On 2 January, the Indian Medical Association (IMA)—its ranks made up of over 300,000 doctors—stood up to the government of India. It demanded that the government walk back its decision to dissolve the medical education regulator Medical Council of India (MCI) for the third time in September 2018.

At the heart of this stand-off is one inescapable truth: India lacks specialist doctors. While India does need more doctors than it has, its need for specialists is even severe. In India, only 1,494 primary healthcare centres out of 25,743 are without doctors. Around 6%. When it comes to specialists like surgeons, physicians, paediatricians, and obstetrician-gynaecologists at the community level, however, there is a shortfall of 18,422 positions out of a total of 22,496. Around 82%. A worrying statistic, especially given that specialists are the ones who can reduce infant and maternal mortality to meet international development targets.

This makes specialists—who not only completed their expensive and gruelling four-year-long course to become allopathic doctors but went the extra mile of becoming specialists through a post graduation course—a valuable and precious commodity.

As one 24-year-old medical officer puts it: The life of a resident doctor in a hospital seems extremely different from the one of a postgraduate specialist. Doctors are not treated with the same level of respect as a specialist even if they are sometimes doing the same task. Their clinical judgement does not carry as much weight, she feels. And they are tossed around from one department to another, unlike specialists who are assigned a field and a department. In addition, specialists’ salaries in most private hospitals are double those of resident doctors. The discrepancy between doctors and specialists is on account of the availability of each.

Everyone—the government, hospitals, and medical associations—agree that the country needs to produce more specialists. The reason it’s still a problem despite the consensus, with the number of graduate seats being double that of postgraduate seats, is that all of them have conflicting approaches on how to go about training more specialists.

Health scarce

As of 30 September 2017, India’s doctor-population ratio was 1:1596. The World Health Organization recommends a ratio of 1:1000


Which brings us to the events surrounding IMA’s 2 January protests.

In September last year, having dissolved the medical education regulator, the government instituted a Board of Governors (BoG) to run the MCI. Passed through an ordinance, the BoG is a clever and temporary alternative to the National Medical Commission (NMC) Bill, which the government shelved after it was opposed by doctors.

AUTHOR

Ruhi Kandhari

Ruhi writes on the impact of healthcare policies, trends in the healthcare sector and developments on the implementation of Electronic Health Records in India. She has an M. Sc. in Development Studies from the London School of Economics.

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