Most people believe that the reason for the sorry state of affairs in Indian healthcare today is the paucity of doctors. The standard impression is that there are too many patients and not enough doctors. So the standard knee-jerk response is to create more medical colleges, and churn more doctors. However, just creating more medical graduate doctors doesn’t solve the problem – it actually exacerbates it! The real issue today is not the number – it’s how they are trained and how they are distributed. The bigger problem is that these doctors will end up providing poor quality care, and make a bad situation even worse. People also forget that a major problem that plagues medi-care today is that of supply-induced demand. Thus, each doctor will create more work to keep himself busy – often by ordering more tests, and offering increasingly expensive treatment options. A far better question is – how do we make sure that patients have access to good medi-care? The answer to that is not creating more doctors. Our focus needs to be on preserving health and making better use of existing medical facilities, rather than worrying about doctor/patient ratios. Doctors need to go to where the patients are – and this is best done digitally! Not allowing people to fall sick or to prevent a mindset of sickness can be a game changer. Keeping people healthy is not a doctor’s job. This requires strengthening of infrastructure, effort of men in power, as well as education in health and wellness as a part of curriculum.
Shortage of medical teachers
Health minister recently told the parliament that hundreds of posts are lying vacant in top government hospitals including AIIMS. If the huge surplus of doctors in urban areas does not result in filling up these posts even in the Capital, obviously, adding to this surplus is not the solution. The low rate of joining could be due to poor working conditions or inadequate professional incentives. The shortage is more acute for doctors willing to work in the rural areas where almost 70% of Indians live, or one who will work in government hospitals. Increasing medical seats in medical colleges can’t help address this shortage. Will city kids trained in technology-intensive settings and metropolitan tertiary care centres ever work in rural areas? Will these doctors understand the health problems of the rural populace? These questions appear to be ignored in the rush to open private medical colleges. Similarly, churning out doctors from government colleges, training them in urban tertiary care centers is unlikely to address the acute rural shortage. Will such a doctor assume the role of health teacher and act as friend philosopher and guide instead of a medicine giver. The role of premier institutes like PGI/AIIMS should be to train faculty for the existing medical colleges and re-train the specialists in the4 field who suffer from inertia.
In India, self-styled doctors without formal training provide up to 75% of primary medical care. “We get very sick babies because most parents seek local remedies and treatment from quacks/sadhus before they bring their children to hospital. We can’t turn anyone away so you’ll often find two to three babies on one bed or two babies in one incubator.
“Strengthening primary healthcare hasn’t got the priority it needs and the sick reach hospitals after faith-healers, quacks and other unqualified practitioners fail to cure them,” said Sujatha Rao, former health secretary, Union Ministry of Health. India keeps announcing new AIIMS-like institutes in states, but where is the faculty to train these medical students? Setting up a building and buying equipment is wastage of scarce national resource. You need trained doctors to teach and provide care.
Whither medical education
Recent studies and reports have cast serious doubts on the quality and ethics of the country’s vast medical schooling system. Long-standing suspicion is that for many private colleges in the country, medical education is just a business. “One out of every six of the country’s medical schools has been accused of cheating, according to Indian government records and court filings.” In a country with the world’s heaviest patient burden, and highest rates of death from treatable diseases like diarrhea, tuberculosis, and pneumonia, corruption at medical schools is an extremely pressing issue. The Indian Medical Association estimates that nearly half of those practicing medicine in the country do not have any formal training, but that many of those who claim to be qualified may actually not be. The 2011 court case against a man was one of the earlier indications of the massive levels of fraud. He brazenly admitted to issuing more than 50,000 fake medical degrees at around $100 a piece from his home, saying that he was doing it in service to the country that desperately needs more doctors. British Medical Journal found that many private medical colleges charged “capitation” fees, which are essentially compulsory donations required for admission. “Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson’s choice – either pay capitation to secure admission at a college or give up on the dream of a medical degree.” This gives rise to a vicious cycle. These medical students who pay heavy capitation fee for admissions and are ill trained do not become skilled or ethical doctors. They have no interest in the affordability of medical treatment by the masses. They pursue their career to recover the cost and earn profit, as a business model.
Saying briefly, doctors have to don the role of health and wellness teachers. They have to be friends, philosophers and guides and not just medicine givers.