I think discussions about doctors’ salaries in Sri Lanka by Sri Lankan doctors are more emotional rather than realistic since they often ignore the most basic economic reality. The government is the main employer of doctors because the average Sri Lankan simply cannot afford globally priced healthcare through the private market. Modern healthcare is extremely expensive due to technology, drugs, and hospital infrastructure, and if healthcare were left mainly to private providers, a large part of the population would not be able to access treatment at all. That is why the state has to remain the main service provider, and naturally, it becomes the main employer of doctors.
Because of this, I don’t think doctors’ salaries in Sri Lanka are really determined by free market forces. They are mainly determined by government budgets and public-sector salary structures. Some people say doctors can always move fully into the private sector, but in reality I don’t see strong competition among employers for medical talent here. The private health sector is small, patient purchasing power is limited, and most private hospitals can operate by using government doctors part-time instead of offering high-paid full-time jobs. Since hospitals are not aggressively competing to attract doctors away from government service, there is no strong pressure to push salaries much higher.
Another thing I think we need to be honest about is the country’s financial situation. Free healthcare means salaries are paid from tax money, not from service charges or insurance systems. Sri Lanka has a weak tax base and very high debt, so expecting large and permanent salary increases in any public sector profession seems unrealistic to me. Governments are forced to choose between keeping hospitals running and raising wages, and they usually prioritize keeping services available to everyone, even if that means salaries remain lower than what professionals can earn abroad.
I also feel that proposals like putting doctors under a separate medical service, as suggested by the GMOA, may help with professional independence, but they won’t fix the main problem. Simply changing the administrative structure does not create new money. (At least it will be a start. But forcing the government to implement it in a hurry could be disastrous. The current wave of TA action is really unfair and politically driven IMO.) As long as healthcare is mainly funded by general taxation, I don’t see how salaries can increase significantly without cutting services or increasing taxes somewhere else.
Personally, I think if doctors truly want salaries closer to international private-sector levels, then the whole system has to change. That would mean more public–private partnerships, wider use of health insurance, and some level of cost sharing by patients who can afford it. But that also means moving away from the idea of almost completely free healthcare. In my view, we can’t realistically expect both near-free universal healthcare and first-world level salaries in a country that is still struggling economically.
I’m not saying doctors don’t deserve better pay, it’s quite the opposite — they absolutely work under very tough conditions and wrt to all other professionals in both state and private sector, doctors are the most hardworking professionals (on average) I have seen in Sri Lanka. But I think the debate should be about whether Sri Lanka is ready to change how healthcare is financed, not just about salary scales within the existing system or in a new system. Without structural reform, I feel we will keep having the same argument again and again, because the economic setup itself does not support what is being demanded.
#GMOA #SLHealthCare