Excerpt:
We pulled the consultant roster of a leading Indian hospital, well-known, charitable, multiple metros, decades old, and ran the surnames against caste. The institution does not publish anything beyond name, sub-specialty and city. We have anonymised the hospital because the point is structural, not gossip. The pattern here is the pattern at twenty others. What we found will not surprise anyone who has sat in an Indian waiting room, but the numbers are worth tabulating.
The Methodology
This is not a census. It is surname sociology. Indian surnames are imperfect caste signals, especially in Tamil Nadu where initials often suppress jati markers altogether, and elsewhere where regional surnames detach from their origin communities through migration and intermarriage. We are not building a genealogical claim about any individual on the list. We are reading the aggregate. Elite institutional patterns in India are often visible precisely through these imperfect signals: when the noise floor is what it is, a strong signal still tells you something. The exercise is probabilistic, not deterministic, and we have tried to keep the language commensurate with that.
The Numbers
The hospital lists roughly one hundred consultants across multiple cities. About fifty-five to sixty percent carry surnames that are unambiguously Brahmin or upper-caste Hindu by any of the standard heuristics. The South Indian branches are dominated by Tamil Brahmin (Iyer and Iyengar) names. Around it sits a Telugu Niyogi minority (Kaza, Lingam, Koka), a Maharashtrian Brahmin cluster (Bhende, Agarkar, Lagvankar, Mashruwala), and a Punjabi or Sindhi commercial-caste tail (Khurana, Bassi, Bhambhani, Ratra, Verma, Kothari, Agarwal).
The North Indian branches are bhadralok in archetypal form: Mukherjee, Banerjee, Sen, Sengupta, Dutta, Dutta Majumder, Guha, Kundu, Paul, Das, Roy, Chowdhury, Biswas. About twelve Tamil consultants carry only initials, no surname. Initials-based naming is widespread across Tamil communities, not specific to any one jati, but the convention also doubles as a caste-opacity layer in elite Tamil contexts, and the distribution of sub-specialties in this subset is consistent with the rest of the upper-caste pattern.
Pakistan was created so that Muslims too could be elite doctors?
Out of roughly one hundred consultants, three are visibly Muslim. Two of those three are women. Christian representation, almost all Syrian Christian or Tamil Protestant, is slightly higher and concentrated in the female pool. We do not find a single Reddy, Kamma, Naidu, Mudaliar, Chettiar, Vanniyar, Nadar, Gounder, Yadav, Jat or Maratha name in the senior list. In a South Indian institution headquartered in Tamil Nadu, the absence of Mudaliar, Chettiar and Mukkulathor consultants at this scale is unlikely to be random. The North Indian branches have zero Muslim consultants in states that are twenty-plus percent Muslim.
Reservation or no Reservation- Caste is Eternal
The South Indian state runs the most aggressive caste-reservation regime in the union. Sixty-nine percent of seats are reserved, a figure protected under the Ninth Schedule of the Constitution since 1994. The state has pushed reservation deep into private and deemed educational structures for student admissions, often against the grain of central jurisprudence and through prolonged litigation. The mechanism still breaks down at three points. Reservation applies to student seats, not to faculty appointments. It applies most cleanly to MBBS-level intake, not to private super-specialty fellowships. And DNB courses run inside private hospitals are governed in practice by the All India Quota, which strips out state-level reservation. The pipeline to a senior consultant chair in a fellowship-running eye hospital sits, by design and by accretion, outside the reach of Mandal. The roster is what that pipeline produces.
Surnames are probabilistic, not deterministic. We are working from one signal, and one signal can mislead. A Tamil “Rao” is usually Tulu or Kannada Brahmin. A Bengali “Sen” can be Baidya or Kayastha, not strictly Brahmin but securely bhadralok. A Punjabi “Verma” is a different beast from a Hindi-belt “Verma”. A “Patil” is Maratha, not Brahmin. The initials-only Tamil names are the largest single source of uncertainty: most will be Brahmin, the rest forward-caste Tamil. None of this changes the topline. Even if we generously assign every ambiguous name to a non-Brahmin upper-caste bucket, the institution remains a forward-caste preserve. The error bar is narrower than the gap.
Institutional DNA
This category of charitable specialty hospital, founded in decades ago in urban India by a US-returned medical professional, mutt-adjacent or temple-adjacent in governance, did not emerge from the logic of a secular public institution. It functioned as a philanthropic upper-caste professional network that admitted patients of all castes. The patient mix is not the consultant mix and has not historically been treated as a metric. Charity flows outward, employment flows inward.
The sharper comparison is not to government medical colleges but to the IIT and IISc faculty. Prestige sub-specialties in India recruit from the same two or three jatis that already dominate the Indian meritocratic ladder.
Cornea, vitreo-retina, glaucoma and uveitis are the apex of ophthalmology, and the apex is staffed by the same population that staffs theoretical physics at Cambridge, machine learning at Stanford, and the senior IAS in Delhi. The reproduction mechanism is not formal exclusion. It is the compounding of a hundred-year head-start in English-medium schooling, professional networks, marriage circuits, fellowship sponsorship, and the ability to absorb the opportunity cost of a low-paid clinical fellowship in one’s late twenties. Reservation does not touch this stack. Reservation was designed for the bottom of the bottleneck, not the top.
The North Indian Counterfactual
The North Indian state does not have the South Indian reservation regime. It has, in addition, almost no Muslim presence in its elite professional rosters despite the state’s demography. The consultant list is bhadralok of a purity that would have pleased Bipin Chandra Pal. If reservation explained nothing, the South and North Indian rosters would look similar in caste composition. They do, allowing for the substitution of Tamil Brahmin for Bengali Brahmin. Two very different state regimes produce very similar elite outcomes at the consultant tier. The escape valve is structural.
In Conclusion
We are not claiming this hospital is uniquely guilty, nor that its consultants are individually undeserving. The opposite. The senior consultants on this list are, almost certainly, among the most competent ophthalmologists in the country. The point is that competence selection in India operates downstream of a caste filter so dense that while merit is real; the pool it picks from is not.
Maybe Indian elite institutions should publish their faculty caste composition the way American universities publish their faculty demographics? Not because it would fix the problem. Because it would stop the polite fiction that the problem does not exist.
I think this has less to do with caste per se and more to do with occupation of preference.
Yes, there’s an association between the caste marker and profession, but there are other significant variables that act as confounders. These mask the true nature of the relationship between the profession and the caste marker.
Perhaps but it exists
I did a similar experiment for a Los Angeles based hospital (Cedars Sinai). Very white with a smattering of Indians and East Asians. Almost no Hispanic/Black. And this is in a very heavy Hispanic city/state with a sizeable Black population.
I am not denying that structural issues don’t exist but they have to be fixed at the ground level rather than at the top – especially for something like medicine.
Also there has to be an interest too. Reddy, Kamma, Naidu, Mudaliar, Chettiar , Gounder, Jat, Maratha etc are not poor castes. Reddys own lots of pharmaceutical companies in Hyderabad. Maybe they prefer to be on the business side rather than be doctors? A similar analysis of say some real estate venture will prop up another group of surnames.
If you go by the Forbes India’s 100 Richest, you will hardly find Brahmins there and more Lohanas, Baniyas, Parsis etc.
In fact you get four Muslims (two Khojas, one Memon, one Mapilla) before hitting the first Brahmin (Murthy).
https://www.forbes.com/lists/india-billionaires/
The government’s aim should be to provide high class educational facilities at the ground level plus general increase in quality of living. Post that, people can gravitate where they want.
At the end of the day, Bangladeshis and Pakistanis come to India for medical treatment, not the other way around.
Yes, thanks for elaborating 🙂 I got lazy to type more. The occupational preference (generational) among certain castes explains a fair bit of the segregation by castes in specific occupations.
this is eliding the discussion on privilege.
Yes of course, that is there – especially regarding Muslims and Dalits/backward castes.
But it is no guarantee that even if equality is attained, there will be a massive increase in numbers.
As mentioned – a lot of the rich business castes are very privileged but you won’t see them either simply because they are not interested.
that is a different conversation; the landed elite and gentry rarely go into the professions..
At least from what i see in Karnataka and neighboring states, the erstwhile gentry, including muslims, do go into medicine and to some extent law, but yes, not so much into commerce. I don’t find muslims to be all that underrepresented in medicine. Also, muslims are major power players in real estate, horticultural trade and logistics. Bangalore has a very distinct (often shia) muslim high society.
A point to be made for some other day – Shias often do really well in India comparatively whether it is the Khojas, Bohras or the Lucknavi Shias.
I think them being more liberal and more accepting of Hindu practices means they can integrate into the Hindu mainstream easier.
Imo privilege cannot and should not be attributed to caste alone. Socioeconomic class also contributes significantly as does intergenerational family occupation.
Different Indian States have very different dominant castes. In MH, Pune used to be Brahmin dominanted because of the Peshwa legacy. Everywhere else the Marathas are still dominant.
Reservation has unfortunately been reduced to a convenient political tool and continues to be used as a crutch instead of being the equalizer it was envisioned as by Ambedkar. It was also meant to be for a finite number of years.
Finally, a comprehensive survey or census is in order to ascertain the mobility of different castes in terms of socioeconomic progress over a long period of time. The definition of impoverished and backward too needs to be reviewed in the current context.
A cross sectional snapshot will not give a complete picture of trends that are most likely visible only after a couple of generations.
for the love of God, Humza, how does this even related to Bangladeshis and Pakistanis in any which way..
A reply to this – Pakistan was created so that Muslims too could be elite doctors?
While I agree that lack of Indian Muslim representation in medical fields is due to their backwardness, that has to be solved by by improving their socioeconomic indicators and education – maybe more AMU/Jamia type institutes, better schools etc.
You cannot have hard quotas in a hospital.
A lot of the anxiety by the Muslim elite was that they would not be able to compete with the more educated Hindu upper castes and that kind of fed into partition.
But even when they got their own countries where they could become “elite doctors” they could not create an ecosystem where their countrymen would not have to cross the border and be treated by those same “Hindus”.
These are things that have to be fixed bottom up, not top down.
due to their backwardness?
Backwardness as in socioeconomic backwardness.
There is a good chance that the reserved guys are staffed more in govt hospitals and colleges in South india.
This is a fact. There you would hardly find a Brahmin.
XTM did you write this including analyze the data
Yes