2.4%
Oto-rhino-laryngology 2.1%
Psychiatry 1.8%
Ophthalmology 0.9%
Source: Secondary data and data shared from/by study colleges
As can be seen from data in Table-8, and as validated by Management/ DGME interviews, highest
vacancies are seen in super specialities (radiotherapy, pulmonary medicine) and surgical specialities
and in pre-clinical specialities like anatomy and forensic medicine. This was attributed to the following
reasons during management discussion:
• Surgery and super-specialities are high paying jobs in private sector and hence attractive,
• And all private (tertiary care) hospitals are mostly in Tier-I metros, so specialists prefer a
private sector job, given their propensity for better quality of life,
• With change in NMC guidelines in 2019 to recruit only MBBS candidates reduces the ability
of medical colleges to fill some amenable non-clinical positions with non-medical post-
graduates (MSc), leading to vacancies in pre-clinical specialities.
• Lowest vacancy is seen in pre/clinical specialities like community medicine, psychiatry. This
was attributed to the fact that PGs in these specialities do not have many job openings; and
teaching position in medical college is by far the most prestigious.

13
Respective state level data from 8 college websites—Chhattisgarh Institute Of Medical Sciences, Dr. Rajendra Prasad
Government Medical College, Tanda, HP; Assam Medical College & Hospital; Veer Surendra Sai Institute Of Medical Science
& Research; Lala Lajpat Rai Memorial Medical College, Meerut, UP; Government Medical College, Haldwani, Uttarakhand;
Sawai Man Singh Medical College, Jaipur, Rajasthan; Mysore Medical College & Research Institute, Karnataka; Villupuram
Medical College, Tamil Nadu.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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29
2.4. Vacancy Status by Faculty Cadre in Study Institutes
Further analysis of data from the study colleges, indicate that shortage is usually seen in Associate
Professor and Assistant Professor cadre at about 35-45%. The lower levels of vacany or overfilling at
Professor level is because of Assured Departmental Promotions every 4 years, leading to a top heavy
inverted pyramidal organizational structure in medical colleges (refer Table 9).
Table 9 – Select Cadre-wise Vacancy Status in Study Institutes across UG & PG Seats
Institute Post
Sanctioned/
Norm
Filled Vacant Overfilled
%
Vacancy
Chhattisgarh Institute
of Medical Sciences
(CIMS)
Prof 24 18 6 0 25%
Assoc 61 19 42 0 69%
Asst. 90 50 40 0 44%

175 87 88 0 50%
Dr. Rajendra Prasad
Government Medical
College, Tanda, HP
(RPGMC)
Prof 20 29 1 -10 5%
Assoc 33 26 9 -2 27%
Asst. 50 46 11 -7 22%

103 101 21 -19 20%
Assam Medical College
& Hospital (AMCH)
Prof 44 35 9 0 20%
Assoc 73 65 8 0 11%
Asst. 107 95 12 0 11%

224 195 29 0 13%
Veer Surendra Sai
Institute of Medical
Science & Research
(VSSIMSR)
Prof 22 24 4 -6 18%
Assoc 45 51 12 -18 27%
Asst. 67 112 4 -49 6%

134 187 20 -73 15%
Lala Lajpat Rai
Memorial Medical
College (LLRM)
Prof 20 28 4 -12 20%
Assoc 33 22 17 -6 52%
Asst. 50 36 20 -6 40%

103 86 41 -24 40%
Government Medical
College, Haldwani
(GMCH)
Prof 20 19 6 -5 30%
Assoc 33 33 6 -6 18%
Asst. 50 44 12 -6 24%

103 96 24 -17 23%
Sawai Man Singh
Medical College
(SMSMC)
Prof 107 227 0 -120 0%
Assoc 133 128 28 -23 21%
Asst. 274 170 103 1 38%

514 525 131 -142 25%
Mysore Medical
College & Research
Institute (MMCRI)
Prof 29 27 2 0 7%
Assoc 73 67 6 0 8%
Asst. 102 81 20 1 20%

204 175 28 1 14%
Government
Villupuram Medical
College (GVMC)
Prof 20 18 2 0 10%
Assoc 26 36 1 -11 4%
Asst. 38 49 3 -14 8%

84 103 6 -25 7%
Total

1644 1555 388 -299 24%
Note: The above data pertains to overall vacancy staus – including both Contract and Regular faculty.



Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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30
Source:
https://cimsbilaspur.ac.in/MCI_Data/Teaching_NonTeaching_Staff/faculty_list_25feb2019.pdf, http://rpgmc.ac.in/clause-
info/, http://rpgmc.ac.in//wp-content/uploads/2020/05/Teaching-Staff.pdf, http://dgmeup.in/docs/staffdetail.pdf,
https://amch.edu.in/pages/about/annual+report, http://www.vimsar.ac.in/upload/List-of-Teaching-Staffs.pdf,
https://education.rajasthan.gov.in/content/raj/education/medical-education-
department/en/administrative_reports/administrative_report.html,
http://www.vmcvpm.ac.in/vmcvpm/content_page.jsp?sq1=facultydetails1743&sqf=2985, https://gmchld.org/wp-
content/uploads/2020/07/faculty-09-July2020.pdf
For instance, in SMS Medical College Jaipur, we find surplus faculty (negative vacancies/ over filling)
at Professor cadre, with substantial vacancy (39%) at Associate Professor level (Table 10). The vacancy
of 139 posts at associate professor level, almost equivalent to the extra posts at the level of Professor.
In fact, the state of Rajasthan has gone ahead creating an additional cadre of Senior Professors to
accommodate the growing number of professors. Further to tide over the gap in base of the pyramid,
increased number of contractual recruitment has been allowed at the level of Associate Professors,
Senior Demonstrators/ Senior Resident for pre-clinical/ clinical specialities respectively.
Table 10 – Overall Cadre-wise Faculty Vacancy Status for MBBS Seats at SMS Jaipur

Sanctioned
Positions
Regular Faculty
Posted
Contractual
Faculty Posted
Vacancy
Sr. Professor 0 138 0 -138
Professor 144 143 1 0
Associate Professor 356 186 31 139
Asst. Professor 167 158 0 9
Sr. Demonstrator 110 71 20 19
Sr. Resident 303 0 250 53
Source: SMS Medical College Jaipur, Administrative Report 2020-2021, uploaded on 05/02/2021, vacancies are across all
specialties
Whether the faculty subsequent to promotion to professor cadre continue to carry out the roles and
responsibilities of their prior level or the change in role couldn’t be ascertained, given the lack of
existence of a clear job description for each cadre. However, in their interviews, faculty informed that
they continued to work as Assistant Professors despite being financially protected for the professor
position.
2.4.1. Management Perspective on Lack of Improvement in Faculty Shortages
While, in our survey, 67% Management respondents (n=17) felt that faculty shortage had improved in
the last three years owing to contractual appointments, there were consistent factors at play for the
shortage of faculty (Fig 2). They are:
Figure 2 - Reasons for non-closure of existing vacancies in the study institutes for last 3 yrs.
25.0%
25.0%
25.0%
40.0%
60.0%
Attrition of Contractual Employees
Delayed Recruitment Process
Better Opportunities
Promotions
Transfer of Faculty


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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31
• Transfer of faculty to other colleges. In fact, while faculty transfers to other colleges within
the state, may not affect overall state vacancy numbers but potentially burdens individual
medical colleges.
• Faculty promotion leaves lower cadres vacant especially Associate & Assistant Professor
levels.
• Contractual faculty leave on contract closure, or for regular position within or outside the
state, or for better opportunities in private sector or AIIMS in each state.
• Delays in the recruitment process, delays in onboarding of faculty, forces new joinees to
consider alternative options.
• Contractual hiring has become a norm in managing shortages; especially for:
o All new medical colleges to jump-start their operations,
o Managing recruitments at Senior Resident and Associate Professor levels, emerging out
of promotions,
o Increasing workload in select departments,
o Delays in recruitment pending decisions on court cases.
Apart from these, there’s general shortage of faculty because of:
o Lack of availability of potential recruits for select specialties in the state, e.g., Radiology,
Forensic Medicine, Neurology, etc.
o No futuristic sanctions of positions based on analytics on potential vacancy/
requirements in terms of workload analysis
o Inability of the colleges to keep pace with Government Order to increase MBBS seats.
14

Therefore, the study explored the issues around faculty vacancy and shortage at two levels as per
the study objectives:
• Barriers to Recruitment of faculty, including the planning process around estimation of the
requirement
• Barriers to Retention of faculty
2.5. Planning for New Positions
NMC issues guidelines regarding the minimum faculty requirement in a medical college based only on
student intake (student/ teacher ratio). The management interviews across the board however,
revealed that,
15

1. all the states fulfil this requirement as per the NMC norm; and therefore, faculty strength is
never optimal to handle the actual clinical workload. (Section 2.5.1)
2. the faculty/college management do not form a part of the state level decision making, and
hence remain underprepared to receive increased number of student intake (impacting loads
in class rooms, dissection halls, hostels, academic environment, labs). (Section 2.5.2)

14
https://www.nmc.org.in/MCIRest/open/getDocument?path=%2FDocuments%2FPublic%2FPortal%2FMeetings%2FBoard
%20of%20Governors(2018)%2F2019%2F06%2F13%2F19th%20meeting%20of%20BoG%20dt.%2013.6.2019.pdf
15
Management feedback from study colleges.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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32
Therefore, the issue was analysed with respect to NMC guidelines for teacher/student ratio and the
doctor/patient ratio in the colleges.
16

2.5.1. Faculty teaching and clinical load
In order to validate faculty shortage in a college, faculty’s commitment to (a) primary workload
(academic activities, hence student/teacher intensity), and (b) secondary workload (clinical activities,
hence number of OPD cases/faculty), was analysed.
Table 11 - NMC Teacher-Student Ratio Guideline for Medical Colleges
Departments Faculty Norm
100 Seats 200 Seats
Para-Clinical and Pre-clinical Departments
Anatomy 3 6
Physiology 3 6
Biochemistry 3 6
Microbiology 3 6
Pharmacology 3 6
Pathology 6 8
Forensic Medicine and Toxicology 2 3
SUB TOTAL (PRE/PARA CLINICAL) 23 41
Clinical Departments
Paediatrics 4 8
Orthopaedics 4 8
OBGYN 4 8
Community Medicine* 5 7
General Medicine 8 14
Pulmonary Medicine 2 2
Dermatology 2 2
Psychiatry 2 2
General Surgery 8 14
ENT 3 3
Ophthalmology 3 4
Radiodiagnosis 3 4
Radiotherapy 4 4
Anaesthesia 7 10
Physical Medicine & Rehabilitation* 2 2
SUB TOTAL (CLINICAL) 61 92
TOTAL 84 133
* Although these are strictly not clinical departments, we have considered in this category
since they do see patients in OPD/IPD.
We assessed the student load per faculty for General Surgery (clinical) and Anatomy (preclinical)
based on faculty strength as per NMC guidelines for 100 or 200 admissions. For calculations the

16
The individual college assessment reports by NMC which could throw light on the way the faculty shortage is calculated
couldn’t be accessed on the new NMC portal. https://www.nmc.org.in/information-desk/college-assessment-reports/


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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33
student load for undergraduate courses for clinical specialities is limited to students in Year 3, 4, and
5 (since clinical studies start in Year-3) and for pre-clinical it was limited to Year 1 and 2.
Table 12 - Faculty Teaching Load
General Surgery Department
No. of Student Admissions / Batch-NMC Norm a 100 200
No. of Undergraduate Students for Year 3,4,5 b =3*a 300 600
No. of General Surgery Faculty as per NMC c 4 8
Avg. Student Load / Faculty = b/c 25 25
Anatomy Department
No. of Student Admissions / Batch—NMC Norm a 100 200
No. of Undergraduate Students for Year 1,2 b =2*a 200 400
No. Anatomy Faculty as per NMC c 3 6
Avg. Student Load / Faculty = b/c 33 33

MBBS student intake apart, convention is that each faculty across the college, up to Associate
Professor level, supervises a maximum of 4 PG students (2 from each year) for their thesis work and
case presentations etc.
17
The secondary data for Post Graduate (PG) medical students across all states
(Table A1.2) also indicate the student/ faculty ratio ranges 0.5 to 3, based on overall PG students and
total faculty numbers in the state (not specific to a particular department as in Table-9).
While law of averages may seem to have reduced this ratio, we believe that even if we have higher PG
student intake in their choice of departments, the faculty/PG student ratio within the department will
hover around the same order of magnitude of single digits.
Next, we assessed the clinical load per faculty in medical college, based on standard norms in the
industry, and also based on actual OPD/ IPD loads from medical colleges (secondary research).
18

Table 13 - Clinical Load per Faculty – based on standard assumptions
All Clinical Departments Assumptions
No. of Student Admissions / Batch a 100 200
No. of Bed required as per NMC b =3*a 300 600 NMC guidelines
No. of OPD Patients/ Day c = 2*b 600 1200 2 OPD Patients per Bed per Day
No. of IPD admissions/ Day d = c/5 120 240 20% conversion from OPD to
IPD in multi-speciality setting
No. of Total Patients (OPD+IPD) / Day e = c + d 720 1440
Total Clinical Faculty as per NMC f 61 92 As per Table-9 above
Total Patient Load / Faculty / Day g = e/f 12 16
Note: Using the norms used by INIs, including that of CMC Vellore, as illustrated during discussions with them and
retrospective estimation from the proposed NMC norms for the given permissible admission.

This ratio of less than/equal to 20 patients per day (OPD plus IPD), as calculated above, is well accepted
as a reasonable patient load for faculty in medical college, given their academic and research
responsibilities (as understood during discussions with INIs). It’s the normal practice that there is a

17
Management inputs; Please note that there is no classroom teaching involved in PG courses.
18
Ramani K.V, Narang Sahil, Roy Debjit: Planning the Activities of Doctors in a Teaching Hospital,
https://web.iima.ac.in/assets/snippets/workingpaperpdf/2313213252013-06-05.pdf


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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34
pyramidal structure of patient referral to an Associate Professor or a Professor. Also Associate
Professors and Assistant Professors are not assisted by Sr. Residents in their chambers unlike a
Professor, and the type of cases referred therefore vary in terms of criticality or uniqueness, which in
turn affects the time spent by faculty for each case. The other aspect, which is often the reason for
erratic workload (in line with feedback from Sr. Faculty survey) is the Emergency Cases.
The aforementioned observations, assumptions and its analysis were validated with some actual data
of OPD loads from study Medical Colleges.
Table 14 - Clinical Load per Faculty – based on actual numbers
Name of the College Beds Avg. Daily
OPD
No. of Clinical
Faculty Filled
No. of OPD
Patients/ Day/
Faculty*
Assam Medical College 1277 1250 105 11.9
Rajendra Prasad Medical College 802 1732 58 35.8
VSS Medical College 982 650 142 4.6
Mysore Medical College & Research
Institute
1050 790 103 7.7
Sawai Man Singh Medical College 6251 10,000 268 37.3
Government Villupuram Medical
College
1100 3245 78 41.6
*Note: For calculating patient load, we have assumed actual faculty numbers belonging to clinical specialties (sourced from
respective college websites-Table-9), which are involved in patient care. This also excludes Junior Residents, who are not
considered under faculty headcounts.
Number of OPD days are considered as 300 working days in a year, adjusting for govt. approved holidays, and weekends.
For calculating patient load, we have assumed actual faculty numbers belonging to clinical specialties
(sourced from respective college websites-Table-9), which are involved in patient care. It also excludes
Junior Residents, who are not considered under faculty headcounts. With a valid argument that there
would be a wide variation in actual patient load distribution across specialties based on disease profile
of incoming patients in the medical college, because of seasonality, disasters, epidemics, etc., there
would be an equivalent time consumption in managing IPD patients. Further, emergency and
surgery/procedure cases are generally handled by Senior Residents and ‘faculty on-call’. Although,
cases are distributed between the various units of a department based on standard scheduling in
hospitals/ medical colleges, and faculty on emergency duty is given post-duty relief as a standard
practice, it is likely that the order of magnitude could be 3-4 times higher than reasonable limits of
20 patients/day/faculty, in addition to the above calculated workload.
This is in line with the feedback from management and faculty that heavy patient workload is a
hindrance to honouring their teaching responsibilities. Added to this, is the extra hours put in by
faculty in administrative tasks including, attending court cases, visits by state officials or dignitaries,
etc.. Hence the expectation of institutes’ management is clearly to dynamically assess the work load
of faculty across all cadres as the starting point for assessing the faculty requirement and use
contractual hiring to keep work load under control.
2.5.2. Inability of the states to keep pace with Government Order (GO) to increase MBBS seats
College management respondents shared feedback that the state government instructs the institutes
to increase seats without consulting the colleges or giving a 3 to 5 years’ timeline to plan for acquiring
resources to accommodate more students in hostels and expand lecture theatres/ labs for practical
sessions. A fallout of that, is a scenario wherein 35 to 40 students crowd out on a single anatomy table,


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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35
and end up just looking at dissected organs, and never get an opportunity to dissect themselves.
Secondly, there was a lack of development of student-teacher relationship in the training process.

A case in point was the increase in MBBS seats in PGIMS Rohtak. MoHFW’s request dated 29
th
January
2019 for increase in seats under the Economically Weaker Section (EWS) category for all government
colleges from the academic session 2019-20. The 13th Board of Governor (BoG) meeting held on the
13th June 2019 approved the MoHFW request dated 29/01/2019 to increase seats under EWS
category for all govt colleges from the academic session 2019-20. The NMC approval was subsequently
reflected as increased seats from 200 to 250 with immediate effect for PGI, Rohtak, Haryana (refer
figure 3) for the same 2019-20 session.
19

2.6. Barriers to Recruitment & Onboarding
In order to understand the barriers to recruitment and on-boarding, it’s critical that the current
recruitment process for faculty at the state level is understood:
2.6.1. The Current Recruitment Process
At the Central level, the Union Public Services Commission (UPSC) conducts examination for all regular
central government recruitments, including that for medical colleges under its ambit, except that for
INIs. The fresh medical officers and specialities appear for an annual combined medical services
examination for requisite positions.
20
The eligibility requirement for applying for faculty position is,

19
https://www.nmc.org.in/MCIRest/open/getDocument?path=%2FDocuments%2FPublic%2FPortal%2FMeetings%2FBoard
%20of%20Governors(2018)%2F2019%2F06%2F13%2F19th%20meeting%20of%20BoG%20dt.%2013.6.2019.pdf
20
For instance, please see notification for the 2020 faculty examination here
https://www.upsc.gov.in/sites/default/files/Notice-CMSE-20-English.pdf, accessed on 27 June, 2021
Figure 3 - Evidence of approval of BOG to increase EWS seats and increased seats in PGIMS,
Rohtak


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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36
completion of MBBS degree or respective post-graduate degrees as per the NMC norm. The test
includes objective and subjective type questions. Candidates who clear the first test are subsequently
subjected to a personality test. The personality test assesses the candidate’s intellectual curiosity,
critical powers of assimilation, balance of judgement and alertness of mind, ability for social cohesion,
integrity of character, initiative and capability for leadership by UPSC.
The State Public Service Commission (SPSC) is the state level counterpart of UPSC for all state level
regular government recruitments undertaken in the similar pattern following the Government
Financial Rules (GFR). Some states have created a separate board, the Medical Recruitment Board
(MRB) to facilitate recruitment of essential services, such as the medical services to save on
recruitment process time.

A typical process of recruiting medical faculty in States, is presented in figure 4, below.
• The State Department of Health sanctions positions put forth by the Directorate of Medical
Education (DME) after due scrutiny and seeking clearance from the Department of Finance on
availability of funds to service such a request and/or make provisions for such a requirement.
• The DME calls for requirements from the medical colleges for the positions to be sanctioned and
communicates with the SPSC or corresponding MRBs for initiating the recruitment process.
• The colleges raise requisition to the DME for the requisite positions as per NMC norms for the
approved seats, doctor: patient ratio.
• The colleges have been also authorised to undertake contractual recruitments as against the
sanctioned positions to tide over the process delays.
While State Public Service Commission conducts recruitment for all kinds of officers in a particular
state, the job of MRB is to manage the recruitment specifically for medical faculty.
However, there are some state level variations in this process of recruitment adopted by the states:
Figure 4 - Typical Recruitment Process in States State (Department of Health)
Sanctions positions after due clearance from
Department of Finance
Directorate of Medical Education (DME)
Calls for requirements from medical colleges for
positions to be sanctioned; communicates to
SPSC/MRB for kick-starting the recruitment
Medical College/s
Raises requisition for positions required as per
NMC norm, doctor: patient ratio;
undertakes contractual recruitment
State Public Service Commission
Undertakes all regular recruitments for all
departments including that of health after receiving
recruitment requirement
Medical Recruitment Board
Undertakes all regular and/or recruitment only for
Department of Health after due approval from DME


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• Delhi is an outlier to this process. It has an additional layer of sanction required from the
centre for select colleges, such as that for Maulana Azad Medical College (MAMC); for sanction
of positions, approval of shortlisted candidates and roll out of appointment letter.
• While universities primarily act as an overseeing body to review if the colleges follow the
proposed and agreed policies; Rohtak Medical College and its affiliated University being
autonomous bodies, also participate in the recruitment process.
• Uttarakhand, Andhra, Assam and TN have created a MRB (referred to as Chayan Aayog in
Uttarakhand) to facilitate recruitment only for medical colleges.
• Rajasthan has adopted a hybrid model, where different channels have been opened to
facilitate recruitment – (a) for the erstwhile government medical colleges through SPSC and
(b) for Society Medical Colleges through Rajasthan Medical Education Society (Raj-MES). For
District Hospitals that are being converted as medical colleges (recruitment through Raj-MES),
transfers are applicable across the state.
21

• TN’s MRB, uniquely has a separate continuous recruitment and retention system, the
Counselling for Transfer and Promotion Policy managed by the Tamil Nadu Medical Services
Corporation, (TNMSC-CTP).

• Assistant Professor appointment, is the entry level for all regular recruitments across country

21
Society medical colleges are eight medical colleges, set up as a ‘Society’. The list of the colleges can be found here:
https://education.rajasthan.gov.in/content/raj/education/medical-education-department/en/Society-Medical-Colleges-
Including-Raj-MES.html#

TNMSC - CTP Model
Tamil Nadu has Tamil Nādu Medical Services Corporation - Counselling for Transfer and Promotion
(TNMSC-CTP) model, has a separate board to undertake recruitment and retention as a complete
end-to-end Human Resource Management Solution for the essential services, i.e., the medical
services at the state level.
a.An integrated institutional structure for campus recruitment and career path was created for the
entire medical workforce in the public healthcare delivery system, not just medical colleges. So,
state level recruitment decisions are made based on not just students in their final year
undergrad courses, but also existing pool of faculty and practitioners across the state public
health system.
b.The state incentivises specialization in scarce specialities: additional allowance is granted for PGs
in scarce specialities, such as- Anaesthesia, Forensic medicine, Radiodiagnosis, Orthopaedics etc..
An allowance is also granted to medical officers working in difficult areas.
c.Private practice is allowed only within the medical college and only after college hours with the
understanding that it not only enhances their income but also enables cross learning and
exchange of ideas between the public and private healthcare systems.
d.A sharing pattern has been devised - 15% of the share is given as incentive to the medical team,
encouraging faculty undertaking private practice, to admit patients (especially from BPL category)
to government hospitals for specialised surgeries.
e.Continual restructuring and sanctioning the teachers’ posts, ensuring that the “post- matrix”
follows the norms in pre-clinical/ para-clinical and clinical departments and for broad specialities
and super specialities; weightage to deal with increased load of patients; considers the existing or
proposed infrastructure availability, so as to ensure comprehensive patient care.


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• Medical colleges have authorization only for recruitment of contractual staff.
• The Assam Directorate of Medical Education has 19 institutes under it. Of which, 8 are medical
colleges (others include dental, pharmacy, paramedical courses). One of the aims of the
Directorate is to develop and sustain medical education through proper planning.
Medical colleges are authorised to recruit contractual faculty on their own. For instance,
examples of recruitment notices of GMC Raipur, GMC Mandi and Chikaballapur Institute of
Medical Sciences show that medical colleges do initiate walk-in interviews for selecting
contractual medical faculty for their colleges. However, MRBs/ SPSCs may also hold walk-in
interviews, typically, for contractual positions.
2.6.2. Time Taken for Recruitment & Onboarding of Regular Faculty
Over 70% of the faculty responded that there is no
fixed annual hiring cycle for faculty recruitment, rather
it is a continual process. This is particularly relevant in
the context of contractual faculty hiring, which
happens on a need-basis and hence the cycle of
recruitment is continual. However, for the regular
faculty requirement, the hiring cycle is a periodic
annual exercise in most states.
Only 16.2% (n=179) of the participants responded that
the process-time for regular recruitment is more than
one year (figure 5). On an average 51.4% faculty informed that it took about 6 months for one regular
faculty recruitment cycle to be completed. Delhi, however took greater than 1.5 years for regular
recruitment, because of the additional level of approval required from the centre for its state colleges,
such as for MAMC and GTB, Medical College, Delhi.
Post approval/sanction at the Directorate, the average time taken in days for the regular recruitment
process is detailed in figure 6.

Note: Majority of response lies within the box refers to a range of 20-40days as time taken for each of
the step in regular recruitment process. The dots refer to outliers of time taken for each step. 51.4%
32.4%
16.2%
< 6 months6-12 months> 12 months
Figure 5 – Overall Time Taken for Recruitment
Process (Regular Faculty)
Figure 6 – Median of Time taken in days for each step in the Regular Recruitment Process


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Feedback from respondents indicates that, once a position was sanctioned, recruitment was easy.
• The average time taken for recruitment, from vacancy advertisement to final letter of offer to
selected candidate, was about 203 days for regular positions, and 94 days for contractual
positions.
• However, the sanctioning of a position at the health directorate itself, typically takes 2-3
months (based on management respondent interviews)
• The sanction to advertisement has been a bottleneck, taking over 2 years in Delhi & UP and
nearly 4 years in Haryana & Chhattisgarh (based on faculty interview and secondary research).
• The desktop research in the state medical colleges reflected that of ‘Application to
Shortlisting’ by far takes the longest time, median being 67.8 days. Rolling out offer letter,
takes the shortest time, with a median of 21.7 days.
The hiring time varies substantially across recruitment steps and across states, because of various
reasons (refer Table 15). Management interviews indicate that recruitment through the SPSCs is often
delayed because of the inability to convene the selection boards on schedule and/or regular intervals,
which is the first step in approval for sanctioned positions. The challenge here is that there is no fixed
timeline attached to this leg of the process – approval and constitution of the Board.
• The States have responded to such delays by:
o Constituting a separate MRB (Uttarakhand, Assam and Tamil Nadu) and/ or giving
autonomy to the colleges or hiving off select activities of SPSC (Karnataka, Andhra Pradesh,
Odisha KBK districts
22
, PGIMS Rohtak) to the colleges; to hasten the process of regular
recruitments & roll out appointments.
o The MRB in Uttarakhand is only for clinical and nursing hiring; Tamil Nadu has TNMSC, with
a separate board that operates under CTP (Counselling for Transfer and Promotion) policy.
o PGIMS, Rohtak being a university does its own recruitment, hence shortens recruitment
time.
o Autonomy to southern states and Odisha (KBK districts) is only for hiring contractual staff
or rolling out letters for onboarding (for both contractual and regular).
Table 15 - State-wise variation in recruitment timelines
State and Process wise mean
time taken for regular
recruitment process
AP (n=32)

Assam (n=15)

Gujarat (n=14)

Haryana (n=9)

Chhattisga rh (n=29)

Karnataka (n=9)

Odisha (n=2)

Rajasthan (n=9)

TN (n=22)

UP (n=53)

UKD (n=19)

Delhi (n=25)

Total (n=251)

Advertisement to
application 29.2 30.9 16.7 37.1 27.4 39.4 60.0 47.8 15.5 28.4 17.8 69.9 34.7
Submission of application to
shortlisting 83.9 40.5 97.8 41.3 70.2 20.6 30.0 176.1 40.4 50.3 14.0 105.8 67.8

22
The old districts of Koraput, Balangir and Kalahandi (popularly known as KBK districts) have since 1992-93 been divided
into eight districts: Koraput, Malkangiri, Nabarangpur, Rayagada, Balangir, Subarnapur, Kalahandi and Nuapada. These
districts account for 19.72% of the population and occupy over 30.59% geographical area of the State. Around 90% of the
people of this region still live in villages. As per the 1997 census of BPL families, about 72% families are below poverty line
among those who live in this region which was 82% during 1992 census. More specifically, 49 CD Blocks of KBK districts are
regarded as "very backward" and 28 CD blocks are considered as "backward".


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Shortlisting to interview
25.4 27.7 7.0 24.0 22.7 20.3 30.0 55.6 12.4 46.0 10.1 46.3 30.0
Interview to selection
11.3 35.9 43.3 14.6 21.1 20.7 30.0 15.6 13.9 37.8 13.3 31.1 24.0
Selection to offer letter
8.0 27.0 10.0 10.0 14.7 24.6 30.0 45.0 21.6 32.9 8.7 48.4 25.3
Offer letter to onboarding
4.8 25.0 7.0 9.4 22.1 18.4 20.0 18.6 17.3 28.6 4.1 46.3 21.7
Total
162.7 187.0 181.8 136.4 178.1 144.0 200.0 358.6 121.2 223.9 68.0 347.9 203.5
Source: Primary Survey
• Gujarat, Haryana, UP, and Delhi undertake recruitment through State Public Service Commission
(SPSC).
• Feedback from respondents’ and grievances has been more around the uncertainty of timeline per
se, rather than the delayed process timelines itself.
o These uncertainties in timelines and the fear of losing their license for the approved seats,
have made contractual hiring a norm in faculty recruitment. This contractual hiring seems
a standard practice not only for new medical colleges to fulfil its requirement before NMC
inspection; but also, to some extent, for the older medical colleges to fill the senior
residents and associate professor vacancies/ shortages.
• While medical colleges circumvent the process and end up recruiting contractual staff; it is a
temporary solution to the true challenge around recruitment process.
o One of the solutions to the recruitment process challenge is the TNMSC-CTP model,
which identifies a potential candidate from the campus itself up to post-graduation and
then stages a career progression path (detailed in section of recommendation).
o One of the recommendations from PGIMS Rohtak, was to absorb Senior Residents as
Assistant Professors if eligible, to save time around recruitment process delays.
• States with an independent system of recruitment (MRB), the recruitment cycle of medical faculty
has a more effective and predictable timeline, leading to fewer vacancies and more regular recruits.
Constituting board and coordinating for regular commissioning of board of senior members at state
level is difficult and usually leads to delays.
2.7. Barriers to Recruitment of Regular Faculty
The barriers to recruitment as informed by faculty across cadre and specialities was scored on a 10-
point Likert scale. The most challenging barriers to recruitment as expressed by the faculty and
management are (refer Table-16):
• Lack of 24X7 support to facilitate form-filling (74.8%). The Army Medical Core provides
support and responds to queries of people who try to apply for faculty positions, especially at
night, because generally doctors do the form filling etc. only at night after completing day’s
work.
• Lack of Facilities to participate in the interview, such as boarding and lodging (68.6%) serves
as a disincentive.
• Lack of Access to Information on Vacancy Status (61%). There is no central database on
national vacancies/ filling status, to facilitate conscious applying and avoiding resignations and


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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re-applying elsewhere. For instance, for recruitment in KBK districts of Odisha, it is clearly
mentioned by the state that the positions in these districts are non-transferable.
• Non-responsive staff or no central point of contact in college or DME for clarification (61.5%).
• Lack of information around terms and conditions of employment, such as transfers, difficult
area postings, state level recruitment & promotion rules
Table 16 – Faculty feedback on barriers to smooth recruitment experience
Challenges
Number / % Of
respondents who found it
Most challenging
Lack of 24X7 Support to Facilitate Form Filling (n=214) 160 (74.8%)
Lack of Facilities to participate in the interview, such as boarding lodging.
(n=207)
142 (68.6%)
Lack of Access to Information on Vacancy Status (n=213) 130 (61.0%)
Non-responsive staff or No contact point in college or DME for
clarification (n=208)
128 (61.5%)
Lack of information around terms and conditions of employment
(transfer, difficult area postings, state level recruitment & promotion
rules) (n=207)
122 (58.9%)
Delay in time taken to receive offer letter after confirmed selection
(n=207)
112 (54.1%)
Lack of information around Roles & Responsibility (n=208) 111 (53.4%)
Cumbersome and Lengthy Form (n=204) 96 (47.1%)
Lack of Access to Application Form (n=208) 88 (42.7%)
Source: Primary Survey of faculty
Other barriers cited by management respondents as barriers to faculty recruitment were –
• Non-cancellation of an unfilled vacancy for 5 years,
• Process delays for complaint resolution within the government setup,
• 70% of management respondents shared that court cases (annexure-2) pertaining to lack of
transparency in recruitment and retention (DPCs) is usual in all states, numbering at least 20-
25 cases each year;
• For instance, in Uttarakhand out of the 312 recruitments done in the last 2 years, only 70-80
joined. 128 cases are pending since 2018 on recruitment, common reasons being:
o hiring of contractual positions happens on upper age limit of a post- 70 years for Professor
and 50 years for Assistant Professor; but regular hiring happens on the basis of eligibility
and bars entry of candidates over 65 years and 45 years respectively.
o regularization of contractual positions/ change in policy.
On the need for information/ transparency around terms and conditions (Table 16), a deep dive of
select court (listed in Annexure 4) cases shows that some of the key processes that were challenged
in the court of law were related to –
• Transparency on the requisite qualification,
• Non-adherence to selection process,
• Eligibility criteria having been overlooked,
• Reservation criteria creates problem in case of unfilled positions.




Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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2.8. Onboarding Challenges of Faculty
The issue of process delays for onboarding, and lack of transparency in processes remains after
recruitment as well. For instance,
• About 32% of respondents did not come to know about their job responsibilities and duties
until after the recruitment process was complete,
i. and of the ones that received their “job
descriptions”, 41% respondents believed that the
documents received by them were unclear about
the onboarding process.
23

• Only 17.4% faculty respondents reported that, they had
some induction during their onboarding in the form of 2hr
introduction to respective departments.
• 82.6% of the faculty respondents (n-202) asserted that there
was no formal induction into the college, which should have
helped for their initiation into the faculty network, roles and
responsibilities, and smoothening the onboarding process.

2.9. Retention Challenges
The retention challenges are more of a factor of aspirations of students or faculty joining medical
colleges and the extent to which they have been met. Career aspiration is the inherent personal goal
of an individual with respect to their professional life and the better it is aligned to the organizational
goals, the better is the retention and may be responsible for life-satisfaction in general.
24

2.9.1. Reasons for Leaving
Overall attrition across states is less than 5%. It has been attributed in the College Management level
interviews commonly to staff leaving for better opportunities or contractual staff converting into-
regular appointments; especially with upcoming AIIMS in
each state the exodus has increased. Based on feedback
from faculty respondents, the topmost reasons for
leaving are – “salary disparity between contractual and
regular staff”, “career progression with movement to
better-known colleges”, “academic and research
environment” in the college, “non-transparent
promotion and tenure policy” related to an almost non-
existent performance management system.

23
A “job description” is a formal written statement of what the faculty actually does, how he or she does it, and what the
job’s working conditions are. Sections of a typical job description include - Job title & identification, job summary,
responsibilities and duties, authority of incumbent, standards of performance, working conditions, and job specifications.
Source: https://www.iedunote.com/job-description. Also refer https://www.randstad.in/hr-news/hr-trends/five-essential-
elements-an-effective-job-description/.
24
Zahid, 2017 Career Aspiration and Life Satisfaction of Final Year Medical School Students at
http://dx.doi.org/10.21649/journal.akemu/2017/23.4.487.491

QUICK FACT
Overall attrition across states is less than
5%, attributed amongst other variables,
to contractual staff leaving or for better
opportunities.
Source: Primary Survey


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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There is a perception of salary disparity between regular and contractual faculty, especially for clinical
specialties. For instance in LLRM (Meerut), a regular Asst. Prof. joins at an average take-home salary
of ₹45,000/month, while a contract staff for same position, on an average, gets a fixed emolument of
about ₹85,000-125,000/month. Prima facie, they are not strictly comparable; since a regular faculty
has salary emoluments (including superannuation benefits, perquisits, leave, among others), which is
not available to contract faculty, along with the important consideration of job security compared to
fixed term of a contractual faculty.
Table 17 - Reasons for Faculty Attrition*
Components of Work Environment/Culture affecting Attrition Most Important
Salary disparity between contractual and regular staff (clinical specialties) (n=206) 153 (74.3%)
Career progression with movement to better-known colleges (n=203) 142 (70.0%)
Better academic and research environment (n=204) 128 (62.7%)
Other non-technical government hospitals (n=201) 120 (59.7%)
Private practice (n=208) 112 (53.8%)
Non-transparent promotion or tenure Policy (n=203) 103 (50.7%)
Lack of leadership and mentoring (n=190) 99 (52.1%)
Compromised living conditions and quality of life (n=200) 91 (45.5%)
Deranged Work-life balance (n=199) 85 (42.7%)
Social and family commitments (n=194) 83 (42.8%)
Isolation of under-represented groups (n=193) 59 (30.6%)
Lack of ambient and clean environment (n=191) 58 (30.4%)
Job security – tenure of contract (n=186) 50 (26.9%)
Note: Source: Primary survey of college faculty. Attrition is defined as faculty leaving their jobs within one year of joining.
Least important reason for leaving job was – “lack of ambient and clean environment”. Interestingly,
“job-security” or “living conditions of self” and “family support systems” didn’t feature as critical
reasons for faculty attrition. In fact, management respondents concurred that while these could be
reasons for dissatisfaction amongst staff but does not lead to attrition.
2.9.2. The Aspirations of Medical Faculty
Given the lack of high attrition rates, it is pertinent to understand the motivation of existing faculties
to engage in an academic career. The factors that motivated faculty across cadre and specialities to
join a medical college was scored on a 10-point Likert scale. The survey included 234 medical faculty
across different stages (Senior Residents, Assistant Professors, Associate Professors, Professors) of
their career, to understand their aspirations. The survey indicated that the faculty were inherently
motivated in the beginning of their teaching career. However, commercial considerations and desire
to have a better quality of life, make them change the course of their career, primarily towards private
practice in a clinic or hospital.
Over 89% of the surveyed faculty had aspirations of becoming a teacher in a medical college. Most
faculty respondents stated that they are motivated to work as faculty because of their inherent
passion for their profession (94%) and motivation to serve the needy (80.4%), prestige associated with
being a professor (87.5%), academic and research to deep dive into clinical challenges (86.4%) and


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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exposure in a public health system (table-17). The usual motivation of job security, social status,
financial considerations were secondary.
Table 18 - Factors influencing Faculty to join Medical College
Motivating factors for faculty to have joined medical college in
% (n=234)
% Respondents
who found it
Most Important
Passion for the profession 94.0
Prestige to associate with the profession / Social Status 87.5
Career progression/ Greater work exposure and challenging
opportunities
86.4
Service to the needy 80.4
Academic and research environment 79.0
Stable Income / Financial Security 78.6
Job security 76.7
Brand of the college and work culture 76.6
Social Pressure / Family and children’s considerations 67.5
Influence of a role model 57.1
Peer group and network 55.3
Convenience of location—proximity to hometown 54.7
Opportunity to work in a tier-I city or well-established township 52.3
Shortage of faculty in medical education 39.2
Note: Source: Primary survey of college faculty.


2.9.3. The Unmet Aspirations and Barriers to Faculty Retention
Since academic and research culture in a college is a major variable, we explored the extent to which
the aspirations of faculty were met after joining the medical college. The faculty in their response have
not been overly enthusiastic on realisation of their aspirations. More than half of the respondents
have shared that their expectations have not been met for most components of their work
environment (refer fig-7).

However, the unmet aspirations have not resulted in an unmanageable faculty attrition. The analysis
of overall tenure served by the respondents as faculty reflects that while the challenges were many;
Figure 7 - % Faculty NOT satisfied with following components of work environment in medical college 43.4
47.0
49.4
52.6 53.4
55.8
58.2 58.6 59.4
63.7
Independence or
freehand for
decision making
(n=142)
Acceptability in
organisation and
department
(n=133)
Accountability &
cooperation of
paramedical staff
(n=127)
Opportunities for
career
progression
(n=119)
Opportunities for
networking for
sharing learning
(n=117)
Oppportunity for
regular and,
specific training
and capacity
building (n=111)
Transperency &
objectivity in
promotion
(n=105)
Safety and
security on
campus (n=104)
Clarity in roles &
responsiblities
(n=102)
Safety and
security during
official tours
(n=91)


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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such as dilapidated houses, low salary, no pension for all recruits after 2007, unhygienic
environment, etc. but none of it were reasons critical enough for faculty leaving a government job.

The feedback from most faculty respondents’
points, not to the salary levels per se, but
broader issues related to the lack of
performance-based incentive within the
defined role (87.6%), or mentoring into a new
role, especially managerial (68.4%), as a
primary grievance; and lack of transparency in
tenures/ promotions and transfers (62.2%)
although regular annual increments was
always available (refer Table-18). Feedback
from respondents indicated that in the mix of
contractual and regular staff in a typical
medical college, there are no
incentives/disincentives to promote a specific
and/or desirable performance; resulting in
lack of accountability. In the absence of a
robust system to appraise performance, there
are no quality indicators which can measure
what a good performance should look like.
Source: Primary Survey
Variables incentivising good performance % Respondents
Lack of Performance Based Incentives and Accountability 87.6%
No system for structured mentoring, transition to managerial role 68.4%
Only Annual Increment is Available (no academic leave etc. is available) 66.3%
No transparency in Tenures/Promotions/Transfers 62.2%
Note: These Percentages were derived from number of respondents with qualitative responses to the question regarding
challenges and barriers.

The survey confirmed an almost non-existent research ecosystem – both hard and soft
infrastructure.
25
And there is almost a consensus regarding this amongst the management and faculty.

Table 20 - Lack of Incentives for Research & Other Academic Activities
Variables affecting research activities % Respondents
Research efforts not appreciated 95.8%
Lack of avenues for research grants 93.7%

25
A thriving university research ecosystem is defined as one that lends to consistency, efficiency and sufficiency in research
output, to achieve sustainability. Source:
https://www.researchgate.net/publication/307678952_University_Research_Ecosystem_A_Conceptual_Understanding
Figure 9 - Faculty retention and years of service of
regular faculty in medical college in %
Figure 9 - Faculty retention and years of service of
contractual faculty in medical college in %
Table 19- Lack of Performance based Financial Incentives


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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Lack of adequate resources for research (Research Assistant/IT Support
in form of PC, software)
91.7%
Lack of support to pursue research 70.8%
Approval to participate in conferences/workshops for personal growth
(but not funded)
69.9%
Non-conducive work environment for peer networking 54.9%
Note: These Percentages were derived from number of respondents (management and faculty) with qualitative responses to
the question regarding challenges and barriers.

2.10. Management Perspective on Faculty Retention
The salaries of medical faculty vary state-wise and depends on the overall budget of the state. At the
union level, the income received by medical faculty at autonomous institutions is regulated by the pay
commission, which is usually adopted by the states through their State Finance Commissions.
26
The
management across colleges pointed out that as there’s no system of monitoring workload (71.4%)
of faculty or measuring their accountability (80%); and therefore, no rational system for regular
review and enhancement of ‘total emoluments’ drawn by a faculty.
The 6
th
pay commission had decided that the Non-Practising Allowance (“NPA”) of doctors would be
capped at 25% of basic pay and the total salary, including Dearness Allowance; subjected to a
maximum value. The Sixth Pay Commission clarified that, doctors should be provided with the NPA,
not only to compensate for the loss of privilege of private practice, but also to compensate for the fact
that, the basic medical course is of a longer duration (4 ½ + 1 year internship), and consequently
doctors have a shorter effective service period, and that the promotion prospects for doctors are
lesser since entry level posts in the cadre of doctors have to be filled by direct recruitment.
27
The
Seventh Pay Commission, in 2017, however, revised the NPA to 20% of the basic pay while increasing
the threshold of total payable amount to about four times the earlier rate.
28
In 2008, the DA (dearness
allowance) component was removed from the equation, but the NPA was brought back to 25% of the
basic salary and the maximum value of such salary provided to doctors was almost doubled.
29


26
See, DoE order dated 6 Oct, 2004 at https://doe.gov.in/sites/default/files/06-10-2004.pdf
27
See, Report of the Sixth Pay Commission, March 2008 at
https://pensionersportal.gov.in/sixthcpc/paycommissionreport.pdf
28
See, DoE notice dated 7 July, 2017 at
https://doe.gov.in/sites/default/files/NPA_Medical%20Posts_other%20than%20CHS_%20Eng.pdf
29
See, DoE notice dated 30 August, 2008 at https://doe.gov.in/sites/default/files/30-08-2008.pdf
Figure 10 - Management feedback on faculty retention in %


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The Management and Faculty interviews revealed that the faculty are not dissatisfied with their
overall salary structure per se, but have grievances against select components of overall emolument
– (i) NPA, (ii) benefits to foster academics and research. There is also a resentment because of mis-
match between salaries and benefits of contractual versus regular staff. While regular staff get lesser
salary, the other benefits accrued in terms of leave, pension, NPA etc. are higher. However, salary for
contractual staff is higher with no benefits, not even casual leaves. The Management Survey further
revealed dissatisfaction amongst faculty:
• Lack of parity in total remuneration across specialities of the same cadre, across colleges at
inter and intra state levels,
• Lack of parity between contractual and regular staff across cadres, commensurate with
responsibility and accountability for each cadre.
• Contractual faculty feel they are exploited and have to work more compared to their regular
counterpart in the same position. Regular faculty feel they share greater responsibility and
accountability and hence should be remunerated suitably.

2.10.1. Absence of Formal Capacity Building Activities
Secondary research revealed that the ‘Faculty Development Programs’ (FDP) in India have been
organized by medical colleges and universities for training the medical teachers, through ‘Basic
Courses’ and ‘Advanced Courses’, on pedagogy envisaged to improve the quality of medical education.
Globally, researchers believe that curriculum change, emphasizing competencies, lies at the forefront
of twenty-first century medical education.
NFDP (National Faculty Development Program) was Initially introduced in 2009 for conducting basic
workshops in ‘Medical Education Technologies’ through selected Regional and Nodal Centres located
at medical colleges with required infrastructural and trained manpower, so that faculty members can
avail modern education technology for teaching. Overtime, the NDFP expanded to include ‘Revised
Basic Course Workshop' in Medical Education Technologies (“BCW”) introduced in 2009, training in
Attitude, Ethics Communication (“AETCOM”) module introduced in 2015, and Curriculum
Implementation Support Program (“CISP”) introduced in 2018.
30

However, the movement to competency-based framework is a slow process and requires a qualitative
understanding of the aspirations and incentives of the medical faculty throughout their career. For
instance, the NMC counterpart in the UK, the General Medical Council (“GMC”) recognises medical
faculty and GP trainers only after they satisfy seven-point criteria on quality of training, which includes,
assessment of whether teachers create a competency-based learning environment for students as
described below:
31

a. Ensuring safe and effective patient care through training
b. Establishing and maintaining an environment for learning
c. Teaching and facilitating learning
d. Enhancing learning through assessment

30
See, AETCOM - NMC, 2018 at https://www.nmc.org.in/wp-content/uploads/2020/01/AETCOM_book.pdf, accessed on
27 June, 2021.
31
For a comprehensive list, please refer to GMC Recognition and approval of trainers at https://www.gmc-
uk.org/education/how-we-quality-assure/medical-schools/recognition-and-approval-of-trainers, accessed on 23 June,
2021.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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e. Supporting and monitoring educational progress
f. Guiding personal and professional development
g. Continuing professional development as an educator
Training of faculty is restricted to NMC mandate on the following topics:
a. Teaching Techniques
b. How to better engage students
c. Teaching Aids and Technology
d. Writing Research Papers
e. Patenting
While one of the significant grievances expressed by senior faculty respondents has been on increased
administrative burden, without specific training for transitioning into management roles; they have a
larger grievance of lack of personal growth opportunity in their respective specialties. 68.4% of faculty
at Associate Professor and Professor level reported non-availability of a structured mentoring to an
administrative/ managerial role. Nor are there any structured mentoring program within the college
with senior faculty administrators. This creates a self-propagating cycle of disenchantment of faculty
in a non-academic role.
2.11. Lack of Facility for Academics and Research in Medical Colleges
In terms of availability of infrastructure, primary survey indicates that, while the college has adequate
and appropriate infrastructure for academics; the infrastructure and support available for research
and stay of faculties is inadequate and inappropriate (Table A1.3).
Secondary research revealed that only 25 (4.3%) medical institutions produced more than 100 papers
a year but their contribution was 40.3% of the country's total research output. In comparison, the
annual research output of the Massachusetts General Hospital was 4,600 and the Mayo Clinic 3,700.
About 57% of Indian medical institution do not have single publication in last 10 years. Most of the
publication in India pertains to three medical institutions i.e., AIIMS, PGI Chandigarh and CMC Vellore.
Number of papers indexed in PubMed in 5 years block period reveals that India contributes only 3-5%
of overall global research (Table 21).
32

Table 21 - Research out of India as % of medical research
Period World India (% of World)
1991 – 1995 392354 12079 (3.07%)
1996 – 2000 442000 13282 (3.00%)
2001 – 2005 606000 26016 (4.29%)
2006 – 2010 699420 51815 (7.40%)
2011 - 2015 806326 49219 (5.49%)
Source: Deswal BS, Singhal VK. Problems of medical education in India. Int J Community Med Public Health 2016; 3:1905-9.
2.12. Quality and Effectiveness of the Current Medical Education System

32
Source: Deswal BS, Singhal VK. Problems of medical education in India. Int J Community Med Public Health 2016; 3:1905-
9.


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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49
This section has tried to understand the impact of barriers to recruitment and retention on overall
quality of medical education and research.
2.12.1. The Aspirations of Medical Students
The study revealed that over 88% students prefer studying in a government medical college, for an
opportunity to learn (85%) and see more patients (82.3%). Overall institute ranking (76.7%), and one’s
own ranking in competitive exams are additional considerations for choosing a medical college (refer
Table A1.4). Significant number of students do not accord huge importance to teacher-student ratio
(54%), proximity to home (54%), quality of research (59%) while choosing a medical college. While
students prefer government medical institutions, in terms of career aspiration after studying
medicine, the preference to become a professor (40.3%) follows closely next to providing patient care
(54.7%) for the students, similar to their faculty (Table 22). Another 35% that are interested in Hospital
Management & Research; and are therefore potential candidates for seeking job in medical colleges,
given an opportunity.
Table 22: First preference (career) of medical students in %
Job Seeking Preferences (n=315) % Student Respondents Most Inclined to
Join in a Private Clinic/Hospital 169 (53.7%)
Join as a medical teacher 127 (40.3%)
Healthcare Consultant 102 (32.4%)
Managing a hospital 71 (22.5%)
Basic Research in a lab 40 (12.7%)
Pharmaceutical Industry 16 (5.8%)
In terms of preference around job location, most student respondents (77.4%) preferred Metro and
Tier-1 cities. And on expected lines almost 39% respondents preferred a work location near their home
(Table-23).
Table 23: First preference (job location) of medical students in %
Job Location Preferences (n=318) In %
Metropolitan City 159 (50.0%)
Near Home 124 (39.0 %)
Non-metropolitan Tier 1 City 87 (27.4%)
State Capital 63 (20.0%)
Tier 2 City 56 (17.6%)
Birthplace 53 (16.7%)
Rural Area 48 (15.1%)
Tier 3 City 34 (10.7%)


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Further, on the issue of the extent to which aspiration of students were met after joining the medical
college, it was seen that expectations varied as the students matured into the system based on
experiences on ground; especially with respect to quality of education. We clubbed the responses of
students in pre-clinical years, clinical years and internship and post-graduation years based on growing
breadth and depth of their involvement in clinical practice, academics and research. The
dissatisfaction levels have grown progressively into internship (65-70%) from clinical years of
studentship (40-50%) and somewhat settles mid-way at 55% during post-graduation, as students
realise the need to take personal initiative in academics and research, if they seek excellence (refer
figure 12).
The topmost reason for dissatisfaction amongst students were:
(i) lack of time for research or bedside teaching (70.6%),
(ii) disparity in infrastructure across specialty (64.7%),
(iii) backdated syllabus & teaching style (55.9%),
(iv) lack of clinical or research skills being imparted (67.6%),
(v) lack of role models (61.8%),
(vi) lack of quality teaching staff (67.6%), and
(vii) others including, lack of hotel facility, low cadaver/ equipment to student ratio, online
classes in these covid times, no facilities for extra-curricular activities within the campus.
The students informed that:
• 91.3% of the scheduled classes are conducted (n=303), of which
o 39.9% classes are taken by Senior Residents (n=264), while
o 48.4% classes are allocated to tutor/assistant professor (n=263), and
o 44.9% classes are allocated to associate/ professors (n=256)
• 37.8% informed that clinical rounds were not held every day (n=312)
42.2
30.4
32.4
24.5
25.5
19.6
27.5
9.8
55.3
50.050.0
41.240.6
35.3
13.5
7.6
70.6
64.7
55.9
67.6
61.8
67.6
14.7
2.9
47.1
58.8
55.955.9
52.952.9
20.6
8.8
52.1
46.5 45.9
40.3 39.4
35.6
1
7.9
Lack of time for
research /
bedside
teaching
Disparity in
infrastructure
across
speciality
Backdated
syllabus and
teaching style
Lack of clinical
and research
skills being
imparted
Lack of role
models
Lack of quality
teaching staff
None Others
1st and 2nd Year Final Year (3rd to 5th)Intern PG Student Total
Othersinclude:No
hotelfacility,low
cadaver/equipment
tostudentratio,
onlineclasses,no
facilitiesforplaying
Figure 11 - Current level of dissatisfaction among students with the college in %


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• 56.9% informed that evening rounds were not held every day (n=209)
• 41.7% informed that bedside teaching is not held every day (n=218)
• 57.3% informed that no system was available to provide feedback on quality of teaching by
the concerned faculty (n=314)
While exploring the reasons for dissatisfaction, we deep-dived into adequacy and appropriateness of
the infrastructure, which was one of the reasons expressed by the students. The findings from student
feedback, was similar to the feedback from the faculty. Students reported inadequacy and
inappropriateness primarily around state of art medical equipment, IT facility for academics and
research, availability of research assistants and hygienic and ambient amenities at workplace (refer
Table A1.6).
• Student Perception of Contractual versus Regular Faculty
The analysis of student satisfaction regarding academics (clinical bedside teaching, evening rounds,
clinical grand rounds) against availability of regular and contractual faculty, revealed that student
satisfaction levels are higher in colleges with higher percentage of regular faculty @85-100% as
against 35-50% in colleges with over 50% of contractual staff (table 24). This can be attributed
probably to the increased belongingness of regular faculty for the institute compared to contractual
faculty.
Note: Faculty % as per management questionnaire estimates, *Data from desktop review
• Student Perception of Private Practice versus No-private Practice:
Study by Ryan et al revealed that career choices are influenced by role models and informal career
advice.
33
Our student survey also reflected strong linkage between private practice and compromised
medical education that is statistically significant (Table-25).
34
The Chi-square test administered to

33
Ryan C, Ward E, Jones M. Recruitment and retention of trainee physicians: a retrospective analysis of the motivations and
influences on career choice of trainee physicians. QJM. 2018 May 1;111(5):313-318. doi: 10.1093/qjmed/hcy032. PMID:
29452409.
34
The Chi-square test of independence or association determines whether there is a statistically significant relationship
between the categorical variables. It is a hypothesis test that answers the question - do the values of one categorical
Table 24 - Student Satisfaction with respect to type of faculty (regular vs contractual)


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establish the depth of relationship between private practice and medical education reveals strong
relationship between private practice and compromised medical education with p-value less than
0.05. ; Private practice compromises all aspects of medical training; in terms of
o faculty taking all scheduled classes,
o clinical beside teaching,
o evening teaching rounds,
o clinical grand rounds.
Table 25 - Establishing relationship between private practice and compromised medical education

Source: SahaManthran analysis based on primary survey data
However, the management response to the perceived dissatisfaction of students was varied across
colleges and State DMETs. Study state medical colleges and DMET at TN and Rajasthan supported the
merit of permitting private practice, in terms of increasing access to specialised care to all at affordable
cost. They further elaborated that, such practice allowed the interns and PG students to see more
patients, and provided them opportunity of greater hands-on learning, and to earn some extra income
while studying.
However, management in Delhi study college was against private practice and believed that it has a
potential to modify the young minds around what is ethics, ethical practice, time spent around
academic excellence, which in turn could potentially impact the brand of the institute, its culture;
creating a vicious downward spiral for medical education at large and the Medical College in specific.
Odisha college management had a neutral take and accepted that private practice is here to stay at
least for the clinicians whether NPA is given or not; and therefore, has accepted it as it is.
2.13. Role of institutions in regulation and governance of medical education
In order to have a streamlined recruitment and retention of faculty, effective functioning of the
medical education ecosystem is critical. Therefore, we undertook secondary research of the

variable depend on the value of other categorical variables: The Null Hypothesis presumes that there’s no relationships
between private practice and clinical teachings. The Alternative hypothesis: establishes that there’s a relationship between
private practice and clinical teachings Not allowedAllowed
Yes75% 56%
Not allowedAllowed
Yes79% 49%
Not allowedAllowed
Yes59% 35%
Not allowedAllowed
Yes96% 87%
Does all faculty take classes
as per schedule?
Is Private Practice allowed?
Pearson Chi2(1) = 5.6269, Pr=0.018; n=303
From the data it was evident that there is a relationship between private
practice and clinical ground round. It is seen that where the doctors are
allowed private practice the proportion of clinical grand round is less
compared to where private practice is not allowed.
From the data it was evident that there is a relationship between private
practice and bedside teaching. It is seen that where the doctors are
allowed private practice the proportion of bedside teaching is less
compared to where private practice is not allowed.
From the data it was evident that there is a relationship between private
practice and evening round teaching. It is seen that where the doctors
are allowed private practice the proportion of evening round teaching is
less compared to where private practice is not allowed.
From the data it was evident that there is a relationship between private
practice and taking classes as per the schedule. It is seen that where the
doctors are allowed private practice the proportion of scheduled classes
is less happening as compared to where private practice is not allowed.
Pearson Chi2(1) = 18.0950, Pr=0.000; n=214
Is Private Practice allowed?Does evening teaching rounds
happen daily?
Pearson Chi2(1) = 11.0488, Pr=0.001; n=205
Do clinical grand rounds
happen daily?
Is Private Practice allowed?
Pearson Chi2(1) = 9.7632, Pr=0.002; n=303
Does clinical bedside teaching
happen daily?
Is Private Practice allowed?


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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governance and management system of 12 states and compared it with international best practices
(US, UK, Canada, Korea, Brazil). One of the reasons for the existing challenges to recruitment and
retention, as assessed from secondary research, was the lack of role clarity between the agencies for
regulating, governing, and managing the medical education in the states. Our secondary research
revealed that:
• Role of NMC is clearly regulatory - to lay down policies for maintaining a high quality and high
standards in medical education and make necessary regulations in this behalf, amongst many
other functions. Role of DMET, however, is not clear. Going through the objectives/ roles and
responsibilities of the DMET of various states, it was observed that the DMET may also have
a regulatory role rather than an executive function. So there seems to be an overlap between
DMET and NMC. Ideally the regulatory roles are shared by the federal and state/provincial
councils; the state/provincial medical education department shares an administrative and
management role for all colleges; and the medical colleges implements the decisions taken
therein (refer section 3.5-3.7 for details).
• Further, a study of objectives, roles and responsibilities of the departments of medical
education of the sample states, shows that only a few have shared their intent (through
citizen’s charter) on imparting quality medical education (AP, Assam, & TN) – and guidance
in terms of “service standards” expected for medical education and related aspects like
35

o Classes as per regulations or guidance, conducting regular theory and practical classes
ICMR Projects, seminars and Integrated teaching,
o Conduction of tests, internal assessments and university examinations as per
guidance,
o Faculty development , conducting workshops for training medical teachers, CME’s
seminars, Research Methodology,
o Post Graduate Teaching- Clinical Postings and Training , Dissertation work ,Theory and
Practical’s, Seminars and Journal Clubs,
o Conducting regular CME for the Post Graduates and Faculty as per guidance.
For rest of the states, medical education, though is the thrust of their work, the roles and
responsibilities differ in terms of their focus on transactional matters such as:
o development of specialties and super specialties at government institutes,
o state of art technology and procurement of latest equipment,
o rights to cancel letter of intent (LoI), no-objection certificate (NoC) or essential
certifications of colleges,
o creation of educational institutes and infrastructures,
o admissions of students and functions related to admissions.
As per the response from interviews with DME officials, all strategize to increase the number
of medical colleges to three times the current numbers, though there isn’t much thought given
to planning of faculty recruitment and development, and other aspects of medical education.

35
https://dme.ap.nic.in/DME_Citizen_%20Charter1.pdf; https://dme.assam.gov.in/resource/citizens-charter-1; accessed on
15 Apr. 22.


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• Furthermore, there is no Human Resource (HR) department in any college/state, with the
same objective of capacity building of faculty in the college, similar to the separate
administrative cadre in Armed Forces Medical Core (AFMC).
• Rajasthan and Gujarat have created separate structure under Society’s Act for creation of
Medical Colleges that are attached to District Hospitals. These operate primarily as National
Health Mission, with great flexibility, autonomy and facilitate hiring of staff primarily as
contractual hires at rates higher/ different than the regular packages.
o The societies are also headed by Administrative Officers and Technical experts from
the state services.
o The Gujarat Medical and Education Research Society (GMERS), is farther from the
Rajasthan model, with its charter ensuring self-sustainability by fixing fees at market
rates and paying its faculty at market rates.
• The Medical Recruitment Board (MRB) created in UKD and TN operates as an extension of
State Public Service Commission to facilitate direct recruitment, in a speedy manner, keeping
in view the nature, importance and essentiality of the faculty positions.
o The MRB was constituted by the Government of Tamil Nadu in G.O. (Ms) No.1,
Health and Family Welfare (C2) Department dated 02.01.2012, headed by a State
Administrative Officer with all clearances under one roof. Prior to the formation of
MRB, the authority for the direct recruitment was vested with different officials of
the various directorates, and hence process delays in various levels of approval.



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2. .
3.






Chapter 3 – Analysis &
Recommendation


Barriers to Recruitment, Onboarding and Retention of Faculty in Government Medical Colleges in India
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3.1. Key Recommendation Emerging from a Lifecycle Approach to Medical Education
The lifecycle of a medical student choosing a career in medicine spans over 12-15 years, traversing
through three stages as shown in the figure 13 below. The career aspirations of a medical graduate
develops primarily from the past experiences of their seniors/ parents, which gets corrected and/or
rationalised when the aspiring student faces the job market challenges. The aspirations finally gets
aligned with the organization that matches closest to their expectations in terms of socio-economic
gains, resulting in retention of the individual within the select organization or medical college.
Secondary literature suggests that the greater the alignment between personal goals of individuals
with that of the organization, the better is the ability of the organization to retain talent.
36

Therefore, we used a systems framework (Figure 13) to analyse our findings, its interlinkages across
the variables and their impact. This Talent Management Framework is a demystified representation
of the complexity in the HR value chain interlinking the intrinsic motivation/ aspirations of the
medical faculty with recruitment, onboarding and retention.
The ‘Talent Planning’ in the case of medical education draws its guidelines from the NMC
requirements that is primarily based on the levels of annual intake of students, to operationalise a
medical college. The ‘Talent Acquisition’ is a factor of intrinsic and extrinsic elements that motivates
an individual to choose career in a medical college. Intrinsic elements are demand side elements that
are aspirational in nature for an individual; recruitment and on-boarding process are supply side
elements of talent acquisition. Extrinsic elements are all other supply side variables/ influencers such
as - the institution’s brand, culture around medical education, and research that attracts people to
choose the teaching profession; and overall vacancies arising out of an increasing intake of medical
students into the system. The ‘Talent Retention’ refers to building capacity and developing the faculty,

36
Lowenstein SR, Fernandez G, Crane LA. Medical school faculty discontent: prevalence and predictors of intent to leave
academic careers. BMC Med Educ 2007; 7:37
Figure 12 - Lifecycle of a Medical Faculty Professional


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engaging with faculty, and strategizing for career growth and development of faculty, to retain the
talent within the medical education system in spite of attractive career alternatives.
3.2. Talent Planning
The biggest challenge to planning for recruitment as evidenced in the study is the lack of reliable data
on exact number of faculty, the
vacancies, or even practicing doctors in
each state and in each medical college
across the country.
3.2.1. Information Asymmetry
Primary reason for this challenge is the
duplication of registration of doctors.
The law permits a doctor to register in
more than one state; i.e., in the state of
graduation, post-graduation, and the
state/s s/he practices; with all
registration/s remaining live
perennially. It gets further complicated
due to the transfer of faculty to colleges
within the state during NMC
inspections/audits; to manage
compliance to the NMC requirements.
Mismatch between the rate of faculty
recruitment and movement/ exit of existing faculty leads to piling up of avoidable vacancies over time.
This not only defeats the purpose of the NMC guidelines, but also adds to the lack of visibility on faculty
vacancies at a macro level to support planning. Thus, each college makes its own faculty acquisition
plan, without much visibility into the actual vacancy levels across the state. In fact, such ad hoc
transfers create a mirage of faculty shortage (inclusive of regular and contractual faculty) for state
planning. Further, the state-level variation in recruitment timelines and its uncertainties, distorts the
demand side information for the prospective medical faculty about vacancies, at state and national
levels.
Therefore, based on the study findings, it is recommended that:
a. Each student (potential faculty) entering medical education be provided with a unique pan-
India ID number, to track a medical professional through their entire career. This should be
legally mandated for medical professionals similar to ITR filing to ensure accountability. This
will avoid duplication and ensure availability of a reliable macro level data on pool of doctors
across various career streams, specialties and sub-specialties.
b. To begin with, a nation-wide database only for the medical college faculty— ‘Centralized
Registry’ could be maintained by NMC and made publicly available, just like UGC portal (see
box below). This will:
• prevent medical colleges to resort to ad hoc appointment of faculty for NMC inspection.
Figure 13 - Framework for Talent Management


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• Line list medical faculty qualified to teach throughout India, which can be used to hire
even the retired faculty as teachers for specific periods
• A reliable information on faculty pool on a digitized platform for recruitment, and
regular cycle of faculty planning and recruitment will also ensure visibility to the faculty
promotions and retirements.
This recommendation is in line with the academic job portal maintained by the University Grant
Commission (UGC) for NET/SET/Ph.D. qualified candidates to bring their academic profile to the
attention of universities/colleges and other employers with the ultimate aim to bridge the gap
between demand and supply with adequate and appropriate position every time, and also generate
visibility around additional job opportunities across the country. All vacancies anywhere in India, is
compulsorily advertised on this portal, so that all interested candidates can get to know about
vacancies through this platform, thus streamlines the information flow.

In the United Kingdom, all doctors, including medical faculty are registered with the General Medical
Council (GMC), that maintains a medical register.
37
The GMC Medical Register boasts of having signed
entry of Dr Alexander Fleming, Professor of Bacteriology at St. Mary's Hospital in London in its register,
the discoverer of penicillin, in 1928. The USA, on the other hand generates the data base of US medical
doctors and faculty at the state levels (there are about 70 state medical boards), and presents it to
centralized level through a Federation of State Medical Boards (FSMB) for compilation.
38

Recruitment planning apart, the lack of visibility on the faculty pool available at the state as well as
country level, makes it difficult to take proactive and informed decisions on (i) increasing the medical
student intake; (ii) opening new medical colleges; (iii) additional resource planning to cater to the
needs corresponding to increased seats (in terms of teaching facilities, experimental lab facilities,
residential and hostel, among others). For instance, opening of eleven new AIIMS in various states,
without commensurate focus on increasing faculty pool over time, has encouraged movement of
senior faculty from existing medical colleges in those states, thus adding to the burden of vacancy in

37
https://www.gmc-uk.org/registration-and-licensing/the-medical-register/a-guide-to-the-medical-register
38
https://www.fsmb.org/education/

UGC Recruitment Process for Higher Education Institutes (HEls)
a.Non-prescriptive: Institutes are asked to follow the selection process as per their Acts, Statutes or
constituent documents and, in accordance with the UGC (Minimum Qualifications for Appointment
of Teachers and other Academic Staff in Universities and Colleges and other Measures for the
Maintenance of Standards in Higher Education) Regulations, 2018.
b.Online, centralized portal for candidates: HEls should, however, ensure that all the vacant posts,
along with the details of reservations, are uploaded on the online portal <https://ugc.ac.in/uamp/>.
The monitoring of the filling up of the vacancies would be done by the MHRD and UGC through this
portal.
c.Time period for selection prescribed: HEls should initiate and complete the selection process within
a period of 6 months.


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the existing medical colleges. The ensuing faculty shortage because of vacancy gets translated into
poor student/ teacher ratio, and adversely impacts teaching outcome.
3.2.2. Recruitment process barriers
Sanctioning new regular positions through the layers of government approval process is a significant
reason of delay as well as uncertainty around timelines (there is no fixed time that could be associated
with this approval process). Although, once the position is sanctioned, the recruitment process is fairly
time-bound.
• The approval process could very well be managed if selection committee could be mandated
to sit regularly with a clear visibility on the overall faculty positions and potential applicants
at the state level. Typically, states that depend on SPSC have such delays because of the
burden on SPSC to process recruitments across all departments in the state, not just medical
colleges. States therefore can constitute MRBs (Medical Recruitment Board) to convene
regular selection committee meetings to streamline medical faculty planning and
recruitment.
• If this regular planning and recruitment cycle, were to be achieved, then the need for ad hoc
or contract faculty will be limited to bridging the gap for the interim period in a regular
recruitment cycle. While the feedback from management of many colleges was for more
autonomy to recruit faculty, study reveals that a centralised faculty recruitment process
successfully implemented through MRB could eliminate the need for contractual
appointments.
• The colleges can be given autonomy for (i) contractual hires to the extent of delay in
recruitment cycle, which some of them currently already have; (ii) and roll out of
appointment letters for faculty getting posted in their college; thus, saving energy and time
of MRB only for planning, advertisement and selection of appropriate candidate for each
medical college at the state level.
• The contractual faculty interested in continuing in academics can be considered for
regularisation over a considered period of time and based on minimum performance criteria
(to be set for such regularization), similar to a blended Contractual-Regularization model
adopted by ILBS. This should act as an incentive to contract faculty for giving commitment for
their academic responsibilities. Longer duration of regularised contract, like Liver and Biliary
Sciences (ILBS) and Rajiv Gandhi Cancer Institute, on regular contract of 4 year period each,
with appraisal by an institute committee and external subject matter experts to decide on
extension for next 4 year period.
• The current SPSC/MRB composition doesn’t include representation of key stakeholders like
public health, medical education, family welfare, women and child, finance, establishment
etc. under one committee, similar to that in TN model. The TN model with 9 directorates
participating together in talent recruitment from medical colleges at the stage of internship,
similar to campus recruitment in MBA and Engineering programs offers one stop solution, to
discuss and advice the candidates on the best option for career progression within the system.
Using a committee composition that is more inclusive of various domain experts critical to
medical education ecosystem not only helps taking informed decisions impacting various
components of the ecosystem, but also hastens the decision making and approval process.



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3.2.3. Capturing the Student Pool at the Graduation Level
In the planning process, understanding the talent pool from where faculty can be sourced, is critical
to assure excellence in the apex institutes (medical colleges) of public healthcare delivery system. The
input to the funnel for a career in academics, stems from the universal set of students enrolling for
medical education. As can be seen (figure 15), the major input to the faculty pool are the students
who pursue medical education, and the existing faculty in the medical education system. External
lateral hires (practicing doctors or even adjunct faculty) currently are not a significant practice across
the country. From the demand side, the determinants are the NMC norms and positions sanctioned
by the state.


The total talent pool is a factor determined by the demand and supply of candidates for the given
faculty positions. The survey indicates that nearly 40.3% of the respondents, at various levels of their
student life, do prefer to join a career in medical teaching (Table 22). Add to that about 12.9% of the
student respondents who have shown preference for a career in “Hospital Management”, and 7.3%
for a career in “Basic Research”. Both of these career aspirations can very well be utilised in career
streams related to medical education ecosystem.
One of the ways other industry professions take care of the talent pool is to catch them early –
essentially go in for campus selection in undergraduate colleges and recruit the students before they
start exploring alternate career streams post-graduation. One of the constant refrains from the faculty
and management respondents, has been that for each vacancy they get a deluge of applications,
hence there was no need for an IIT/IIM kind of a campus recruitment system. Facts around shortage
of faculty, however, point towards the need for a proactive approach, as against the current passive
advertise-to-recruit strategy:
a. A faculty position is competing against a private sector job as medical practitioner or researcher,
with a relatively higher financial remuneration.
b. Capturing the aspirations of a medical undergraduate through campus selection, from a larger
and better talent pool, helps the student/s to remove uncertainty from his/her career and
showcases a clearer time-bound path to an academic career; and
Figure 14 - End-to-end Talent Sourcing Professor & Senior
Management
Associate Professor &
Middle Management
Assistant Professor &
Junior Management
Internal
Promotion
Internal
Promotion
Contractual
Contractual
Regular +
Contractual
External
Sources:
Faculty
Recruitment
Internal
Sources:
Students
External
Sources:
Practicing
DoctorsAttrition
Planning needed to
reduce this gap
Visiting Faculty/ Prof. of Practice


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c. Planning for faculty vacancies becomes more streamlined.
The TNMSC CTP Policy will go well with this end-to-end HR thinking, by considering participants at
each stage in the lifecycle of a medical student, as potential candidates for medical faculty. TN under
its CTP policy provides the students pre-placement offers during their final year (campus hires), are
assisted in selection of their choice of post-graduation, and post a mandatory one-year probation, are
automatically regularised at an Assistant Professor level. The decadal learning and success of TNMSC
CTP in Tamil Nadu medical education system, is worth emulating in other states.
3.2.4. Lateral Entry into Faculty Pool – Professor of Practice
The study revealed that while Visiting Consultant hiring has been permitted by NMC for lateral entry
of faculty at a professor level in medical colleges, deans were not comfortable using that option,
because of lack of accountability on the part of these senior professors. In fact a petition was filed by
faculty in Punjab to disallow the lateral entrants, as they cannot be considered as equivalent to other
regular appointees within the system.
39
While instances of lateral entry in select specialities have been
reported in some states, such as in Andhra Pradesh at the Assistant Professor level, and at Professor
level in all specialities in Odisha; it is merely akin to well-defined regular or contractual recruitment of
faculty.
40
It is nowhere similar to the mid-career entry of distinguished professionals and industry
practitioners into teaching as “Professor of Practice (PoP) ” in IITs and IIMs.
41

The premise here is that a mid-career doctor, just like their counterpart in engineering and
management profession, irrespective of their affiliation to private sector and commensurate financial
remuneration, may like to come back to teaching and contribute to medical education and research
and share unique industry experience with the students. However, there’s currently no established
practice of lateral recruitment of “Professor of Practice”, to cater to the growing requirements of
trained faculty. The system in IITs can be explored by the government and standardized to support
hiring of PoP in the country, in line with lateral entry of ad hoc or permanent faculty, of industry
practitioners into engineering colleges and management institutes as shown in (box below). The UGC,
the regulator of higher education in India, has acknowledged the requirement of augmenting faculty
resources by utilizing the services of superannuated academics, reputed scientists, engineers,
physicians, both serving and retired. The guidelines could include:
a. Continuous Professional Development: Mandatory participation in teacher training
programs, prior to joining as a faculty, similar to the practice in NHS UK – General Medical
Council (“GMC”) recognizing medical faculty and GP trainers only after they satisfy seven-
point criteria on quality of training and Continuing Professional Development (CPD).
b. Separate Clinical and Academic Career Paths: That cut off for such lateral entry as a teacher
can be 15 years as in IITs to ensure that they have adequate industry knowledge to share with
the students. Sahai (2016) suggests introduction of the concept of clinical teachers for clinical
work, and academic teachers for teaching, projects and research work and make allowance

39
https://www.tribuneindia.com/news/archive/punjab/50-interview-marks-for-medical-faculty-stir-row-762783
40
https://dme.ap.nic.in/E11/2021/NOTIFICATION_Jul2021_270721.pdf
41
https://www.iiitd.ac.in/careers/pop


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for floating posts to attract the best adjunct faculty, visiting faculty, distinguished professor,
etc.
42
.
c. Define Standards for Recruitment of PoP: That such faculty are hired with the same degree
of rigor as adopted for full-time faculty so that the right type of candidate is identified for such
assignments. It is also necessary to have uniformity and transparency in the process of hiring
PoP in institutions of higher education.

42
https://asiindia.in/Previous-Issues/2016%20dec%20issue/Medical-Education-in-India--Introspection--Cha_2016_Journal-
of-the-Anatomica.pdf accessed on 4 July, 2021


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d. Objective & Transparent Process for Recruitment of PoP: That the process be objective and
transparent, by making the qualification criteria fair and transparent, and cadre entry,
promotion, and salary levels be in line with system for existing faculty.
3.3. Talent Retention: Creating an Ecosystem

Professor of Practice Appointment in Indraprastha Institute of Information Technology, Delhi (IIITD)
Appointees in the Professor of Practice category are distinguished professionals, either practicing or retired. A
few may have traditional academic backgrounds, but most do not. The working title of Professor of Practice helps
promote the integration of academic scholarship with practical experience. PoP Appointees provide an
understanding of the practical applications of a particular field of medical study to faculty, undergraduate
students, and graduate students. These positions will be limited-term contractual positions, and will be for the
purpose of teaching courses, advising students, and setting up research collaborations in areas related to their
expertise and experience.

1. Responsibilities/Expectations: They may be involved in designing and teaching courses, research and
development activities, setting up research collaborations, promoting industry-institute linkages, consulting
assignments, entrepreneurship-related activities, contribute in placement-related activities and other
institutional initiatives.

2. Appointment Method: These positions will be offered on a consolidated basis for a limited period of up to 3
years. The appointment may be on full-time or part-time basis. Appointment is done through a Faculty Selection
Committee with at least two industry experts.

3. Terms of Appointment and Compensation:
(a) Appointment duration: Typical appointment will be up to three years. Full Time/ Part Time
appointment is given based on the tasks identified and responsibilities assigned.
(b) Profile: Selected candidates will be persons of repute/eminence (typically be or have been senior
managers) with a strong track record with substantial contributions to their fields and currently have
extensive networks of contacts in the field. They will be people who have the potential to contribute
uniquely and substantially to the Institute and in the field of engineering.
(c) Eligibility Criteria: The eligibility criteria and the necessary qualifications will be based on the courses
and/or research activities for which such faculty are being hired. The candidates must preferably hold
a PhD, but it is not an essential criterion. However, this requirement will be waived if she/he is a
graduate in any discipline from a reputed educational institute with over 15 years of industry experience
for Professor of Practice. The applicant will have specialist knowledge in the domain, expertise that will
complement the available expertise within IIIT-Delhi and be able to bring practice-oriented teaching
frameworks into the classroom.
(d) Compensation: The overall compensation will be equivalent to that of a professor in the visiting
faculty consolidated scale, which is defined from time to time by the Board. The compensation of a part-
time faculty is proportionate to the number of days expected in the appointment (e.g., a half-time
appointment will be offered half of the full-time consolidated). The part-time faculty member is paid
proportionate remuneration to the weekly workload of the full-time faculty member. Additional
allowances may be permitted by the Director on a case-by-case basis.
(e) Housing: These faculty members will not be eligible for campus housing.

5. Terms of service: This category does not convey membership in the Academic Senate. Appointees in this
category are not eligible for sabbatical leave, but are eligible for other types of leave with pay in accordance with
the institute's policies.

6. General Information and Conditions: Since it is a rolling advertisement, positions will remain open until filled.
Applications received will be reviewed once a semester against positions not filled.


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3.3.1. Creating an Objective Performance Appraisal System
In terms of type of medical colleges, and their response to aspirations of medical faculty, the survey
indicated that the autonomous medical colleges such as AIIMS, Delhi and PGI Chandigarh are able to
foster an overall engaging and thriving environment for their faculty because of their ability to attract
talented individuals by recognising and rewarding merit. However almost all management
respondents gave feedback that either the colleges didn’t have a comprehensive performance
management system, and whatever appraisal system they had, was hardly used to assess and reward
good performance. Annual Confidential Reports (ACRs) were never reliable, since colleagues generally
didn’t write adverse or objective comments for two primary reasons –
(a) to maintain the congenial atmosphere through their tenure within and outside the
department/institute, and
(b) to continue that relationship so that post retirement contractual positions could be bagged
by senior faculty.
There are two workarounds to this cultural aspect around an objective performance appraisal system,
both of which segregate the annual performance appraisal system from the promotion appraisal
system:
a. Best Practice at All India Institute of Medical Sciences (AIIMS)
In institutes like AIIMS, annual appraisal system is a reasonably filial system of giving feedback and
standard ratings commensurate with annual increment. There is hardly any differentiation
reflected in the appraisal ratings (i.e., no bell curve assessment is used).
• However, the appraisal for promotions is far more rigorous and is carried out by a committee
constituted by not only faculty from the same college, but also experts from outside the
college system.
• All the positions are open positions, which essentially means that the inhouse prospective
faculty competes with other potential faculty from all over the country. In this assessment, all
possible inputs including academic performance, research output, clinical performance,
annual appraisal ratings, personality assessment, are taken into consideration during the
interviews.
• The signalling effect of this process is that promotions to the next level are not automatic
and is eventually dependent on the merit of the candidate, irrespective of their performance
assessment in annual appraisal cycles.
b. Best Practice at Institute of Liver and Biliary Sciences (ILBS) & Rajiv Gandhi Cancer Institute
(RGCI)
In institutes like ILBS and RGCI, each faculty is contracted for a period of 4 years, at the end of
which they are appraised by a committee of institute’s internal faculty and subject matter experts
from outside.
• All inputs including academic, research and clinical performance, annual ratings are taken into
considerations for movement to the next level at ILBS. While the idea has never been to
remove faculty for bad performance, there have been instances of non-renewal of contracts
post this appraisal, for non-performing outliers. This has acted as a strong signal to the faculty
on significance of merit.


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• Those whose contracts are renewed, progress on the same pay scale (salary and emoluments
continue as if that faculty has never left his/her job).

An objective appraisal system has to have key performance indicators (KPI) at its core, in line with
a set of outcomes desired by the medical college, or aligned to the state’s broader healthcare
education goals. This could include, at the least, indicators for (a) teaching and learning outcomes,
(b) research outcomes, and (c) healthcare delivery outcomes. KPIs for similar outcomes can be
found in National Institutional Ranking Framework (NIRF), which is used for ranking institutions of
higher education in India (Refer Annexuree-3).
c. Incentivizing to retain talent – “Pay-for-Performance”
• Incentivising performance in ILBS happens by allowing Pay-4-Performance, with faculty
receiving additional allowance (approx. 10- 25%) of the OPD/ IPD fees for patients they
handle; over and above their salary.
• Under the Chief Minister’s comprehensive Health Insurance Scheme in Tamil Nadu, a sharing
pattern has been devised for fees accruing to Government Hospitals-- 15% of the share is
given as incentive to the medical team, encouraging faculty undertaking private practice, to
admit patients (especially from BPL category) to government hospitals for specialised
surgeries (GO (Ms) No. 22, 21 January 2016).
• Allowance and Sabbatical for research and academics as in AIIMS.

3.4. Creating a Career Path for Faculty
In their career path, medical faculty have to often take up administrative roles of managing the
departments, college and the accompanying hospital operations. The survey shows that most
clinicians are not inclined to, nor are they temperamentally suited for such roles. They felt that such
roles imposed huge workload equivalent to the existing clinical and academic workload; implying
handling two full-time roles within one position, for which they are neither inclined nor trained for;
nor are suitably compensated for. Also, the study revealed a set of students aspiring for administrative
jobs. Therefore, the study recommends that:
a. Create a separate professionally trained administrative cadre for managing the hospital
operations and college administration of the institute from the junior faculty pool or create
separate ‘Hospital Administration’ cadre like in INIs. Professionally trained hospital
administration team will ensure implementation of administrative decisions taken by the
technical heads of the institution (dean and medical director) – ‘Medical Superintendent’ of the
hospital functions of medical college, or ‘Registrar’ of the college, as in AIIMS or other INIs.
• The feedback from most management respondents to this suggestion was positive and they
felt that this specialised hospital administration team would be a great value-add in execution
of administrative and academic decisions, compared to clinicians, who are usually not
knowledgeable about regulations and quality practices in managing a medical college; and
also, are unable to spare time because of increased patient loads in medical college OPDs.
• In medical colleges clinicians who are academicians are best positioned to take decisions with
a techno-managerial professional from hospital management to support execution of
decisions.


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• Also, this team being from medical background, understand the nuances of a hospital and
medical college, and thus can ensure seamless implementation of administrative decisions,
which takes away a lot of the time of the clinicians from the academic and patient care work.
b. For an organization like Medical
College, not all faculty, at a certain
seniority, will/can be automatically
promoted to an administrative
position. And a suggested solution, in
line with similar practice in private
sector organizations, would be to
“plan the career path” of a faculty
getting promoted to an
administrative position.
• Shortlisting such pool of faculty for
a planned career path, calls for
i. use of their inherent interest to get into a responsible leadership position in stream
of:
a) academics & research,
b) patient care provision as a clinician,
c) patient care provision as a hospital administrator;
as each of these is an executive position and requires full time dedication for the
particular role,
ii. having a structure to manage the academic activities of such faculty moving away to
admin roles:
a) offer a lighter teaching load;
b) consider an exemption from teaching duties for that faculty member;
c) provide more flexibility with time commitments.
• All those faculty candidates in contention for administrative positions could be trained
through structured courses and experiential journeys early on in their career during
graduation so that, as and when they get promoted to these responsible administrative
positions, they are ready for it.
• The other option could be rotational headship of departments for all potential senior faculty
members, to reduce burden on one/select clinicians in the department. Rotation every two
years is a common duration among senior most faculty in most engineering colleges.
• Mentoring role by senior faculty will be a great way of preparing the individual to take up a
leadership role in the institute. This could either be for an administrative position or in
academic and/or research field. Learning from a peer has been proven to be far more effective
than a formal training process. However, a proper system for mentoring needs to be set up
rather than an ad hoc practice of advice from seniors and peers.
c. A dedicated HR team within each medical college would go a long way to address this creation
of admin cadre and career pathways for individual faculty members. And individual hospital HR
would be able to take care of the individual peculiarities in the college ecosystem to make a
workable plan. A centralized ACR-related performance management system is not a robust or
comprehensive HR management system.

QUICK FACTS
Columbia University Irving Medical Centre offers
faculty who currently have leadership/
management responsibilities, or who wish to
include these in their career goals, an annual
Leadership and Management Course. The four-day
program helps participants develop knowledge
and skills necessary for current and future
leadership positions in the academic health
sciences.


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3.5. Creating an Ecosystem for Medical Research
As noted in earlier section on research output, a lot is left desired in Indian medical education
ecosystem. Two of the key reasons for such poor results in research world are:
a. Lack of a culture of research activities and industry academia collaboration: The current
mechanism to motivate faculty to publish research is linked to their promotions. However, the
pathway for medical college institutes to foster an environment that encourages faculty to seek
research grants and incentivize research and publications is absent in the current policy
framework. While there is a general lack of research productivity in India, premier autonomous
institutes such as the Indian Institutes of Management (IIMs), the Indian Institutes of Technology
(IITs), and the Central Universities (CUs) established by the central government fare better in
research output in India in comparison.
• While research culture is ingrained in institutes like IITs, feedback seems to indicate that,
contrary to perception, research work and output is limited to a low percentage of the faculty.
Moreover, by linking published papers with promotion, applied research activities with an
industry-academia flavour is almost discouraged, because such applied research usually
doesn’t result in published papers.
• Invariably the feedback has been that much of the culture setting is dependent on institutes’
leadership. In fact, a lot of improvement in IIT research rankings recently have happened
because of publication of papers in international journals, thanks to the push of Human
Resource Ministry (HRM) to benchmark IITs to international peers.
• Even in AIIMS, New Delhi that has a better leadership and culture of research, there is almost
a discouragement on applied research with industry-academia partnership. Engineering or
Medical education are applied sciences and institutes of excellence therefore should be
expected to prioritize applied research - research that can have a direct bearing on a product
and/or process of a commercial nature. So, it makes sense that current line of thinking of
(basic sciences) research resulting in publishing papers, is shifted towards a better industry-
academia induced applied research. This is also an area which most faculty or prospective
faculty would be excited about, given the massive investment on health technology ventures
worldwide.
b. Lack of hard research infrastructure Clearly there is lack of state-of-art hard infrastructure in
terms of lab facilities, research labs, IT & Computing infrastructure, libraries, which affects the
ability to carry out high end medical research. At the beginning of a medical student career, this
may dampen the enthusiasm for research-led career path. At the senior faculty level, this will
dampen their enthusiasm to explore new areas of research or even deep dive on their existing
areas of research, the likely outcome being either stopping any meaningful research or look for
better research opportunities in private research labs offering better alternatives (primary
reference here is to pharma research labs, but over the last decade other center of excellence
has also taken shape in India.

Industry sponsored applied research, noted above, will also take care of this critical aspect of
research - need of funding for setting up research center of excellence. And this will include


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enhanced use of support staff and research assistants, which is also a dampener in current research
ecosystem in most colleges.

c. Lack of soft research infrastructure
Interventions on softer aspects of research infrastructure include enhanced engagement within the
academic ecosystem –
• faculty exchange program with international universities,
• research conferences in chosen area of specialization,
• proctorship with reputed medical equipment/ devices companies,
• co-development of clinical procedures, developing optimized utilization techniques on
equipment, training on new equipment modalities, etc.
Some aspects like conferences etc., are supported liberally in Institutes like AIIMS and PGI
Chandigarh. While it would be desirable to have such engagement activities implemented across
all medical colleges across the country, creation of a critical number of Medical Institutes of
Excellence (beyond the known INIs) by designating and developing one Medical College in each
state as a Center of Excellence. This COE would act as a pivot for seeking excellence in medical
education among the network of hospitals within the state.
3.6. Creating an Ecosystem – Strengthening Governance
In NSU Florida, the Key Functions of the Department of Medical education includes- (i) Patient centred
education and Assessment of Clinical Skills; (ii) Data Analysis; (iii) Faculty Development; (iv) Curriculum
Review, Assessment and Development; (v) For each of the above functions, the details of the person
responsible for the function, along with contact details is provided, for easy access.
43

Brazil adopts a “Student Centric Medical Education” system, which clearly defines the roles and
responsibilities of stakeholders in medical education.
In any country, there is an optimum point between quantity and quality. Usually, the health authorities
(as the ministry and secretaries), responsible for delivering health, have their focus in quantity, often
pressurizing for more physicians. While education authorities (as specialists in health and education)
and medical authorities (as federal boards and councils) have their focus in quality, calling attention
to improve graduation process.
Brazil has recognized the risk of operating so many schools without adequate time to prepare
teachers, clinician-educators, curricula, and sufficient pedagogical structure to ensure quality
medical education. To get the balance, Brazil has defined the role of each stakeholder clearly and
shifted from a teacher-centred and hospital-based approach to student-centred and community-
based education as shown in the Figure 16.

43
https://osteopathic.nova.edu/education/key-functions


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Note: Health Authorities--Health Ministry, HR Managers
Medical Authorities--Federal or State Medical Council Board
Education Authorities—Specialists in Medical Education, Professors, Consultants and Researchers
Independent institutions for accreditation—e.g., Recognized by World Federation for Medical Education
Source: Antunes Dos Santos R, Nunes MDPT. Medical education in Brazil. Med Teach. 2019 Oct;41(10):1106-1111.
doi: 10.1080/0142159X.2019.1636955. Epub 2019 Jul 8. PMID: 31282823 duties of medical

Figure 15 - Defining Roles of Stakeholders - Brazilian Best Practice


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3.7. Summary of Recommendation
A lifecycle approach should be adopted to offer end to end solution to address the barriers to
recruitement and retention of medical faculty, using the Talent Management Framework interlinking
the intrinsic motivation/ aspirations of the medical faculty with recruitment, onboarding and
retention.
A. Talent Planning and Recruitment
1. To address the lack of reliable data for Talent Planning, there is a need to provide unique pan
India-ID to track the lifecycle of a medical professional. It is to be legally mandated for medical
professionals similar to ITR filing.
2. Use the above data to create a nation wide Centralized Registry, readily available to all colleges
and faculty, to address the information asymmetry to manage the demand-supply gap.
3. Creation of MRB for planning, advertisement and selection of appropriate candidate for each
medical college at the state level.
4. The colleges can be given autonomy for (i) contractual hires to tide over delay in recruitment
cycle process time; (ii) and roll out of appointment letters for faculty getting posted in their
college; thus, saving energy and time of MRB.
5. The intent in the long term should be to reduce contractual faculty hiring and move towards a
system for more regular and seamless appointments, gradually over time, as states mature in
their HR management system.
6. Recruit students early through campus selection, before they start exploring alternate career
streams/ post-graduation. The TNMSC CTP Policy with an end-to-end HR thinking, will be a
good model to adopt, with its focus on creating career paths at each stage in the lifecycle of
a medical student. Tamil Nadu under its CTP policy provides the students pre-placement during
their final year (campus hires), are assisted in selection of their choice of post-graduation, and
post a mandatory one-year probation, are hired at an Assistant Professor level. The decadal
learning and success of TNMSC CTP in Tamil Nadu medical education system, is worth
emulating in other states.
7. Creating and institutionalising a model (currently non-existent) for mid-career entry of
distinguished professionals and industry practitioners into medical teaching, as “Professor of
Practice (PoP)”.

B. Talent Retention
1. Creating an objective Performance Appraisal System with key performance indicators (KPI) at
its core. This could include indicators for (a) teaching and learning outcomes, (b) research
outcomes, and (c) healthcare delivery outcomes; aligned with the objectives of state’s broader
healthcare education goals or the medical colleges’ goals.
2. Creating an objective Promotions Appraisal System with, (a) external members in selection
committee, (b) all the positions after Associate Professor level should be ‘open positions’,
forcing inhouse prospective faculty compete with other potential faculty from all over the
country.
3. In this assessment, all possible inputs including academic performance, research output, clinical
performance, annual appraisal ratings, personality assessment, are to be taken into
consideration during the interviews. The signalling effect of this process is that promotions to


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the next level are not automatic and is eventually dependent on the merit of the candidate,
irrespective of annual appraisal cycles.
4. Longer duration of regularised contract, like that in Institute of Liver and Biliary Sciences (ILBS)
and Rajiv Gandhi Cancer Institute - each faculty is contracted for a period of 4 years, at the end
of which they are appraised by a committee of institute’s internal faculty and subject matter
experts from outside. It is always advisable to test a faculty’s fitment in the organization, before
regularising them.
5. Pay-for-Performance -- Both TNMSC and ILBS allows to take in a portion (approx. 10- 25%) of
the OPD/ IPD fees they consult, over and above their salary. Provisional allowance and
sabbatical for research and academics as in AIIMS has served well to incentivise faculty.

C. Development of Career Path
1. Create a separate professionally trained administrative cadre for managing the hospital
operations and college administration of the institute from the junior faculty pool or create
separate ‘Hospital Administration’ cadre like in INIs. Professionally trained hospital
administration team will ensure implementation of administrative decisions taken by the
technical heads of the institution (dean and medical director).
2. Plan the career path of a faculty getting promoted to a leadership position across streams of
(a) academics & research, (b) patient care provision as a clinician, (c) patient care provision as a
hospital administrator; recognizing that each of these is an executive position and requires full
time dedication for the particular role. Have a structure to (a) manage the academic workload
of such faculty moving away to admin roles, (b) train them through structured courses, and/or
(c) experiential journeys early on through a proper system for ‘mentoring’.
3. Rotational headship of departments for all potential senior faculty members to reduce
administrative burden on one clinician.
4. Dedicated HR team within each medical college would address the creation of this admin cadre
and also manage career pathways for individual faculty members.
D. Creating an Ecosystem for Medical Research
1. Creation of state-of-art hard infrastructure in terms of lab facilities, research labs, IT &
Computing infrastructure, libraries, which affects the ability to carry out high end medical
research.
2. Explore and permit industry-academia partnership for applied research.
3. Dedicated institutional budget to stimulate and facilitate research activities similar to that in
AIIMS/ PGIMER.
4. Creation of a critical number of Medical Institutes of Excellence (beyond the known INIs) by
designating and developing one Medical College in each state as a Center of Excellence
(CoE). This COE would act as a pivot for the network of hospitals within the state.






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3.8. Summary of Policy Interventions
From the discussion above, follows the recommendations on policy interventions:
1. The basic function of a Medical College must be reinforced by the policy makers. It has three
core responsibilities – (a) Medical Education & Training, (b) Medical Research, and (c) Patient
Care. It differs from that of a Hospital, which is envisaged to focus on only one element -
Patient Care. So, a career as medical college faculty has to be looked at as a separate career
stream, primarily focused on education, however related it may seem to a career in clinical
practice.
The intent in the long term should be to reduce contractual faculty hiring and move towards
a system for more regular faculty cadre, gradually over time, as states mature in their HR
management system.
2. Focus on end-to-end HR thinking for alignment of policy initiatives – right from the stage of a
final year medical graduate to a retired professor. This would call for following interventions:
a. Thrust on up to date information on medical graduate pool, and faculty pool across
colleges, states, or country;
b. Create a dedicated medical recruitment board or any similar body which has a focus
on planning, recuitment, and retention of faculty;
c. Create a stream of “professor of practice” so as to tap practicing clinicians inclined to
academics, as well as pollination of industry best practices;
d. Each institute has to have a dedicated HR to manage the key HR functions, especially
strategies around talent planning, career planing, performance assessment, and
performance linked incentive systems.
3. Thrust has to be reinforced on “medical research” which is a healthy mix of basic and
industry-relevant applied clinical research.


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Annexures


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4.1. Annexure 1 – Primary Data Collected from Colleges

Table A1. 1 – Survey Coverage of Study Colleges


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Table A1. 2 - Medical Faculty and PG Students in India
State
No. of
Faculty
No of PG
Students
(Broad
Speciality)
No. of PG
Students
(Super
Speciality)
No. of Non-
PG JR
No. of SR
Andaman Nicobar
Islands
102 0 0 37 17
Andhra Pradesh 6317 4483 313 991 1136
Arunachal Pradesh 75 0 0 37 17
Assam 1128 998 33 364 604
Bihar 2818 1759 42 826 1136
Chandigarh 772 1314 297 19 424
Chattisgarh 1393 484 3 569 385
Dadra and Nagar
Haveli
87 0 0 28 17
Delhi 2620 5183 1909 1638 3091
Goa 238 249 6 37 80
Orissa 2487 2100 212 336 592
Haryana 1775 1205 38 537 407
Himachal Pradesh 804 649 6 78 291
Jammu & Kashmir 1210 1423 179 405 890
Jharkhand 705 569 8 253 250
Karnataka 11432 8586 535 1740 2545
Kerala 6252 3407 617 1204 1297
Madhya Pradesh 3696 2533 71 636 922
Maharashtra 10241 8556 572 1714 2489
Manipur 341 516 11 130 166
Meghalaya 93 38 6 72 70
Mizoram 84 0 0 26 16
Pondicherry 1711 1440 156 281 439

Table A1. 3 – Faculty Perception on Adequacy and Appropriateness of Infrastructure and Facilities
Infrastructure and Facilities Adequacy Appropriate
Teaching Infrastructure n
% Respondents
for whom Most
Important
n
% Respondents for
whom most
important
Well-lit Classrooms 217 63.1% 204 56.9%
Online Aid 216 50.0% 198 48.5%
Bedside Teaching 192 69.3% 175 62.3%
Library and Journals 219 62.1% 197 63.5%
Academic and Research Infrastructure

Requisite Labs & Special Clinics 212 45.8% 194 43.8%


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IT Facilities (Hardware, Software) for Academics 213 32.4% 193 36.8%
Research Assistant’s Provision 200 24.0% 181 26.5%
Hospital Infrastructure

State of the art medical equipment to provide services 203 39.9% 187 42.2%
Facility for Relaxation and Discussion 206 28.6% 191 29.3%
Hygienic and ambient amenities for physical
convenience of faculty to work comfortably
204 37.7% 186 35.5%
Facility for faculty and residents to stay during night
duties, inside the college premises
141 40.4% 119 35.3%
Living Facilities n
% Respondents
for whom Most
Important
n
% Respondents for
whom Most
Important
Family related assistance 188 27.1% 175 24.0%
Housing and messing arrangements 194 28.4% 180 26.7%
Facilities, such as schools, employment opportunities for
spouse
183 16.9% 169 19.5%
Facilities for Handling Public Health
Disasters/Pandemics

Availability of PPE Kits 152 69.7% 143 62.9%
Provision of proper alternative arrangements for faculty
to stay, during pandemic/disasters
148 38.5% 136 36.9%
Secure and safe transport facilities for faculty to perform
their duties
137 41.6% 126 35.7%

Table A1. 4 - Factors Considered by Students for Selecting a Medical College - in %
Factors considered
% Respondents who found it
Most Important
Government Medical College (n=344) 303 (88.1%)
Opportunity to see more patients (n=342) 290 (84.8%)
Opportunity to Learn (n=344) 283 (82.3%)
Ranking of the Institute (n=344) 264 (76.7%)
Rank in the competitive exams (n=336) 258 (76.8%)
Opportunity to serve the community (n=304) 229 (75.3%)
Quality of Teachers/Role Models (n=344) 248 (72.0%)
Teaching Environment (n=344) 245 (71.2%)
Fee structure of the college (n=344) 235 (68.3%)
The Core Faculty (n=344) 234 (68.0%)
Peer Group (n=343) 225 (65.6%)
Quality of Research Activity (n=344) 204 (59.3%)
Student-teacher Ratio (n=344) 186 (54.1%)
Close to Home (n=343) 185 (53.9%)
Time for preparation to study abroad (n=295) 114 (38.6%)



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Table A1. 5 - Student Perception on infrastructure adequacy and appropriateness
Infrastructure and Facilities Adequate Appropriateness
Teaching Infrastructure n
% Respondents for
whom Most Important
n
% Respondents for
whom Most Important
Well-lit Classrooms 329 75.4% 292 74.3%
Online Aid 322 65.2% 284 64.1%
Bedside Teaching 311 64.3% 278 62.6%
Library and Journals 322 66.5% 285 64.9%
Academic and Research Infrastructure
Requisite Labs & Special Clinics 319 63.3% 283 56.5%
IT Facilities Hardware, Software) for
Academics
315 51.4% 276 46.4%
Research Assistant’s Provision 313 50.8% 279 49.1%
Hospital Infrastructure
State of the art medical equipment to
provide services
203 39.9% 278 55.0%
Facility for Relaxation and Discussion 206 28.6% 284 52.8%
Hygienic and ambient amenities for physical
convenience of faculty to work comfortably
204 37.7% 281 53.4%
*Note: Likert 10-point scale was used to score each of the parameter being assessed.



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4.2. Annexure 2 – Questionnaires
4.2.1. Intro Note
Thank you for taking out time to participate in this survey. This survey is being conducted by
SahaManthran Pvt Ltd, at the behest of NITI Aayog, the central think tank and advisory body of
Government of India. This survey is a part of NITI Aayog’s strategy to understand the barriers to
recruitment and growth of faculty in medical colleges across the states in the country. The intent is
not to judge the performance of the institute/organization but to understand the bottlenecks creating
medical faculty shortage so as to address the growing requirement of faculty in medical colleges over
time and incentivize medical professionals to seek medical education as a career option. This is a
unique opportunity to contribute to a study, being undertaken at a national level, across government
medical colleges to understand and inform policy for sharing best practices across board. Your inputs
will go a long way in representing your suggestions and novel ideas as a part of the solution to this
challenge.
Your responses will help us to understand the processes and suggest ways to improve the recruitment
and onboarding processes for faculty in medical colleges. It will also help us in understanding the
incentives and dis-incentives for a professional to choose serving as a faculty in a medical college. We
shall be undertaking this survey across departments and cadres in the state medical colleges, and its
management to get a 360-degree view of the issues.
This survey will take approximately 30 minutes to complete. You can complete the entire survey in
one go or in parts. If you plan to do the survey in parts, just save your responses before exiting. You
are requested to complete the survey in next 5 days of receipt of this link.
We would like to submit here that the study is design and the method of data collection assures
complete anonymity of the information provider. Therefore, while SahaManthran will have access to
your personally identifiable details for the purpose of collating and analysing the data, no personally
identifiable details will be shared in the public domain. Thank you once again, for putting in your
responses and adding value to the study.
By participating in this survey, you agree and consent to SahaManthran’ s Pvt. Ltd.’s use of the data
provided by you as described above.
4.2.2. Student Questionnaire
Module A: Basic Profile and Demographic Particulars of the Respondent
1. State
2. Age of the respondent
3. Sex of the respondent
4. Marital Status of the respondent: Unmarried/ Married/ Widow/ Judicially Separated/ Divorced/
Other (Specify)
5. Current Position
• UG Student
• PG Student
• Others
6. Which year are you studying in?
• Year 1
• Year 2


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• Year3
• Year 4
• Year 5
Module B: Student Aspirations
7. Did you have the choice to choose this medical college?
8. What did you consider while choosing the medical college? (Kindly rank as per priority)
(Score 1-10. 10 being the score for the highest priority and 1 being the lowest)
Factors considered for Joining the Medical College Score
a. The core faculty
b. Student-teacher ratio
c. Rating of the institute
d. Quality of research activity
e. Teaching environment
f. Quality and brand of teachers/ role models
g. Government Medical College
h. Close to home
i. Opportunity to learn
j. Opportunity to see more patients
k. Fee structure of the college
l. Peer group

9. As a student, did you find what you expected from the college? (Yes/No)
10. If yes, what expectations were met in the college?
11. If not, which expectations were not met?
12. Do all the faculty take the classes as per the schedule?
• What is the % of classes out of the total
scheduled classes that were finally conducted?
• What are the % of classes scheduled for
Senior Resident/ Demonstrator, Tutor/ Asst Prof, Associate Prof/ Professor
13. What are the % of classes taken by Senior Resident/ Demonstrator, Tutor/ Asst Prof, Asso. Prof,
Professor
14. Which are the classes that are not held regularly? Do you know of any reason why they are not
held?
15. Is there a system to provide feedback on teachers' effectiveness in teaching? (Yes/No)
16. If yes, how many times has feedback been actioned? Give some instances.
17. Are you satisfied with the teaching and academic environment of your college? (Yes/No)
18. What facilities are you very satisfied with or not satisfied with?
(Score 1-10. 10 being most adequate / Appropriate and 0 being least appropriate/ adequate)
Definition of Adequacy: As in numbers asper the specifications in terms of student ratio
Appropriate: Quality as per requirement and specifications

Infrastructure and Facilities
Adequate
(score)
Appropriate
(score)


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Teaching infrastructure
● well-lit classrooms,
● online aid,
● bedside teaching,
● library and journals
Academic and research infrastructure
● requisite labs and special clinics,
● IT facilities (hardware, software) for academics and high
end/ specialized research

● research assistants’ provision
Hospital infrastructure
● state of the art medical equipment to provide services,
● facility for relaxation and discussion,
● hygienic and ambient amenities for physical convenience of
faculty to work comfortably


19. If there are any other infrastructure, not listed above, please mention and elaborate below
20. Do clinical grand rounds/ Bedside teaching happen daily? (Yes/No)
21. Does the evening round of teaching happen daily? (Yes/No)
22. What are the basic problems you face at present in your college? (You can tick more than one)
• Backdated syllabus and teaching style
• Disparity in infrastructure across speciality
• Quality of teaching staff
• Lack of academic and research skills
• Lack of role models
• Absence of time with teachers to clarify doubts
• Others, please elaborate

23. When you would seek a job, what will be your job preference?
• Join as a faculty
• Join in a private Clinic/ Hospital
• Basic research in a lab
• Pharmaceutical Industry
• Consulting
• Managing a hospital
24. If you choose to join as a faculty, what are the motivating factors in becoming a faculty member?
25. When you seek a job, what will be your preferred location?
• Metropolitan City
• Non- metropolitan Tier 1 City (Example: Bangalore, Chennai, Delhi, Hyderabad, Kolkata,
Mumbai, Ahmedabad, Pune)
• Tier 2 City (Example: Agra, Ajmer, Aligarh, Amravati, Amritsar, Asansol etc.)
• Tier 3 City (Example: Salem, Jhansi, Gwalior, Vijayawada, Rajahmundry, Meerut, Mathura,
Bhatinda, Bikaner, Cuttack etc.)


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• Rural Area
• Near Home
• Birthplace
• State Capital
• Others
26. Reasons for the above choice/ choices
27. Do you feel that before becoming a faculty one should have training in teaching skills and
methods? (Yes/No)
28. In your opinion, what are the obstacles to becoming a faculty in a college?
29. What are your suggestions for improvement of the teaching environment in your medical
college?



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4.2.3. Faculty Questionnaire
Module A: Basic Profile and Demographic Particulars of the Respondent
1. State:
2. Age of respondent in yrs.:
3. Sex of the respondent:
4. Marital status—Unmarried/ Married/ Widow/ Judicially Separated/ Divorced/ Other (Specify):
5. Current position of the respondent:
• Senior Resident/Demonstrator,
• Tutor / Asst Prof
• Associate Professor,
• Professor
1. Department/Specialty:
2. Qualification:
• Graduate (Medical)
• Graduate (non-Medical)
• Postgraduate (Medical)
• Postgraduate (Non-Medical)
• DM/ MCh
3. Have you done PhD- Yes/ No
4. Type of Post: Regular/Contractual/Adjunct/Visiting faculty:
5. What’s your current pay scale?
6. Please provide the break-up of your emoluments, including allowances with take home?

Module B: Aspiration of Faculty
6. Which medical college did you study in?
7. Was it your aspiration to join the medical college as a faculty? Yes /no
8. What is your total years of experience as a faculty?
9. When did you join this medical college? (Month/Year)
10. Is this your first appointment? Yes/no
11. Kindly elaborate on your journey as a faculty/clinician/as a professional in various medical
colleges/ institutions to date (in 80-100 words)
12. What motivated you to join as a faculty? Score each item on a scale of 10, where 10 is the
highest motivating factor, and 1 is the lowest motivating factor.

Motivating Factors Score
a. Self-interest/ passion for the profession

b. Stable Income / Financial Security

c. Parents wish / Social Pressure

d. Prestige to associate with the profession

e. Influence of a role model

f. Service to the needy

g. Shortage of faculty in medical education

h. Convenience of location—proximity to hometown



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i. Opportunity to work in a tier-I city or well-established township

j. Family and children’s considerations

k. Opportunity/ time for private practice

l. Academic and research environment

m. Brand of the college and work culture

n. Financial considerations

o. Career progression and growth possibilities

p. Peer group and network

q. Greater work exposure and challenging opportunities

r. Job security

s. Social Status

t. Power and prestige of the profession


13. If there are any other motivating factors not listed above, please elaborate below

Module C: Recruitment and Onboarding of Faculty
14. What is the system for recruitment in your medical college, to fill the requisite positions as and
when they arise? - annual/ biannual/continual Please tick
15. How much time did the recruitment process overall take from application to your onboarding?
(Give response in days):
16. Which step in the recruitment process took the longest time (in number of days)

Recruitment Process Time Taken in days
a. Advertisement to application

b. Submission of application to shortlisting

c. Shortlisting to interview

d. Interview to selection

e. Selection to offer letter/ government order

f. Offer letter / Government order to onboarding


17. What were some of the challenges that you faced in the recruitment and onboarding process?
Score each item on a 10-point scale, where 10 is the most challenging factor, and 1 is the least
challenging factor



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Challenges Score
a. Lack of Access to information on vacancy status

b. Lack of 24X7 call centre, especially operating at night to facilitate the ease of filling
form (like that in armed forces)

c. Lack of Access to the application form for submission

d. Lack of Information around the roles and responsibilities of the job (job description)

e. Lack of Information around terms and conditions of the job, such as leave policy,
allowances, facilities, working hours, etc.

f. Cumbersome (unnecessary questions) and lengthy form

g. Lack of Facilities provided to participate in the interview, such as boarding lodging,
TA/DA like in Armed forces or Railways

h. Non- responsive staff or no contact point in the college or DME to seek clarification

i. Lack of time taken to receive offer letter

18. If there are any other challenging factors not listed above, kindly elaborate below:
19. Kindly elaborate on the interview process and who constituted the selection board
20. Was there any formal induction program to onboard you as a faculty?
• Yes, (If yes go to q no. 27)
• No, (If No. go to q no. 29)
21. If yes, what were the components of the induction program? (You can select more than one
option)

Components of Induction Programme Tick
a. Introduction to Dean, Medical Director, Staff and Department

b. Sharing of mission and vision of the college

c. Tour of the medical college and campus

d. Information of facilities and amenities available

e. Details around Job description (JD) and its terms of reference (TOR)

f. Terms and conditions (TOC) of appointment

g. Point person for seeking clarification as regards JD/TOR/TOC

h. Details regarding TOC of service, service rules, emoluments, relevant regulations

i. Work culture and code of ethics, disciplinary processes

j. Others – Please elaborate


22. Did the induction program help in smooth onboarding and settling in the organization? Yes/No:
23. What are your suggestions for streamlining the recruitment and onboarding of faculty? Are
there some examples that you could share which can be emulated?

Module D: Retention and Growth of Faculty
24. Are you aware of your job description? Yes/No
25. When did you get to know about your job description?
26. How clear was the JD in terms of your ability to carry out your current roles and responsibilities?
27. What challenges do you face to fulfil your stated responsibilities on a day-to-day basis?
28. Would you please describe a typical day in the life of a medical faculty? (Respond within 80-100
words) Please describe in terms of your time spent on teaching UG students; teaching PG


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students; patient care in OPD, IPD, and OT; bedside teaching in morning and evening; research
and publication; and administrative activities
29. What is your opinion on a faculty shouldering both administrative and patient care
responsibilities along with academics and research?
30. Are the infrastructure and other facilities available to fulfil your responsibilities adequate and
appropriate?
(Score each point on a scale of 1-10, where 10 is the most Adequate/Appropriate and 0 is the
least Adequate/Appropriate)
Definition of:
Adequacy: Numbers or quantities required to meet student load
Appropriate: Quality as per requirement and specifications

Infrastructure and Facilities
Adequate
(score)
Appropriate
(score)
Teaching infrastructure

• well-lit classrooms,

• online aid,

• bedside teaching,

• library and journals

Academic and research infrastructure

• requisite labs and special clinics,

• IT facilities (hardware, software) for academics & specialized
research

• research assistants’ provision

Hospital infrastructure

• state of the art medical equipment to provide services,

• facility for relaxation and discussion,

• hygienic and ambient amenities for physical convenience of
faculty to work comfortably

• Facility for faculty and residents to stay during night duties, inside
the college premises (comfortable duty rooms)

Living facilities

• Family-related assistance,

• housing and messing arrangements,

• facilities, such as schools, employment opportunities for spouse

Facilities for handling public health disaster/ pandemics

• Availability of PPE kits

• Provision of proper alternative arrangement for faculty to stay,
when they are not able to go home during pandemic / disasters

• Secure and safe transport facilities for faculty to perform their
duties

31. If there are any other infrastructures or other facilities, not listed above, please mention and
elaborate below:
32. What are the financial and non-financial incentives available to the faculty in your college at your
level?


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Systems and Provisions
Tick
Whichever
is
applicable
a. Review of Salary structures and Emoluments; including incentives or bonus,
including non-practising allowance

b. Provision for inclusion of incentives for performers/non-performers in salary

c. Ease of undertaking research and support for publishing nationally and
internationally

d. Facilitation & creation of conducive environment to encourage peer networking,

e. Ease of participating in CMEs

f. Ease of getting in-service training on department-specific or relevant issues

g. Approval for participating in conferences/workshop to share knowledge

Leadership & professional development

h. Policy around choice of career progression (clinical/administrative)

i. Structured mentoring programmes for technical/ techno-managerial/ managerial
roles and their career growth path

Culture and climate

j. transparency in tenure/ promotions/ transfers,

k. encouraging belongingness through involvement in decision making;

l. Policy and flexibility to maintain work-life balance—in terms of annual leaves,
day-offs, Night and day duties, academic leave

Disasters and Pandemic

m. Provision of support to family members of faculty during public health disasters,
to take care of the family’s basic needs

n. Provision for time off, to offer respite due to extended working hours

o. Provision of flexibility in working hours during disasters / pandemics

p. Any other (please specify)


33. How does the administration support you in carrying forward your daily routine activities? Give
some instances.
34. How does the administration support you in carrying forward your activities during public health
disasters? Give some instances.
35. What can be the areas of improvement for support from administration?
36. Have you ever received training on teaching and research methodology? Yes/no
37. If yes, from where did you receive the training?
38. What was the duration of the training? (In days)
39. Do you think training on teaching methods and research methodology is of value? Yes/No:
40. What is the incentive or support you get from the college for undertaking value added
outstation trainings?
41. How many research projects have you undertaken in the last 5 years?
42. Give titles of few projects undertaken
43. How many papers have you published?
44. Give titles of few with name of journal


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45. What is the incentive or support you get from the college for undertaking research, publishing
original work in high impact index journals?
46. Is there a system for monitoring the workload of faculty in the medical college? Yes/No:
47. If yes, what is the process for appraisals of staff in this medical college?
48. How would you describe the work environment/culture in your college?

Components of Work Environment/Culture
Available (Yes/
No)
Comments
a. Independence or freehand for decision making

b. Absence of prejudice in promotion

c. Opportunities for career progression

d. Opportunity for regular, specific training and capacity building

e. No compulsion on the conversion of cases for financial gains

f. Accountable and Cooperative paramedical staff to assist in
patient care and academics

g. Opportunities for networking for seeking excellence and
sharing learning

h. Welcoming organization and department

i. Growth Opportunities

j. Organized and systematic workflow with well-defined roles and
responsibility

k. Safety and security during official visits

l. Safety and Security on Campus

k. Others (if any)



49. In your opinion, what are the reasons for the medical faculty to leave their position? Score each
item on a scale of 10, where 10 is the top-most reason, and 1 is the least reason for leaving the
position

Reasons for Leaving Score
a. Career progression with movement to better-known colleges

b. Better salary—the gap between contractual vs regular staff

c. Academic and research environment

d. Other non-teaching government hospitals

e. Private practice

f. Non-transparent promotion and tenure policy

g. Lack of leadership and mentoring for growth and development

h. Living conditions, quality of life at par with peers/ professionals living and serving in
higher education institutions across other sectors

i. Work-life balance

j. Social and family commitments for education and medical requirements

k. Isolation of under-represented groups

l. Lack of ambient and clean environment

m. Job security-Tenure of contract



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50. Is there a system of exit interviews when a faculty leaves? Yes/No:
51. If yes, can you recollect and share any improvements made post feedback from the exit
interviews?
52. What are your suggestions for the improvement of retention of faculty in this medical college?


Areas Your
views
a. Adequacy of salary to support a decent living for the family


b. If inadequate, what would you benchmark it against with


c. Views on carrying out administrative tasks along with teaching, research
and patient care


d. NPA and other incentives are miniscule

e. Difficult Posting or hardship allowance


f. Salary gaps between contractual and regular workforce is appropriate or
not


g. Postretirement benefits


h. Should transfers be allowed to enhance career growth opportunities?


i. Administrative responsibilities come as default, as you rise in hierarchy in
medical college. How do you propose to ensure effectiveness of patient
care and teaching along with administrative activities?


j. Do you think a separate techno managerial cadre is an answer to reduce
workload of teaching faculty?


k. Do you think additional incentives for administrative activities in same line
as NPA, will help faculty to justify both their administrative and technical
(teaching and research and patient care) responsibilities


l. Growth Opportunities for MC faculties similar to nationalised services
(e.g.- IPS, IAS,)


m. Social affiliation vs positional affiliation of MC faculty vis-a vis transferrable
jobs


n. Recruitment of, Sr. Resident as faculty in terms of numbers of years of
teaching experience and numbers of publications






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4.2.4. Management Questionnaire
Module A: Basic Profile and Demographic Particulars of the Respondent
1. State:
2. Current position of the respondent:
3. Qualification
4. Experience in this position or medical education per se (In Years):

Module B: Status of medical faculty positions in the medical college
5. What is the % vacancy of faculty in your college, in each cadre, across each department?
6. Has the faculty shortage situation improved in the last 3 years? Yes/No:
7. If no, what are the reasons for no improvement?
8. In which cadre are there more vacancies? Clinical / super specialities or Pre/ Paraclinical
9. What is the reason for this Variation?
10. What is the system of planning for faculty requirements and onboarding in your college? Kindly
elaborate
11. Is there a provision to recruit faculty on a temporary or contractual basis? Yes/No:
12. In which departments are contractual positions allowed/recruited? (Multiple choice question)
• Clinical
• Paraclinical
• Basic Science
• All of the above
13. What is the duration of contract generally given for a faculty on a contractual basis? (No of
Months)
14. Is there a separate recruitment process for faculty positions in tribal and non-tribal areas? If yes,
how are they different?
15. Is there a possibility of shifting a reserved post to a general post, in case the reserved position
does not get filled up in the recruitment process?
Module C: Recruitment and onboarding of faculty
16. Which bodies are responsible for recruitment and for which positions?

Boards/Bodies Designation
Position (regular/contractual/
visiting faculty)
State Public Services Commission (SPSC)
Similar commissions for medical services (Give
names)

An Autonomous Body (Give name)
Others (Give name)

17. Is the system for recruitment an annual/ biannual/continual process to fill the requisite
positions? (Please tick whichever is applicable, you can tick more than one)
18. NMC has made a provision for the recruitment of visiting faculty from the private sector for
teaching. Are you aware of any provision made by NMC for the recruitment of Visiting Faculty?
Yes/No:
19. If yes, do you recruit Visiting faculty?
20. If no, why not?
21. If yes, what are the benefits of recruiting a Visiting faculty?


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22. NMC expects a regular update on sanctioned, vacant, filled positions. How often does this is
updated currently? Respond with a numeric value (in days).
23. What, in your opinion, are the barriers to updating the NMC site with such data regularly?
24. How does the NMC intervene if there are unfilled positions?
25. What are the barriers to the faculty recruitment process? Score each item on a scale of 10,
where 10 is the top-most barrier, and 1 is the least barrier.
Process Score
a. The process of approving a position
b. Modes of advertising a position.
c. The process of filling up the application form is cumbersome for a candidate in terms
of its format, method and mode of application

d. Constitution of the selection board. Considering that the board consists typically of
high-level officials, there are delays due to time constraints of board members.

e. Coordination of the selection board schedule for taking interviews.
f. Time taken to get approval after selection of candidates, at the level of
DoHFW/DGME

g. Delays in rolling out the order

26. If there are any other barriers not listed above, please elaborate below.
27. Is the mode of advertising appropriate and adequate?
28. One of the IIMs advertises in the leading newspapers and writes letters to the top institutes. In
addition, they also write individually to people who have made inquiries in the past for a
position. Do you think this IIM’s mode of advertisement is worth emulating for faculty
recruitment in medical colleges?
29. Are there any practical solutions for simplifying the process of filling up an application form?
30. For any given vacancy for a medical faculty, what is the ratio of MBBS and non MBBS applicant?
31. Once the selection process is completed, is a separate waiting list being prepared? Yes/No:
32. If yes, what is the validity of such a waitlist?
33. What is the mechanism to inform the candidates that they are selected or waitlisted?
34. Do all the candidates who are issued the letter join? Yes/No
35. If no, what is the average percentage gap between the numbers of candidates selected and
joined? (In % <= 100%)
36. Does the medical college have a budget for the recruitment of faculty? Yes/No:
37. If yes, what is the percentage utilisation of the budget on the recruitment process over the last
three years, 2018-2021? (In % <= 100%)
38. Does the medical college have the autonomy to use their budget, especially on recruitment and
growth of faculty? Yes/No:
39. Is the budget being allocated on a timely basis? Yes/No:
40. Is there a provision to get an extra budget in a financial year, if required? Yes/No:
41. If yes, do you have the budget to appoint a faculty temporarily? Yes/No:
42. Have there been cases wherein a candidate has challenged the recruitment in the court of law?
Yes/No:
43. If yes, what were the key learnings?
44. Kindly provide a split of lawsuits filed by - Senior Resident/Demonstrator, Assistant
Professor/Tutor, Associate Professor, Professor, from April 2018-March 2021, if any.
45. What are your suggestions to improve and streamline the recruitment and onboarding of faculty
in the medical colleges? (Respond with short term and long-term strategies)


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Module D: Retention/Growth of Faculty
46. What is the infrastructure or other facilities provided in the medical colleges to support medical
education?
(Score 1-10 where 10 is the most Adequate/Appropriate and 0 being the least
Adequate/Appropriate)
Definition of
Adequacy: As in numbers as per the specifications in terms of student ratio
Appropriate: Quality as per requirement and specifications of what you have/bought/received
from the concerned department or vendor

Infrastructure and Facilities
Adequate
(score)
Appropriate
(score)
Teaching infrastructure
● well-lit classrooms,
● online aid,
● bedside teaching,
● library and journals
Academic and research infrastructure
● requisite labs and special clinics,
● IT facilities (hardware, software) for academics and high
end/specialised research

● research assistants’ provision
Hospital infrastructure
● state of the art medical equipment to provide services,
● facility for relaxation and discussion,
● hygienic and ambient amenities for physical convenience
of faculty to work comfortably

Living facilities
● Family relocation-related assistance—house hunting,
furnishing

● Housing and mess arrangements for bachelors, recreation
● facilities, such as schools, employment opportunities for
spouse

Facilities for handling public health disaster/ pandemics
● Availability of PPE kits and vaccines
● Provision of proper alternative arrangement for faculty to
stay, when they are not able to go home during pandemic
/ disasters space for faculty to take rest during extended
duty hours

● Secure and safe transport facilities for faculty to perform
their duties


47. If there are any other infrastructures or other facilities not listed above, please mention and
elaborate below:
48. How often do you review or audit the provisions made to create the ecosystems and examine
the quality of teaching? Can you share some audit reports/findings?


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49. Do you have any formal induction program to onboard a faculty? Yes/No:
50. Is there a job description for every post? Yes/No:
51. When do you share the job description with the faculty?
52. Do you have training programmes for the faculty?
• Teaching methods
• Upgradation of personal knowledge
• Both
• None
53. Who conducts these trainings?
54. Content of such training?
55. What are the systems provided to incentivise the retention of faculty? (The respondent can
select multiple options)

Systems and Provisions
Tick
Whichever is
applicable
a. Review of Salary structures and Emoluments; including incentives or bonus,
including non-practising allowance

b. Provision for inclusion of incentives for performers/non-performers in salary
c. Ease of undertaking research and support for publishing nationally and
internationally

d. Facilitation & creation of conducive environment to encourage peer
networking,

e. Ease of participating in CMEs
f. Ease of getting in-service training on department-specific or relevant issues
g. Approval for participating in conferences/workshop to share knowledge
Leadership & professional development
h. Policy around choice of career progression (clinical/administrative)
i. Structured mentoring programmes for technical/ techno-managerial/
managerial roles and their career growth path

Culture and climate
j. transparency in tenure/ promotions/ transfers,
k. encouraging belongingness through involvement in decision making;
l. Policy and flexibility to maintain work-life balance—in terms of annual
leaves, day-offs, Night and day duties, academic leave

Disasters and Pandemic
m. Provision of support to family members of faculty during public health
disasters, to take care of the family’s basic needs

n. Provision for time off, to offer respite due to extended working hours
o. Provision of flexibility in working hours during disasters / pandemics
p. Any other (please specify)

56. Is there a system for monitoring the workload of faculty in your medical college? Yes/No
57. Is there a system for appraisal of faculty in your medical college? Yes/No:
58. If no, what is the system for ensuring accountability of the faculty and their performance?
59. What is the average turnover of a faculty in the college in the last three years (April 2018 to
March 2021) across clinical/para-clinical/basic sciences specialities? Please share cadre and
department wise split.


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60. How many or what % of these faculty left within six months to 1 year of joining?
61. Is the turnover across cadres (regular/contractual) and departments (clinical/ paraclinical/basic
sciences) different? If yes, how?
62. Is there a system of exit interviews? Yes/No
63. If yes, do you take any actions based on the feedback received from candidates? Give some
examples of activities taken?
64. In your opinion, what are the reasons for the medical faculty to leave the position?
Score each of the items out of 10, where 10 is the top-most reason for leaving, and 1 is the lowest.

Reasons for Leaving Score
a. Career progression with movement to better-known colleges
b. Lack of normalization of salary across cadre irrespective of type of employment
(contractual vs regular staff)

c. Appointment as regular faculty instead of contractual
d. Lack of incentives (financial/ non-financial) to undertake and publish research
e. Jobs in another non-teaching government hospitals
f. Convenience and independence in private practice
g. Non-transparent promotion and tenure policy
h. Lack of leadership and mentoring for growth and development
i. Living conditions, quality of life not at par with peers/ professionals living and serving
in other higher education institutions across other sectors

j. Distorted work-life balance
k. Social and family commitments for children’s education and family’s medical
requirements

l. Isolation of under-represented groups within the college
m. Lack of ambient and clean environment
n. Lack of Job Security-Tenure of contract
o. No additional financial incentive for performing against a non-performing faculty

65. What are your suggestions for improvement to ensure retention and growth of faculty? (Give
your thoughts on short term and long-term strategies)



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4.2.5. DGME Questionnaire

Module A: Basic Profile and Demographic Particulars of the Respondent
1. State :
2. Qualification of respondent
3. Position
4. Experience in this position or medical education per se?
Module B: Status of medical education in the state
5. One of the strategies in health system strengthening as per NHP 2017 is to increase the
healthcare infrastructure and human resources. To achieve this, what are the strategies of the
Department of Medical Education in increasing the production of doctors:
• graduates
• post-graduates
6. How many medical colleges are there in the state currently? (Please give the public and private
split-if possible)
• Public Colleges:
• Private Colleges:
7. How many more medical colleges are planned in the state in the coming years to meet the
estimated requirement of doctors?
8. Does the state have enough Faculty to teach in these medical colleges? Respond with the
current and future estimated number of the faculty.
9. Has the Faculty shortage in the medical colleges improved in the last 2-5 years, or has it
deteriorated? [If it is improved, explain how it has been improved or if it has deteriorated,
please mention the reasons]
10. In which cadre are there more vacancies? Clinical / super specialities or Pre/ Paraclinical
11. What is the reason for this variation?
12. How does the shortage and requirement of Faculty in medical colleges across the state get
reported to the DGME?
13. NMC expects a regular update on sanctioned, vacant, and filled positions. How often this gets
updated currently? Respond with a numeric value (in days).
14. What, in your opinion, are the barriers to updating the NMC site with such data regularly?
15. How does the NMC intervene if there are unfilled positions?
16. NMC has made a provision for the recruitment of Visiting Faculty from the private sector for
teaching. Are you aware of any provision made by NMC for the recruitment of Visiting Faculty?
(Yes/No)
17. If yes, do you recruit Visiting Faculty?
• Yes (Go to Q20)
• No (Go to Q19 and skip Q20 and Q21)
18. If no, why not?
19. What are the benefits of recruiting a Visiting Faulty?

Module C: Recruitment and onboarding of Faculty
20. Is the system for recruitment an annual/biannual/continual process to fill the requisite
positions?
• Annual
• Biannual
• Continual



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21. What is the level of autonomy allowed for recruitment, at the local level and under what
conditions (emergency recruitment) medical college can hire on its own?
22. Kindly elaborate on the steps/process of faculty recruitment and onboarding in your state?
Please provide a copy of the advertisement/notification published in newspapers or on the web
inviting applications.
23. Does the DGME recruit for regular/contractual positions or both?
• Regular
• Contractual
• Both
24. How is the recruitment process different for contractual and regular positions? Please provide a
copy of the Terms & Conditions of Service of all faculty posts for recruitment.
25. When do you inform of the Terms and Conditions of the employment?
26. Which bodies are responsible for recruitment and for which positions?

Boards/Bodies Designation
Position
(regular/contractual/
visiting faculty)
State Public Services Commission (SPSC)
Similar commissions for medical services (Give
names)

An Autonomous Body (Give name)
At the medical college level (Give name)

27. For any given vacancy for a medical faculty, what is the ratio of MBBS and non MBBS applicant?
28. What are the criteria or situations for releasing a position for recruitment as regular or
contractual?
29. In which departments are contractual positions allowed/recruited - clinical, paraclinical or basic
sciences? (Respond with a tick mark)

Department Contractual Regular Both
Clinical
Paraclinical
Basic Sciences
30. What is the duration of contract generally given for a faculty hired on a contractual basis?
31. Do you consider the lead time for internal approvals and external factors when advertising for a
contractual position? If yes, what is generally the internal and external lead time for hiring for
various categories
32. How much or what is the salary gaps between regular and contractual medical faculty?
33. Is there a separate recruitment process for faculty positions in tribal and non-tribal areas? If yes,
how are they different?
34. Is there a possibility of shifting a reserved post to a general post, in case the reserved position
does not get filled up in the recruitment process?
35. Are there any norms on the duration in which a recruitment process for a medical faculty should
be completed? Yes/No:
36. If yes, how many days are there for each step in the recruitment process approximately?

Module D – Barriers to recruitment and onboarding
37. What, in your opinion, are the barriers to the faculty recruitment process?
Score each of the items out of 10, where 10 is the highest barrier, and 1 is the lowest barrier



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Process Score
a. The process of approving a position
b. Modes of advertising a position.
c. The process of filling up the application form is cumbersome for a candidate
in terms of its format, method and mode of application

d. Constitution of the selection board. Considering that the board consists
typically of high-level officials, there are delays due to time constraints of
board members.

e. Coordination of the selection board schedule for taking interviews.
f. Time taken to get approval after selection of candidates, at the level of
DoHFW/DGME

g. Delays in rolling out the order

38. If there are any other barriers, not listed above, please elaborate below
39. What are the eligibility criteria for recruitment of Senior Residents as faculty?
40. Is the mode of advertising appropriate and adequate? (Yes/No)
41. One of the IIMs advertises in the leading newspapers and writes letters to the top institutes. In
addition, they also write individually to people who have made inquiries in the past for a
position. Do you think this IIM’s mode of advertisement is worth emulating for faculty
recruitment in medical colleges?
42. Are there any practical solutions for simplifying the process of filling up an application form?
43. Once the selection process is completed, does the state prepare a separate waiting list?
(Yes/No)
44. If yes, what is the validity of such a waitlist?
45. What is the mechanism to inform the candidates that they are selected or waitlisted?
46. Do all the candidates who are issued the letter join? (Yes/No)
47. If no, what is the percentage gap on an average between the numbers of candidates selected
and joined?
48. What have been some of the innovative measures taken by the state to streamline the
recruitment process and reduce the turnaround time required for hiring?
49. Is there a separate budget for managing the recruitment process? (Yes/No)
50. What is the overall budgetary layout for DME? How is it split for various activities of DME?
51. Have there been cases wherein a candidate has challenged the recruitment in the court of law?
(Yes/No)
52. If yes, what were the key learnings?
53. How have they impacted the overall recruitment process, and what has changed?
54. Kindly provide a split of lawsuits filed by - Senior Resident/Demonstrator, Assistant
Professor/Tutor, Associate Professor, Professor, from April 2018-March 2021.
55. What are your suggestions to improve and streamline the recruitment and onboarding of
Faculty in the medical colleges? (Respond with short term and long-term strategies)

Module D: Retention/Growth of Faculty
56. What are the infrastructure facilities provided in the medical colleges to support medical
education?
(Score 1-10 where 10 is the most Adequate/Appropriate and 0 being the least Adequate
/Appropriate)
Definition of
Adequacy: As in numbers as per the specifications in terms of student ratio
Appropriate: Quality as per requirement and specifications of what you have/bought/received
from the concerned department or vendor



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Infrastructure and Facilities
Adequate
(score)
Appropriate
(score)
Teaching infrastructure
● well-lit classrooms,
● online aid,
● bedside teaching,
● library and journals
Academic and research infrastructure
● requisite labs and special clinics,
● IT facilities (hardware, software) for academics and high end/
specialized research

● research assistants’ provision
Hospital infrastructure
● state of the art medical equipment to provide services,
● facility for relaxation and discussion,
● hygienic and ambient amenities for physical convenience of
Faculty to work comfortably

Living facilities
● Family relocation-related assistance—house hunting,
furnishing

● Housing and mess arrangements for bachelors, recreation
facilities, such as schools, employment opportunities for spouse
Facilities for handling public health disaster/ pandemics

● Availability of PPE kits and vaccines
● Provision of proper alternative arrangement for faculty to stay,
when they are not able to go home during pandemic /
disasters space for faculty to take rest during extended duty
hours

● Secure and safe transport facilities for faculty to perform their
duties


57. If there are any other infrastructures not listed above, please mention and elaborate below:
58. What are the systems provided to incentivise the retention of faculty? (The respondent can
select multiple options)
Systems and Provisions
Tick
Whichever is
applicable
a. Review of Salary structures and Emoluments; including incentives or bonus,
including non-practising allowance

b. Provision for inclusion of incentives for performers/non-performers in salary
c. Ease of undertaking research and support for publishing nationally and
internationally

d. Facilitation & creation of conducive environment to encourage peer
networking,

e. Ease of participating in CMEs
f. Ease of getting in-service training on department-specific or relevant issues
g. Approval for participating in conferences/workshop to share knowledge
Leadership & professional development
h. Policy around choice of career progression (clinical/administrative)


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Systems and Provisions
Tick
Whichever is
applicable
i. Structured mentoring programmes for technical/ techno-managerial/
managerial roles and their career growth path

Culture and climate
j. Transparency in tenure/ promotions/ transfers,
k. Encouraging belongingness through involvement in decision making;
l. Policy and flexibility to maintain work-life balance—in terms of annual leaves,
day-offs, Night and day duties, academic leave

Disasters and Pandemic
m. Provision of support to family members of faculty during public health
disasters, to take care of the family’s basic needs

n. Provision for time off, to offer respite due to extended working hours
o. Provision of flexibility in working hours during disasters / pandemics
p. Any other (please specify)
59. How often do you visit a medical college to monitor the provisions made to create the
ecosystems and review the quality of teaching?
60. What is the process for appraisals of staff in the medical colleges across the state or system for
ensuring accountability of the faculty and their performance?
61. What is the average turnover of a faculty in the college in the last three years (April 2018 to
March 2021) across clinical/para-clinical/basic sciences specialities? Please share cadre and
department wise split.
62. How many of these Faculty left within six months to 1 year of joining?
63. Is the turnover across cadres (regular/contractual) and departments (clinical/paraclinical/ basic
sciences) different? If yes, how?
64. In your opinion, what are the reasons for the medical faculty to leave the position? (Score each
of the items out of 10, where 10 is the highest reason for leaving, and 1 is the lowest

Reasons for Leaving Score
a. Career progression with movement to better-known colleges
b. Lack of normalization of salary across cadre irrespective of type of employment
(contractual vs regular staff)

c. Appointment as regular faculty instead of contractual
d. Lack of incentives (financial/ non-financial) to undertake and publish research
e. Jobs in another non-teaching government hospitals
f. Convenience and independence in private practice
g. Non-transparent promotion and tenure policy
h. Lack of leadership and mentoring for growth and development
i. Living conditions, quality of life not at par with peers/ professionals living and serving
in other higher education institutions across other sectors

j. Distorted work-life balance
k. Social and family commitments for children’s education and family’s medical
requirements

l. Isolation of under-represented groups within the college
m. Lack of ambient and clean environment
n. Lack of Job Security-Tenure of contract
o. No additional financial incentive for performing against a non-performing faculty




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4.3. Annexure 3 – Legal Cases
4.3.1. Type of Legal Issues in Recruitment of Medical Faculty
Issue 1: Should seniority of obtaining a qualifying degree/diploma play a role in recruitment?
In the case of Hari Om Singh and Anr. Vs State Of U.P, it was held that merely obtaining diploma in X-
Ray from State Medical Faculty does not confer any right on petitioners to claim appointment in the
State service on the post of X-Ray Technician.
44

Issue 2: Effect of change in minimum qualification of medical teachers
Punjab regulations regarding medical faculty were introduced in 1998 to disqualify non-medical
teachers who taught pre-clinical subjects such as anatomy, biochemistry etc. from being a regular
medical faculty if they hadn’t obtained their degrees at medical colleges. This was challenged before
the Punjab and Haryana High Court in the case of Medical Council of India vs Union of India. The court
refused to entertain the matter or to direct the MCI/Punjab Government to regularise posts of persons
who were hired earlier but did not qualify for regularisation after the new notification.
45

Issue 3: Issue of transfer
In the case of Vijaykumar Chandulal Popat vs State, the medical teacher approached the Gujarat High
Court alleging that their transfer was illegal and arbitrary and on the basis of reports in a newspaper
about the medical teacher practising outside of the college, despite getting a non-practising
allowance. However, since the only reason given in the transfer order was that of a lack of faculty in
the area of transfer, the high court dismissed the petition of the medical teacher.
46

Issue 4: Changes in rules/regulations to apply prospectively, unless otherwise provided for in the
amendment itself
In the case of Dr B S Meena vs State Education Department, it was held by the Rajasthan High Court
that any regulation that is introduced by a state regarding age of superannuation will be applied
prospectively, and the petitioner who had already retired when the new rules were notified, cannot
claim advantage of the same.
47
Court Cases related to Recruitment & Regularisation of Contractual
Staff







44
https://indiankanoon.org/doc/28701891/
45
https://indiankanoon.org/doc/679502/
46
https://indiankanoon.org/doc/96445919/
47
https://indiankanoon.org/doc/16849682/


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4.3.2. Court cases related to recruitment & regularization of contractual staff
Case Court Issue Judgement
Aakash Srivastava
vs State Of HP - 20
July, 2021

HP High
Court
Petitioners were contractual staff
who wanted to be absorbed into
permanent as per regularization
policy. Two policies of the state,
were examined:
1. Regularize services of
contractual appointees in the
government departments, who
have completed three years
continuous service as on
30.9.2017 (and similar policies
released in 2019).
2. Resident Doctor Policy of 2019
whose repeat tenure clause
stated that no candidate can have
a repeat tenure as a senior
resident/tutor specialist in any
specialty, particularly, in GMC.
However, a senior resident, who
has completed his/her tenure in
one specialty will be entitled for
Senior Residency in the
concerned super specialty
department, but s/he shall be
placed below the fresh
candidates while drawing up
merit irrespective of the marks
earned
The court asked the state to
consider regularization of the
contractual staff.
Reading the two policies
together, the court observed that
the petitioners were not seeking
their regularization against the
post of Professor, rather against
the posts of Tutors, Senior
Residents and Junior Residents,
respectively. The court also
observed that doctors with same
qualifications as petitioners in
General Wing were regularized
under the same policy




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4.3.3. Court cases related to recruitment & regularization of contractual staff
Case Court Issue Judgement
Medical Council
of India vs Union
Of India

Punjab and
Haryana
High Court
Medical council of India
Regulations 1971 allowed
persons with M. Sc. in relevant
subject to teach as medical
faculty, without additional
requirements.

However, the 1993 Regulations
revised the criteria and stated
that such persons who have done
MSc from specific medical
colleges can only be considered
medical faculty. With this change,
the persons who had been
working for more than a decade
were considered ineligible to
compete for regularization.
The Court held that the
respondents should be
considered for HoD position and
regularization basis the
following:

1. Respondents were appointed
as per the advertisement of
February, 1997 on contract basis.
The qualifications for the post as
prescribed and mentioned in the
advertisement itself were
keeping in view the qualification
as available in Punjab Medical
Education Clause (i) Rule 1971
and the respondent duly fulfilled
this criterion. The appointment
was in accordance with the rules
by a duly constituted Selection
Committee.

2. Subsequently the post was re-
advertised on regular basis vide
Advertisement dated 26-04/02-
05-1997. The appointment was as
such proper and not a backdoor
entry. The petitioners were all
eligible under the 1971 rules.

3. They have suddenly been
made ineligible on the basis of
1998 rules. The very basic
qualification of M.Sc. has been
changed. A basic qualification
cannot even be improved by the
candidates even if they wish to
do so at this later stage. It would
amount to throwing them out
from the field of their
specialization forever and at a
time when they are all overage.




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4.3.4. Court case around transfer and super annexation age
Case Court Issue Judgement
Vijaykumar
Chandulal Popat
vs State

Gujarat
High Court
The petitioner approached the
Gujarat High Court alleging that
his transfer was illegal and
arbitrary and was made on the
basis of reports in a newspaper
about the medical teacher
practicing outside of the college,
despite getting a non-practicing
allowance.
Since the only reason given in the
transfer order was that of a lack
of faculty in the area of transfer,
the high court dismissed the
petition of the medical teacher.
Chandra Mohan
Varma vs State Of
Uttar Pradesh

Supreme
Court of
India
Whether the notification dated 6
February 2015 extending the age
of superannuation will apply to
the appellant who attained the
age of retirement on 13 August
2014
It was held that the appellant will
not be entitled to the benefit of
the notification dated 6 Feb,
2015. This is because the
appellant who attained the age of
60 years – the age of retirement
which prevailed at the relevant
time – was not entitled to the
benefit of the later notification
dated 6 February 2015. The
appellant was continuing until
the end of the session (30 June
2015) after retirement, in terms
of the decision dated 19
November 2012. He was not
entitled to the enhanced age of
retirement of 65 years.


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4.3.5. Court case around transfer and superannuation age
Case Court Issue Judgement
Dr B S Meena vs
State Education
Department Ors
Rajasthan
High
Court
Whether the post of Principal
should be encadered by the
MCI Regulations and not in the
Rajasthan Medical Services
(Collegiate Branch) Rules, 1962
(for short, ‘the Rules of 1962’),
even though a mention of the
post of Principal is made in Rule
3 (f) of the Rules of 1962.
The court held that the
Principals/Deans will be
encardered by Riles of 1962,
and not MCI Regulations
because the posts of Principal,
Dean, etc. are the selection
posts and such selections have
to be made only from amongst
the persons who are
substantively holding the post
of Professors. The selection of
the petitioners on the post of
Principal or Deal, etc., does not
in any manner result in
discontinuation of their lien
from the substantive post of
Professor. In fact, they gave
been appointed on these posts
only because they were treated
eligible for such appointment by
virtue of their substantive
appointment as Professors.
Even after selection on these
administrative posts, they
continue to be the members of
service under the Rules of 1962
on the posts of Professor
encadered therein.

Case Court Type Issue Judgement
Gujarat
High
Court
Superann
uation
and
rehiring
on
contractu
al basis
Whether the reinstatement of
petitioner on the post of
Associate Professor of
anasthesia inspite of his
superannuation and the
expiration of his contract as per
the Employees’ Service
(general) Rules, 2014 is just and
proper
The court reversed the decision
of the lower court to reinstate
the respondent as an Associate
Professor. This is because the
respondent herein pursuant to
fresh advertisement was
selected and appointed as a
Professor of Anaesthesia at
Himmatnagar College but he
refused to join and insisted to
be appointed at Sola. There is
no right for the respondent to
continue to claim the he be
continued at Sola. His
appointment was contractual
and came to an end when as per
Rulesin force he attained the
age of 62. Once having
appeared and accepted the


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contract and again on
termination accepted a fresh
appointment at Himmatnagar
and then refusing to come to
join shows the conduct of the
respondent in blowing hot and
cole. He had no vested right to
post the therefore even the
directions to create
supernumerary post is uncalled
for.



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4.4. Annexure 4 – National Institutional Ranking Framework (NIRF)

4.4.1. NIRF Detailed Scoring Table
S
l.
Parameter Marks % Weight
1
Teaching, Learning & Resources
100 30.0
1
A
Student Strength including Doctoral Students (SS)
SS = f (NT, NE) × 15 + f(NP) × 5
20 6.0

NT = Total sanctioned approved intake in the institution considering all UG and
PG programs of the institution
15 4.5

NE = Total number of students enrolled in the institution considering all UG and
PG Programs of the institution

NP = Total number of students enrolled for the doctoral program
(MS/MD/DNB/MCh/DM) till previous academic year
5 1.5
1
B
Faculty-student ratio with emphasis on permanent faculty (FSR)
48

FSR = 30 × [15 × (F/N)]
F: Full time regular faculty
49
in the institution in the previous year
N = NT + NP
30 9.0
1
C
Combined metric for Faculty with PhD (or equivalent) and Experience
(FQE)
FRA is the percentage of Faculty with Ph.D. (or equivalent qualification) with
respect to the total no. of faculty required or actual faculty whichever is higher,
in the previous year.

Here F is the percentage of Faculty with Ph.D. (or equivalent qualification), over
the previous 3 years.
Min #3, F1=Fraction with Experience up to 8 years;
Min #3, F2= Fraction with Experience between 8+ to 15 years;
Min #4, F3=Fraction with Experience > 15 years.
20 6.0
1
D
Financial Resources and their Utilization (FRU)
FRU = 7.5×f(BC) + 22.5×f(BO)
30 9.0

BC: Average Annual Capital Expenditure per student for previous three years
pertaining medical discipline only. (Excluding expenditure on construction of
new buildings)
7.5 2.25

BO: Average Annual Operational (or Recurring) Expenditure per student for
previous three years pertaining medical discipline only. (Excluding maintenance
of hostels and allied services)
22.5 6.75
2 Research and Professional Practice 100 30.0
2
A
Combined Metric for Publications (PU)
PU = 40 × f(P/FRQ)
P is weighted number of publications as ascertained from suitable third-party
sources
FRQ is the maximum of nominal number of faculty members as calculated on
the basis of a required FSR of 1:15 or the available faculty in the institution
40 12.0
2
B
Combined metric for Quality of Publications (QP)
QP = 20 × f (CC/ FRQ) + 20× f (TOP25P/P)
40 12.0

48
Expected ratio is 1:15 to score maximum marks. For F/N < 1: 50, FSR will be set to zero.
49
Regular appointment means Faculty on Full time basis. Faculty on contract basis/ad-hoc basis will be considered if the
concerned faculty has taught in both the semesters of academic year 2019-20. Faculty members with Ph.D. and Master’s
degree will be considered and counted here. Faculty member with a Bachelor’s degree will not be counted.


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106
CC is Total Citation Count over previous three years
FRQ is the maximum of nominal number of faculty members as calculated on
the basis of a required FSR of 1:15 or the available faculty in the institution
20 6.0
TOP25P: Number of citations in top 25 percentile averaged over the previous
three years
P is as computed for PU.
20 6.0
2
C
IPR and Patents: Published and Granted (IPR)
IPR = IPG + IPP
10 3.0
IPG = 5 x f (PG)
PG is the number of patents granted over the previous 3 yrs.
5
IPP = 5 x f (PP)
PP: No. of patents published over the previous 3 yrs.
5
2
D
Footprint of Projects and Professional Practice (FPPP)
FPPP = FPR + FBD
10 3.0
FPR = 5 x f (RF)
RF is average annual research funding earnings (amount actually received in
rupees) per faculty at institute level in previous 3 yrs.
5 1.5
FBD = 5 x f (PBD)
PBD is percentage of bed occupancy in a day.
5 1.5
3 Graduation Outcomes 100 20.0
3
A
Combined metric for Placement and Higher Studies (GPH)
GPH = 25 × (Np/100 +Nhs/100)
Np = Percentage of graduating students (in UG/ PG programs) placed in the
previous 3 yrs.
Nhs = Percentage of graduating students (in UG/ PG programs) who have been
selected for higher studies in the previous 3 yrs.
25 5.0
3
B
Metric for University Examinations (GUE)
GUE = 25 × min [(Ng/80), 1]
Ng is the percentage of Students (as a fraction of the approved intake),
averaged over previous three years, passing the respective university
examinations in stipulated time for the program in which enrolled.
25 5.0
3
C
Metric for Number of PG Students Graduated (GPG)
GPG = 30 × f(Npg)
Npg = Average number of PG students (MD/MS/DNB) students graduated over
the previous 3 yrs.
30 6.0
3
D
Metric for Number of Super Specialty Student Graduated (GSS)
GSS = 20 × f(Nss)
Nss = Average number of Super Specialty (MCh/DM) students graduated over
the previous 3 yrs.
20 4.0
4 Outreach and Inclusivity 100 10.0
4
A
Percentage Students from other States/Countries - Region Diversity
(RD)
30 3.0
Fraction of total students enrolled from other states 25 2.5
Fraction of students enrolled from other countries 5 0.5
4
B
Percentage of Women/ Women Diversity (WD)
50

WD = 15 × (NWS/50) + 15 × (NWF/20)
30 3.0
NWS = percentage of Women students. 15 1.5
NWF = percentage of Women Faculty including the women members in senior
administrative positions, such as Heads of Departments, Deans or Institute
Heads.
15 1.5

50
Expectation: 50% women students and 20% women faculty.


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4
C
Economically and Socially Challenged Students (ESCS)
ESCS = 20 × f(Nesc)
Nesc = percentage of UG students being provided full tuition fee reimbursement
by the institution to pursue their degree programs.
20 2.0
4
D
Facilities for Physically Challenged Students (PCS)
PCS = 20 marks, if the Institute provides full facilities for physically challenged
students, as outlined.
Else, in proportion to facilities.
20 2.0
5 Perception 100 10.0
Peer Perception: Employers & Academic Peer (PR)
• This is to be done through a survey conducted over a large category of Employers,
Professionals from Reputed Organizations and a large category of academics to
ascertain their preference for graduates of different institutions.
• Comprehensive list will be prepared taking into account various sectors, regions,
etc.
• Lists to be updated periodically.
100
10.0


4.4.2. Participation in NIRF Rankings 2018-2021
In order to encourage larger participation in India Rankings, all institutions that had applied in the
previous year, were pre-registered for India Rankings 2021 and were invited to participate in the
ranking exercise. In addition, other institutions desirous of participating in the India Rankings 2021
were invited to register on the NIRF Web portal through a public advertisement.
State 2021 2020 2019 2018
CFTIs and CFUs 2 2 2 2
North 24 27 28 30
South 56 62 51 43
East 7 6 4 4
West 24 23 30 24
Total Number of Institutions 111 118 113 101
Source. https://www.nirfindia.org/Home
CFTI: Centrally Funded Technical Institutes
CFU: Centrally Funded Universities