Healthcare leaders hail govt’s pathbreaking reforms in higher medical education

New Delhi: On 6 August 2020, a Gazette notification by the Ministry of Health and Family Welfare introduced post-graduate diploma courses in eight medical specialties under the prestigious National Board of Examinations. These are two-year courses that can be undertaken after completing the MBBS degree. According to the regulations, these structured training programs can be run by any well-equipped public or private hospital with over 100 beds and staffed with senior medical specialists. The regulatory change brought about by this notification will transform healthcare in India, making ours the first nation in the world to dissociate healthcare from affluence.

Why do we need more post-graduate seats?

Every year, approximately 1,70,000 doctors write the NEET post-graduate exam to apply for about 50,000 post-graduate seats under the Medical Council of India and the National Board of Examinations (this includes 15,000 non-clinical seats). This means that, annually, the remaining 1,20,000 doctors who do not get one of these seats will not return to clinical work. They may waste two to five years attending coaching classes in Kerala or Kota and in the end, some even give up on becoming doctors. Adding a few thousand seats in post-graduate diploma courses will immediately bring these doctors back to patient care in accredited government or private hospitals. It also gives them the option to apply for an MD or MS seat after completion of the course. It is an attractive alternative for bright young doctors from poor families, because the diploma course is available at a nominal cost, and they earn a stipend during the program which can be used to support their families.

What kind of specialists are we lacking?

Even though women and children comprise 60% of the population, India has one of the worst maternal and infant mortality rates in the world. We need gynaecologists, paediatricians, family physicians, anaesthesiologists, and radiologists to take care of women’s and children’s health. Most public hospitals, especially in tier 2 and tier 3 towns, suffer an 80% shortage in the availability of these medical specialists. If those hospitals introduce diploma training courses in all these specialities, the shortfall of medical specialists can be completely made up in two to four years.

Diploma in Obstetrics and Gynaecology: In India, a woman dies during childbirth every 20 minutes. We need to perform at least 4.2 million cesarean sections every year for 24 million pregnant women, and this requires at least 2,00,000 gynecologists. But we have only about 40,000 practicing gynecologists, of which a significant number of them do not practice obstetrics, and most of whom live in big cities. With the diploma, this huge shortfall can be bridged in a short period of time, dramatically reducing maternal mortality.

Diploma in Paediatrics:  Every year, thousands of infants die in hospital ICUs across India, with the scale of these recurring tragedies capturing national media attention. The 24 million babies born every year have only about 24,000 pediatricians to take care of them. This course will quickly and efficiently produce passionate doctors trained to manage new born babies on ventilators in the ICU, thus helping to reduce our infant mortality rate.

Diploma in Anaesthesiology: No surgeries can be done without anaesthesiologists. However, we have only 30,000 practicing anesthesiologists available for the 65 million surgeries needed annually. Of these, only 26 million surgeries can be performed, while the rest slowly perish and become statistics. The shortage of anaesthesiologists in rural India is the primary cause of this calamity. Critical Care is the country’s fastest-growing health care requirement, and this department is managed by anesthesiologists. Unless we produce enough anaesthesiologists, there cannot be critical care units. During this time of the coronavirus, they are the true “corona warriors” because their expertise is required to manage COVID patients on ventilators.

Diploma in Tuberculosis and Chest Disease: Pulmonologists are primarily involved in treating the diseases of lungs, and they are at the forefront of the COVID pandemic. India is the respiratory disease capital of the world, with millions of Indians suffering from tuberculosis, pneumonia, and asthma. These numbers are increasing in a post-COVID world, and there are less than 3000 pulmonologists in the country. With the launch of this diploma, we can produce thousands of specialists to fill the gap in a short period of time.

Diploma in Radio-Diagnosis: No major procedure can be performed on the human body without a scan, and this scan needs to be seen by a radiologist. For example, thousands of pregnant women have foetal abnormalities that go undetected because they have not been seen by a radiologist. Unfortunately, India has only about 11,000 radiologists. This course is a vital requirement, especially in rural India where the shortage is even more acute.

Diploma in Family Medicine, Diploma in Ophthalmology and Diploma in ENT: 

These Diplomas will make an impactful difference in the shortfall of doctors in these specialties, especially in rural India. No large and busy hospital today can function efficiently without post-graduate students managing patient care. These youngsters are at the frontline, taking care of sick patients with guidance from their seniors. When taluk and district hospitals become vibrant post-graduate training institutions attracting passionate young doctors, the quality of healthcare in small towns will undergo a dramatic transformation.