Shortage of Specialists crippling India’s Healthcare

By Dr Dharminder Nagar

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In 2016, India ranked a lowly 145 among 195 nations on a global healthcare access and quality (HAQ) index created by the Global Burden of Disease study. The index analyzes accessibility of treatment on 32 causes of death considered preventable with effective medical care. It ranks Bangladesh, Sri Lanka and Bhutan higher than India. Even the sub-Saharan nations of Sudan and Equatorial Guinea are ranked higher.

Shortage of doctors and specialists continues to be a major concern as far as India’s healthcare system is concerned. According to Statistics of the Ministry of Health & Family Welfare, around eight percent of the Primary Health Centres (PHCs) across rural India were running without a doctor in 2014-15. At the same time, the Community Health Centres (CHCs) faced a whopping 81% shortage of specialists. In some states and Union Territories, there is not even a single specialist practicing in public healthcare sector.

India has a dismal doctor patient ratio of 0.62:1000, implying is less than one doctor for 1,000 people. A study found that there was just one government doctor catering to 10,189 people. In some of India’s poorest states, this ratio is even more pathetic. In Bihar, one doctor caters to roughly 28,391 people; in Jharkhand the ratio stands at 1: 18518 while in Uttar Pradesh it is 1: 19962.

The recent proposal of Union Health Ministry to scrap NEET PG and allow admissions to PG on basis on a national MBBS final exam (NEXT) is a good move in the direction of reforming medical education. It will not only reduce unnecessary burden from medical students but will also streamline the process. Currently post MBBS, students start practicing as junior doctors in hospitals which is a strenuous job. At the same time, they are also preparing for PG entrance exams, and this puts them under excessive stress. The national MBBS final exam has also been proposed to be sufficient for acquiring a license to practice, unlike previously when doctors needed to clear a separate exam for a license. 

Instead of preparing for these medical exams, one should focus on adding skills around medical treatments, usage of medicines and right line of treatment.

Removing this plethora of exams and replacing them by one national test will tremendously help improve the working conditions of doctors.

More Focus Points:

Specialists in short supply

An extreme shortage of specialists is another major roadblock in ensuring accessibility of treatment to all people. Take any specialty, shortage is the story. Be it, pulmonologists, neurologists, nephrologists or general surgeons, India has a perpetual short supply of specialists. In a country which is increasingly being referred to as the heart disease capital of the world, there are a paltry 4,000 cardiologists, when what we require is 88,000. For a nation where more than 25% of all deaths occur due to cardiovascular disease, this is an unforgivable situation. Even as child mortality remains a major concern, we have an estimated 23,000 pediatricians only when the number should ideally be 2, 30,000. India has only 650 specialists in Endocrinology at a time when over 70 million of its people have diabetes. More worrisomely, most of the existing specialists are concentrated in urban areas, leaving a vast majority of the Indian population deprived of treatment for preventable diseases. It must be underlined that MBBS doctors cannot treat all life-threatening conditions which need specialist care.

Increase Post Graduate seats urgently

At present, there are 479 total medical colleges in the country in both government and private domains. The aggregate annual admission capacity in these colleges stands at around 67,352 MBBS and 31,415 PG seats. Apart from this, there are 6,848 DNB seats which are equivalent to MD/MS. When a country of 1.25 billion people produces less than 50,000 specialists a year, it makes a mockery of its target of achieving universal healthcare. There are a meagre 315 PG seats in cardiology against an estimated need for 3,375 seats. In nephrology, there are around 120 PG seats in total across the country when we need to produce more than 2,000 kidney specialist every year. Only 78 PG seats are available in endocrinology against a requirement of nearly 28,000. What is worse is the fact that a significant number of these doctors leave the country for foreign shores, leaving us with an even shorter supply.

The urgent requirement of the time is to not just increase the number of MBBS seats but simultaneously augment Post Graduate seats as well. The government has already announced plans to double MBBS seats and add 80,000 PG medical seats by 2024 with participation of private healthcare providers. In fact, through amendments in ‘Post Graduation Medical Education Regulations 2000’ recently, the Medical Council of India has changed the required ratio of PG teachers to students which will open up around 5,000 new PG and 250 super-specialty seats by the next academic year. These are welcome steps.

The Ministry of Health must now work to convert at least 100 district hospitals in India to medical colleges over the next 10 years with sufficient allocation for PG seats in all these colleges. It is also important that the hospitals chosen to be converted into medical colleges must be located in under-served areas. Understandably, this would require significant expenditure from the government. However, this is more an issue of political will than of availability of resources. A whopping 10.6% of the total amount in the last budget was allocated to defense while healthcare got a paltry 2.2 %. The paucity of funds share for healthcare is less a matter of resource crisis and more a matter of misplaced priorities. The government must find ways to fund a healthcare overhaul.

Relax norms for setting up private medical colleges

Even as the government pushes through the bill to replace the tainted Medical Council of India with a new body called National Medical Council, it must ensure that the lopsided past-era laws governing medical education must also be done away with to allow private players to establish more medical colleges.

The government must do away with the strict land area requirement that necessitates a 10-acre campus and a 25 lakh population (of the place) for establishing a medical college. Instead, the criteria should be based on the number of beds and the available infrastructure. Similarly, the provision to require a medical college to be run by a trust or a society must be done away with to allow individual entrepreneurs and private organizations to start medical colleges and institutes. Of courses, all these institutions must be subjected to a uniform quality control and rating mechanism to ensure the best education providers are rated as the most desirable.

Author: Dr Dharminder Nagar, MD, Paras Healthcare