A silent attrition of women doctors ails India's healthcare system

A silent attrition is hollowing out India's healthcare workforce, with implications for patient care and equity

Dipali Jaju’s journey does not follow the neat arc often associated with a medical practitioner’s career. A homeopathic physician from Akola in Maharashtra who graduated in 2010, Jaju practised for a few years before moving cities after marriage. She then returned to clinical work, took a break after childbirth, retrained as an acupuncture therapist, and eventually pivoted again — this time to yoga. 

Today, nearing 40, she is a yoga trainer in her hometown, a career she combines with looking after her daughter and ageing parents. “I have been a meritorious student throughout. My parents wanted me to study medicine, and I did practise homeopathy,” she said. “But circumstances kept changing. When my daughter was born, I had to go on bed-rest. Later, my mother’s health worsened and I had to take charge of the house.” She smiles when asked if she regrets stepping away from medical practice: “No regrets,” she said simply. 

Jaju is not an MBBS doctor, but her story reflects a larger gender pattern playing out across India’s healthcare system — women enter medical colleges in record numbers but end up shuffling out in a silent mid-career exodus from clinical practice, leadership and research. 

The vanishing half 

Women account for roughly half of India’s MBBS graduates. But the pipeline thins rapidly after that. According to a joint analysis by Boston Consulting Group (BCG), a consultancy, and Dasra, a nonprofit, around 30 per cent of women drop out between completing MBBS and entering early-career practice or postgraduate training, compared with a drop-out rate of 5-10 per cent for men.  

Roshni Rathi, managing director and partner, BCG said India has 500,000-550,000 women medical graduates, but only 350,000-400,000 are in active practice or postgraduate training, translating to a continuation rate of 65-75 per cent, versus 90-95 per cent for men. 

In discussions with clinicians and educators, women noted that a combination of limited post-grad seats (a general problem in medical education), extended specialisation timelines, and their overlap with personal life-stages holds them back from moving into PG training. 

“This drop-off happens at precisely the stage when continuous learning and specialisation become critical,” said Neera Nundy, cofounder and partner at Dasra, which worked with BCG on the Women in Leadership in Healthcare report. “The challenge is not that women doctors are less committed. It is that the system often prevents them from pursuing training consistently.”  

High-demand specialisations — cardiology, orthopaedics, neurology, gastroenterology and oncology — are particularly affected. These fields require long and continuous training that can overlap with women’s peak caregiving years. Relocation for postgraduate seats, fellowships or observerships is often non-negotiable.  

“Many women simply cannot move cities at that stage because of marriage or family responsibilities,” Nundy said. “That barrier is significant, but often overlooked.” 

Unsupportive ecosystem 

Hospital work compounds the problem. Long hours, night duties and unpredictable rosters leave little space for continuous medical education, advanced courses or research. Access to opportunities is frequently shaped by informal networks and visibility to senior leaders — where women are structurally disadvantaged due to mobility constraints and domestic responsibilities. 

“Life-stage transitions like maternity leave further reduce exposure and slow re-entry into high-intensity roles,” Nundy added. “The barrier is not ambition. It is whether the system is designed to support women at every stage of their careers.”

The implications extend well beyond individual careers. India already faces a shortage of 700,000-800,000 medical specialists. Retaining women doctors, the report argues, is among the fastest ways to expand capacity — potentially adding 130,000-170,000 doctors back into the system. 

Leadership ladders  

The attrition becomes even sharper at senior levels. While women account for a substantial share of hospital staff, they remain starkly underrepresented in leadership roles — particularly those that feed into chief medical officer or chief executive officer 

positions. 

“A glass ceiling persists in healthcare leadership, visible in how pathways to power are structured,” Nundy said. “Women dominate nursing and HR (human resources) — critical functions for patient care and culture — but these are not the traditional routes to the C-suite.” 

In specialisations such as cardiology, orthopedics, neurology, gastroenterology and oncology, women are a small minority — typically below 10 per cent, even though these disciplines account for over 50 per cent of hospital revenues. “Across several high-demand specialties, women told us that the challenge is not aspiration, but structural hurdles that make progression harder at key transition points,” Rathi said. 

Management and operations follow a similar pattern. Roles where an individual would be responsible for a department’s profits and loss, business development and strategy — key stepping stones to becoming a CEO — have relatively few women. “This is not a capability issue,” Rathi said. “It reflects how exposure, mentorship and early career assignments are distributed.” 

The same dynamics play out in research. Women are no less capable or interested than men, but fewer make it into specialist and faculty roles that anchor research programmes. Long clinical hours, career breaks for maternity, and reliance on informal academic networks further restrict access. 

“There is no evidence that women doctors contribute less to research,” Nundy said. “The issue is continuity and opportunity.” 

Nursing the system 

The leadership gap is even starker among nurses and midwives. Women make up 70-85 per cent of India’s nursing workforce, yet only 15-20 per cent progress to senior leadership roles, according to the report. Chronic staff shortages, high workloads and limited upskilling opportunities push many mid-career nurses out — often to overseas markets offering better pay and conditions. 

“Nurses repeatedly said that the issue is not entering the profession,” Rathi said. “It’s the limited avenues to grow within it.”

Advancing women leaders in healthcare is not just an equity issue. The report points to a “quadruple dividend”. Patient outcomes improve with diverse clinical teams — women patients treated by women cardiologists are two to three times more likely to survive.  

Workforce retention improves, reducing the high costs of churn — replacing a single nurse can cost a hospital up to a year’s salary. Productivity and margins rise, and institutions align more closely with national priorities such as India’s women-led development agenda. 

Emerging exemplars 

Some healthcare businesses are beginning to respond. Max Healthcare, Wockhardt, Dr Agarwal’s and Tata Memorial Centre have introduced structured nursing ladders, modular clinical training, leadership partnerships with management institutes, and targeted mentorship programmes. 

At Max Healthcare, for instance, leadership programmes developed with Indian Institute of Management Kozhikode saw 50-60 per cent participation by women at chief experience officer (CXO-1 and CXO-2) levels. Dr Agarwal’s has partnered with XLRI business school to build management capabilities among operational leaders. 

“These are not isolated initiatives,” Rathi said. “Institutions that built sustained programmes saw a clearer flow of women into CXO-adjacent roles.” 

Crucially, the most effective interventions were shaped by employee feedback, on-site accommodation to reduce commute stress, flexible shift planning for returning mothers, refresher modules after career breaks, and visible safety systems. 

“The most effective enablers were those directly shaped by what women employees said they needed,” Rathi said. 

Gendered redesign 

The message from the research is clear: This is not about asking women to “lean in” harder. It is about redesigning training pathways, leadership pipelines and workplace norms to reflect real life trajectories. 

Hospitals that institutionalise transparent upskilling pathways, support safe mobility, offer flexible rosters, and normalise re-entry after breaks are already seeing results. As private healthcare expands rapidly — adding millions of jobs and thousands of leadership roles — the window to embed these changes is open, but still narrow. 

Vipul Jain, CEO of CK Birla Hospital, said career breaks — often taken for family reasons — do not reflect a lack of professional dedication. Many women head clinical departments at the Delhi-based hospital, he added.  

Through flexible roles, telemedicine, and structured mentorship, hospitals can help returning doctors bridge any gaps in evolving technology or protocols. “Re-entering clinical practice after a break is very much achievable with the right institutional support… We actively support doctors joining after a career break through continuous medical education, focused training programmes, and appropriate clinical mentoring,” Jain said. 

For doctors like Dipali Jaju, the system never quite made space for continuity. Her medical training did not vanish — it simply flowed into other forms of care. The question for India’s healthcare sector is whether it can afford to keep letting so much trained expertise slip quietly out of practice — or whether it will finally build structures that allow women doctors to stay, return and lead.