When doctors can move, healthcare benefits
In a first-of-its-kind reform, Andhra Pradesh has thrown open its doors to doctors from across India by removing state registration hurdles. An MBBS graduate holding a recognised medical qualification and valid registration with any state or UT medical council in the country will now be allowed to practise in the state, without a separate Andhra Pradesh Medical Council registration or a No Objection Certificate (NOC) from the council where they are registered. The order cuts through a bureaucratic roadblock that has long deterred doctors — particularly young graduates and specialists — from moving to states where there are better opportunities. With Andhra Pradesh’s registered doctor base standing at roughly 1.05 lakh for a population of nearly 5 crore, and the country’s overall doctor-population ratio hovering at 1:811 against the WHO benchmark of 1:1,000, this is likely to help address shortages in specialist care and strengthen the state’s ambition to attract medical talent from across India. The significance of the decision is not limited to healthcare administration alone. In a country that routinely speaks of the ease of living and doing business, domicile preferences in public employment and local registration requirements have often tested the spirit, if not always the letter, of constitutional guarantees. Driven by political and administrative considerations, states frequently create procedural hurdles that limit opportunities. For instance, in an attempt to stem high attrition rates, Bihar recently made it mandatory for government doctors to complete three years of continuous service before becoming eligible for NOCs. There are also other tangible costs for those seeking to relocate. Re-registration fees at state councils typically range from Rs 5,000 to Rs 10,000, while obtaining an NOC from a home-state council — a prerequisite for re-registration elsewhere — can take weeks and involve additional paperwork. Andhra Pradesh’s move also aligns with the broader objective behind the National Medical Commission’s efforts to create a seamless national registration framework. The “One Nation, One Registration” platform was launched in August 2024 to eliminate impediments to professional mobility. Yet only around 1,800 registration certificates have been issued so far, while more than 30,000 applications remain pending verification at state medical councils. By lowering barriers to mobility, Andhra Pradesh has not only moved to strengthen healthcare delivery, it has shown that states need not wait for administrative bottlenecks to be resolved before adopting the principle underlying the reform.
- 1Andhra Pradesh's reform engages directly with Article 19(1)(g) of the Constitution, which guarantees every citizen the right to practise any profession or carry on any occupation, trade, or business — subject only to reasonable restrictions under Article 19(6). State medical council registration requirements that impose mandatory domicile conditions or lengthy NOC processes have long been challenged as unreasonable restrictions on professional mobility. The Supreme Court in various licensing and professional regulation cases has held that procedural requirements must be proportionate and not create arbitrary barriers. This reform effectively exercises state executive power to pre-empt constitutional litigation.
- 2The reform aligns with India's broader national healthcare policy framework: the National Health Policy 2017 targets a doctor-population ratio of 1:1,000 (India currently stands at 1:811 nationally but with extreme rural-urban disparities), and the Ayushman Bharat – Health and Wellness Centres programme requires a large primary healthcare workforce. The National Medical Commission Act 2020, which replaced the Medical Council of India, explicitly aimed at enabling a unified national registration system. Andhra Pradesh's unilateral reform acts as a workaround while the NMC's own 'One Nation, One Registration' portal — launched in August 2024 — processes only 1,800 of over 30,000 pending applications.
- 3Legally, the regulation of medical practitioners in India involves a complex interplay between central and state law. The National Medical Commission Act 2020 (central legislation) governs medical education and a national register, while state medical councils — established under state Acts — handle local registration. Entry 26 of List III (Concurrent List) of the Seventh Schedule covers 'legal, medical and other professions,' meaning both Parliament and state legislatures can legislate. Bihar's restrictive three-year bond for government doctors and AP's open-door policy illustrate how different states can adopt diametrically opposite legal approaches within the same constitutional framework.
- 4India's doctor density masks severe regional inequalities: urban areas have roughly three times more doctors per capita than rural areas, and states like Bihar, Uttar Pradesh, and Jharkhand have acute shortages of specialists. The NMC's 2023 report estimated a shortage of over 600,000 doctors against current demand, with specialist shortage (cardiologists, neurologists, oncologists) even more acute. Globally, the World Health Organization projects a shortfall of 10 million health workers by 2030, predominantly in low- and middle-income countries. Policies like AP's open registration are backed by economic evidence — professional mobility increases welfare both for doctors (better opportunities) and patients (better geographic distribution of care).