The Wire, through excellent fact-based reporting, highlighted recently the issue of faculty resignations from AIIMS institutions over the past few years. The immediate reaction upon reading the report is that this is a “bad thing” that reflects a crisis plaguing these institutions.

While no institution should lose talent and any form of mass exodus could represent a genuine crisis, a more nuanced case could be made about how faculty mobility can benefit academic medical institutions and should be encouraged. But it does require systemic reforms.

What is not clear from the report is the eventual destination of the faculty members who left AIIMS, and whether the posts that fall vacant get filled by suitable replacements.

Faculty movement between universities and across sectors could represent a natural flow of career development rather than an institutional crisis. In the West, academic physicians routinely transition between not only institutions but also academia and industry. For example, a cardiologist might spend years at Harvard Medical School, move to a biotech startup to develop therapeutics and return to academic medicine at Stanford with valuable industry experience. This bidirectional mobility strengthens both sectors through knowledge transfer and nurtures professional networks, and is encouraged and celebrated. European universities have formalized staff mobility programs where faculty members spend structured periods at partner institutions overseas, which increases international cooperation.

Faculty turnover provides opportunities for benefits to both the individual and the organization. It creates space for fresh perspectives and brings new expertise, updated clinical protocols, surgical skills, new research ideas and approaches, and education methodologies and technological fluency. This circulation prevents institutional stagnation and keeps teaching hospitals abreast of medical advances.

Faculty departures also establish collaborative bridges between institutions. A doctor moving from AIIMS Delhi to a private hospital can facilitate research partnerships and knowledge sharing that would not exist otherwise. This professional mobility could strengthen the overall healthcare research network rather than weaken individual institutions.

In contrast, Indian medical academia's rigid employment structures have created artificial barriers preventing the natural circulation of talent. There is no system of such transfers across sectors in India; rather, working with industry is considered retrogressive. The only exception is the possibility of five years' sabbatical leave (two years at a time). This, even though a 2006 expert group on strengthening academia-industry interface – set up by the Planning Commission and chaired by the then director of CSIR, Dr. R.S. Mashelkar – made several recommendations for facilitating such collaboration.

Finally, not all turnover represents institutional failure. It may reflect natural sorting where doctors find better fits for their skills and career goals. Faculty who leave for misaligned expectations or inadequate mentorship create space for more motivated, better-suited academics. From my personal experience at one such institution, I can say that most colleagues who left for opportunities elsewhere weren't fully engaged or productive in their roles.

While departures attract the most attention, the real crisis is when posts remain vacant, leading to institutional weakening, compromised quality and range of patient care services, disrupted teaching and reduced mentorship ratios and research output. Collaborations become harder to sustain without adequate faculty strength.

The rigidity problem

The faculty exodus reflects structural problems that limit the positive mobility aspects. The current faculty recruitment and promotion system follows entry at the junior-most (assistant professor) level and time-based progression, guaranteeing advancement regardless of performance. Such a system creates frustration among high-performers while protecting underperformers, driving away capable academics. Lateral entry, which allows the recruitment of professionals with experience and unique skill sets at senior levels, is theoretically possible. However, it hardly ever occurs, unlike in international systems, where accomplished clinicians or researchers join as professors or department chairs/heads.

Since 2019, the National Medical Commission has allowed medical colleges to appoint private doctors as “visiting faculty”. The provision is poorly utilized, however. Moreover, this does not apply to institutions such as AIIMS and PGIMER.  These barriers prevent knowledge transfer between academia and the private sector. Unlike universities in the West, Indian institutions do not permit fractional appointment models that allow professionals to split time between clinical practice and academic roles or joint appointments with independent research organizations.

So far as the newer AIIMS are concerned, the shortage of faculty in many of them is real. These institutions will take a decade or longer to mature and attract talented faculty. Filling positions by recruiting faculty who have superannuated elsewhere and by extending the retirement age to 70 years represent a band-aid, rather than a future-focused, solution. Investments in human resources should align with long-term strategic thinking about India's healthcare future and creating permanent assets that will serve communities for generations.

Crisis to opportunity

Addressing these institutional rigidities could transform faculty turnover from being a crisis into healthy talent circulation. The current assured promotion systems that reward people for serving time should be modified to attract high-achieving professionals wanting recognition for excellence. Opening senior positions to external candidates would bring experienced professionals with fresh perspectives -- both from other academic institutions as well as the private sector -- into academic medicine. This is not to minimise the value of steady contributors who should have job security and a defined career progression pathway.

Institutions should experiment with competitive salary packages that consider private sector alternatives (such as including flexible components), particularly for high-demand specialties. Visiting faculty programs that allow generous external participation should be established rather than the current restrictive limits.

Utilizing fractional and joint appointments would allow institutions to access broader talent pools without requiring full-time commitments, enabling private practitioners to contribute while maintaining their own practices. All institutions should have a systematic “sister center” and “education/research ambassador” faculty exchange with partner institutions. Sabbatical programs should be made available to early-career faculty and their duration should be made more flexible.

Institutions should implement effective faculty career development programs tailored to the needs of their faculty, encompassing scholarly development, teaching excellence, clinical skill enhancement, and leadership competencies. Institutions with effective faculty development programs see a reduction in departure likelihood and significantly higher promotion rates. This can only happen in an environment that supports research and professional development and fosters a positive work environment.

Institutes should monitor their performance through regular faculty satisfaction surveys and honest exit interviews. Speaking from experience again, I cannot emphasize enough the importance of mentorship and strong peer networks, as well as the lifelong learning opportunities they provide.

AIIMS institutions have a unique opportunity to develop networked programs across institutions that enable faculty exchanges, shared expertise, and resource optimization. Different institutions could create centres of excellence in specialised areas -- one at Raipur, another at Jodhpur, a third at Madurai, and so on.

A long-standing neglected area is professional research support systems that provide the infrastructure, expertise, and administrative framework necessary to facilitate high-quality research. These systems manage statistics, support grants, ethics review, and central laboratory facilities, as well as data management platforms. Effective research support enables faculty to focus on scientific inquiry rather than administrative burden.

All this can happen only in an environment that celebrates innovation and measured risk-taking. Institutions should recognize diverse career contributions beyond traditional academic metrics and create communities of practice that support collaborative learning across institutions.

Reform efforts should focus on creating flexible, merit-based systems enabling productive turnover rather than simply preventing all departures. Institutions do need to address retention challenges, but recognizing potential benefits of strategic faculty mobility could guide more effective solutions that strengthen rather than merely preserve the current system.

Vivekanand Jha is the executive director of the George Institute for Global Health India and the chair of Global Kidney Health at Imperial College, London.

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