PMJAY: continuous upskilling of docs

Shortage of doctors is a major contributor to the ailing healthcare system in India. While we are aware that India has a shortage of allopathic doctors, with only one doctor per 1,597, the ratio of specialists to generalists is even less favourable, when compared to developed countries. The total yearly input for MBBS is 60,600 whereas for MD/MS/diplomas it is 30,253 and for super-specialties such as DM cardiology or MCH cardiothoracic surgery, the yearly input is only 2,771.

With the introduction of the Centre’s Ayushman Bharat insurance scheme, the burden on healthcare is only expected to rise. In covering 50 crore households or 500 million people, healthcare not just needs to become more accessible but more efficient in diagnosing and treating patients with a strong primary care system in place.

In India, people who have access to healthcare reach super-specialists for treatment of basic ailments which can be addressed even by a good primary care doctor. This puts unnecessary load on the already scarce specialist’s resources. The primary care system should be strengthened such that they are capable of doing the initial assessment, diagnosis and basic management and appropriate referral if need be.

The key for strengthening the primary care system includes continuously re-educating and upgrading the skills of its existing doctors with latest guidelines, investigation and management protocols.

The hurdle from patients’ side is lack of trust in primary care doctors which comes from a perceived lack of adequate capabilities to tackle chronic health conditions. Continuing Medical Education (CME) helps to improve the competence and skills of the primary care provider and plays a key role in building the patient’s trust in the primary care system.

Medical training is likely to get outdated over a period of time. Hence, the Indian medical associations have long emphasised on the need for doctors to get continuing medical education to keep them aware of the latest developments in the field of drugs, equipment and medical practices.

In the recent past, several cases have been reported where doctors were still recommending single or double anti-retroviral for HIV/AIDS patients instead of triple combinations which are standard. This knowledge gap, a major hazard for the healthcare system, arises when excessively busy doctors fail to keep abreast of the latest developments in the fields. This is particularly relevant for doctors operating in smaller towns or rural areas who find it difficult to step out of their remote areas on a regular basis to stay connected with the medical fraternity.

Role of medical councils

The Medical Council of India has been working to promote Continuing Medical Education since 1985. Various medical councils have followed the western model of enacting punitive measures such as not renewing licenses of doctors who do not adhere to CME requirements. The practice has been adopted by various medical councils such as Maharashtra, Karnataka, Andhra Pradesh, etc by making CME credit hours compulsory for renewing licenses.

Given that health is a state subject, the role of state governments in advancing the cause of re-skilling health professionals becomes all the more important keeping in view poor rural infrastructure and inadequate proficiency in the primary health system. It is up to the government to adopt a carrot and stick approach to motivate doctors to sign up to CME.

A nationwide law to make CME mandatory can benefit a great deal in this regard. The government doctors can also be given points in their promotion criteria for upgrading their skills continuously through CMEs.

With the advancement in information and communication technologies, getting CME has become a far easier task for the doctors. A doctor sitting in a PHC at a remote place in India can easily access latest medical tutorials using his smartphone or desktop all without leaving his workplace and wasting time on travel. He can access videos and lectures by top experts from across the country on a various specialties based on his interest. This system will prove to be a boon for doctors associated with rural healthcare setup as they are the first point of contact for the community.

(The writer is CEO, Omnicuris)