India Needs More Physician-Scientists and Promotion of a Culture of Clinical Research

Lack of Research Culture and Training

Medical education in India is predominantly knowledge acquisition in the lecture halls or laboratories or clinics with no avenue for student-driven projects and hands-on research exposure. Even the principles of research methodologies used in basic science research or in randomised controlled trials in the clinics are not taught to the medical students. Unlike medical education, research is a culture that needs to be developed, nurtured and sustained.^10-13

Lack of Adequate Research Funding and Infrastructure

Both basic science and clinical research are expensive.¹⁴ In addition, unlike clinical service, research is not a revenue-generating work. It only consumes money without producing any revenue. However, the outcome of research findings can save millions of lives and substantially reduce healthcare costs.¹⁵ Thus, the benefits of doing research far outweigh the upfront costs. It is like building a multi-purpose dam on a river.

Inadequate Mentorship

There is a huge difference between being a good teaching professor versus good research mentor in a medical school. Anyone can become a good teacher through practice or experience. Research involves imparting tacit knowledge that requires mentorship. Becoming a research mentor in a medical school is not a formal process with a single defined path, but it requires commitment to a specific area of research, demonstrated success and strong interpersonal skills.¹⁶ To become a successful mentor, faculty members need to be role models, career guides and have a strong track record of research in their field.¹⁷

Career Perception and Disgrace

This is an important factor in India. A prevailing prejudice against research careers, in favour of clinical practice, deters many bright medical graduates to pursue research careers, despite their passion for research. Even if one dares to take up research, there is unspoken disgrace from colleagues or community or even family members in a society where success is often measured by the ability of a person to create wealth and/or visibility in the society. In 1976, soon after completing MBBS, when I told my friends that I wanted to pursue academic research in lieu of clinical practice, they thought I became insane with a nut loosened in my head. Having gone through such an experience, I can assure you that it takes a strong passion, deep-rooted commitment and infinite patience to pursue academic research in India. Added to that, unlike clinical practice, it takes decades to prove one’s worth or success in research. Because of this, recently, I published my journey as a scientist across the globe as a book,¹⁸ with the goal that it may be a useful guide for young doctors.

No Incentive or Reward for Doing Research

In India, faculty positions and promotions are time-bound and the pay structure is uniform. There is no monetary incentive or reward in terms of promotions for doing research. Salaries are not negotiable based on merit. This starkly contrasts with conditions in the United States, where positions or ranks and pay are negotiable based on individual merit, research accomplishments and their impact at national and international levels. Universities keep track of the global impact of their faculty and reward them. Many universities in the United States also pay bonuses for securing federal funding for research.

It is Not Enough if Mds Take Care of Patients in India

One may wonder if it is not enough if doctors just take care of patients well in India? In 2019, the world had about 12.8 million physicians.¹⁹ India has about 1.3–1.4 million allopathic doctors recorded by the National Medical Commission (NMC) around 2022–2025.²⁰ With 17% of the world population, and a large disease burden (20% of the global burden), India produces a relatively small share (4–6%) of global clinical trials, thus highlighting a significant deficit.^21,22 The huge gap between the healthcare needs and clinical trials in India offers ample opportunity for clinical research.^23,24 Surveys conducted in India revealed that although many physicians show interest in research and might have published a case study or meta-analysis, if not an original research paper, only a small percentage of Indian physicians are passionate about research and will commit their time to research. Several barriers were identified for this lack of progress in research despite having interest, such as a lack of mentorship, no formal training and very little financial support, among others. These dampened the motivation of physicians interested in conducting research.²⁵ In contrast, more than 3/4^th of medical students in India considered research to be pivotal to their academic trajectory. The majority of these students had taken the United States Medical Licensing Examination and Professional Linguistic Assessment Board of the United Kingdom.²⁶ These numbers highlight the need for an integrated curriculum with robust supporting mechanisms to nurture research culture and skills, through seminars, courses and interactive sessions as well as collaborations with physician-scientists in other countries, such as the United States. As per the analysis of the data from the 2022 National Sample Survey of Physicians, conducted by the American Association of Medical Colleges, about 8% of non-academic and 24% academic physicians in the USA are involved in serious research. Clinical and translational research was more prevalent among academically affiliated physician scientists²⁷ and about 24% of physicians have academic affiliations. Research is the backbone of clinical medicine. Without continued research on diseases, clinical medicine does not progress.

Relevance of Clinical Research to Reduce the Burden of Non-Communicable Diseases (Ncds) in India

In the above context, the burden of NCDs in India is significant and growing. The leading NCDs are cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and chronic kidney disease, which contribute the most to the country’s morbidity and mortality. NCDs have surpassed communicable diseases as the leading cause of death in India. In 2017, India had about 4.7 million deaths and 226.8 million disability-adjusted life years (DALYs) due to NCDs with a ratio of DALYs to deaths of 48 to 1.²⁸ DALYs negatively impact the economy of any country. This trend in India is projected to continue and is exacerbated by an ageing population and a rising economic burden on households. Key risk factors include unhealthy diets, tobacco and alcohol use, physical inactivity and obesity. Unless the prevalence of these is brought down significantly in the next 10 years, India cannot afford the rising healthcare costs. The Indian healthcare sector was projected to grow to $638 billion in 2025, from $372 billion in 2023. It is growing at an annual growth rate of 17.5–22.5%.²⁹ If it continues the same trajectory, it will exceed $1 trillion by the year 2030, when the projected gross domestic product of India will be about $7.3 trillion. That will be a huge economic burden on India. Hence, there is an urgent need to reduce the burden of NCDs by targeted clinical research on the management of these diseases.

Finally, it is alarming to see the huge differences in premature all-cause mortality due to high body mass index obesity over a 30-year period (1990–2019) among different age groups between the United States and India.^30,31 Note the values shown for India in green boxes are lower than the corresponding values for the USA in 1990 but rose enormously by 2019. This rapid rise in NCDs in India may continue unless some drastic measures are taken to contain it [Table 1].

Recommendations to the NMC, the State and Central Governments and Medical Institutions in India

A paper published in the Journal of the Association of Physicians of India in 2019 reported that six to ten medical colleges publish over 60% of research papers in indexed journals out of 450 medical colleges in India at the time of publication of the report.³² This number must be expanded drastically. Modern medical research is a community culture, not an individual effort as in the past. Research needs passionate MDs and PhDs with creative thinking, infrastructure and facilities and equipment, funds to carry on the research at a minimum as well as training programs for aspiring researchers both at the undergraduate and postgraduate level. The need for research funds, research training and the inclination or thrust to conduct research have been highlighted in the National Education Policy in 2019 by the Ministry of Human Resources Development, Government of India.³³ Apart from these three, to promote and sustain passion, there should be incentives for the faculty aspiring to do research by walking an extra mile. In most developed countries, faculty compensation and promotions are directly linked to the research activity and productivity of the individual faculty members as determined by the committees. If this is not possible in India, there should be a separate package or compensation added to the salaries of faculty actively involved in research. Medical institutes in India should also actively collaborate with Indian MDs and PhDs doing research in countries such as the United States, the United Kingdom, Australia and Europe by offering them visiting professorships. This not only strengthens research programs by offering long-term bonds but also helps to build a research culture and environment in the medical colleges in India. Many Indian American academicians, including me, are ready to support our Alma Mater in India to boost their research capability. Many academicians of the Indian diaspora are also willing to spend time in India on sabbatical if such arrangements are made by the medical institutes in India supported by the Government of India. Tapping the expertise of the Indian diaspora is easy and offers long-term collaborations. Many emerging economies and developing countries are following this model. And India should emulate those countries.

About the Author:

Prof. BK. Kishore, MD, PhD, MBA, is an academician, innovator, entrepreneur and author and lives in Sandy, Utah, United States. He is a Senior Member of the US National Academy of Inventors and elected Fellow of several scientific bodies. He is the Founding Editor-in-Chief of the Journal of American Association of Physicians of Indian Origin (JAAPI). Dr. Kishore publishes his books on Amazon or Notion Press in India, under the Living with a Purpose Series. He received Hind Rattan (Jewel of India), Nelson Mandela and Mahatma Gandhi Leadership awards from the NRI Welfare Society of India in New Delhi. Website: www.bkkishore.online .