Family medicine in India is on the up. There is an infectious enthusiasm for training, especially amongst the bright, young doctors who are taking up family medicine as a career. November 2015 saw the second national Family Medicine and Primary Care conference in New Delhi. It was attended by over 600 participants and organised by the Academy of Family Physicians of India, a nascent organisation growing in both confidence and influence under the leadership of its President, Dr Raman Kumar. Clinical education sessions and research presentations jostled with sessions from policy makers, educators and international speakers, attesting to the organisation’s impact.
Bipin Batra, a radiologist, and Executive Director of the National Board of Examinations has co-authored the paper we feature on page xxx of this issue and recognises that family medicine training is an important part of the solution to the help create a health care system more relevant to the needs of India. The Indian Government aspires to Universal Health Coverage yet this will be unworkable without an expansion in primary care even if the increase in healthcare spend from 1.2 to 2.4% GDP, promised by the 2013 Planning Commission, materialises. Batra’s challenge is how to deliver the numbers of family physicians necessary, given the relative lack of both undergraduate and postgraduate education and training. Since 1983 family medicine has been recognised as a specialty with its own postgraduate three year Diplomate programme from the National Board of Examinations but, despite this, it boasts only 192 training positions, 0.7% of the total; pitifully low for the numbers required to address the healthcare needs of a populations of 1.252 billion.
In his presentation to the conference, Professor Batra drew attention to the problem. With 380 medical colleges, the highest of any country in the world, India should be more than self-sufficient with an additional million additional doctors by 2030.
Most proponents of Indian healthcare education reform recognise that primary healthcare is the backbone of the healthcare system. The Prime Minister’s National Knowledge Commission, the National Rural Health Mission task force on human resource development, and the Planning Commission’s Steering Committee on Health are agreed on one point: India needs to produce 15,000 trained family medicine specialists per year by 2030. In 2013 the then Health Secretary Keshav Desiraju, also present at the conference and speaking eloquently on the problem, wrote to State governments asking them to start MD/DNB programmes in family medicine in all colleges. But as long ago as 2002 National Health Policy envisaged a progressive increase in family medicine MD positions until they represented a quarter of the total. If this had been implemented, by now there would be more than 6000 such training posts. The actual number in 2015, is two.
There is a significant lack of role models for aspiring family physicians. The regulatory body, the Medical Council of India, contains no representative from family medicine among its 102 Council members. The DNB in Family Medicine faced regulatory challenges in 2006 with a new set of rules aimed at expansion of the programme and initially this worked contrary to the placement of family medicine programme amongst other clinical disciplines. Since streamlining in 2010 there has been a surge in demand for pursuing Family Medicine however, but whereas specialist doctors who have a postgraduate qualification can become faculty in medical colleges, this does not apply to graduates with the DNB Family Medicine. The lack of availability of Fellowships and advanced training options for family medicine graduates and lack of defined positions in state funded jobs are two major challenges identified by aspirants to the programme.
However, despite the invisibility of generalists as faculty and lack of exposure to the primary care setting for both medical students and postgraduates the growth in interest in family medicine is creating a palpable and audible buzz in India. Education for Primary Care would welcome further papers on this topic.
Values Based Healthcare Education, Institute of Health and Society, University of Worcester, Worcester, UK
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