How many medical graduates do we need to produce to meet the health care needs of India’s 1.4 billion people?
While the Covid pandemic has put a spotlight on health systems in general, the war crisis in Ukraine has put a spotlight on the state of medical education in India. Nearly 90,000 allopathy medical students graduate annually from approximately 595 medical colleges, and an additional 53,000 AYUSH medical students graduate from approximately 733 AYUSH colleges. According to the statement made in Lok Sabha by the Union Minister of State for Health and Family Welfare in July 2021, there are 12.68 registered allopathic physicians and 5.65 lakh AYUSH in India. In addition, students educated at overseas medical schools are allowed to practice after passing the Medical Graduate Examination Abroad (FMGE) held by the National Examinations Board (NBE). The number of students appearing on the FMGE has been increasing over the years. Many state governments have recently announced the establishment of new medical schools in each district.
The WHO recommends a minimum of 1 doctor per 1000 people. To meet this, India needs about 14,000 doctors. The WHO does not specify whether officially qualified AYUSH physicians practicing alternative systems of medicine should be counted in the assessment. Given the above statistics, we are apparently approaching the benchmark if we were to count only allopathic physicians. However, we do not have accurate data on annual turnover due to retirement, migration, career change and death to estimate the number of new graduates needed to replace the loss. Additionally, the revolution we are witnessing in digital health, particularly in the area of telemedicine, clinical decision support systems, self-care applications and AI, could change the equation. Dr Krishna Reddy Nallamalla President, In order, Regional Director, South Asia, ACCESS Health International
The problem is not in the numbers. It’s in the distribution of doctors!
Although we seem to be close to the desired numbers, they are not distributed according to the needs of the population in terms of geography and specialization. While two-thirds of the population still live in villages, two-thirds of doctors live in cities, leading to mismatches between supply and demand. As people seek specialists for their needs, their number is not proportional to the disease burden of the population. Mobile clinics, telemedicine, increased road connectivity, etc. are partly bridging the gap in the villages. But telemedicine cannot replace a real doctor who speaks and touches a patient! Systematically assessing the gap between supply and demand for specialists is necessary to plan places in specialty courses.
There is a great concern for quality
While medical schools adhere to the standards set by the national medical board on paper, the quality of students coming out in terms of knowledge and skills is not uniform. Standards have evolved in terms of simulation labs, teaching privileges for visiting professors, online courses, and teaching methods. Competency-based curricula are being developed. However, exposure to a range of clinical cases, diagnostics and therapeutic technologies continues to pose challenges. The flexibility of clinical rotations could solve this problem.
Just as the Common Entrance Examination – NEET, is designed to ensure common standards across the country, the proposed Common Exit Examination called NEXT, can bring uniformity in the standards of outgoing students across the country. However, some states have begun to oppose NEETs in the name of federalism and state freedom. Since we don’t have a separate state-level license to practice medicine, it makes sense to have state-level entrance and exit exams. While the above ensures quality at the output level, how to maintain competence in the face of rapid advances in medical science. Unlike some developed countries, India does not have a system of compulsory Continuing Medical Education (CME) credits and license renewal exam every 10 years to maintain competence.
Medical education is fundamental to strong and resilient health systems.
Medical training must prepare the student for the most complex and dynamic health systems. In addition to traditionally focusing on the medical sciences, a student today should be knowledgeable in health systems, health management, public health, health informatics, health economics, health policy, health regulation, health care purchasing, behavioral science, etc. trained to the highest level of professionalism in terms of medical ethics, compassion, patient-centeredness, fairness and human dignity.
The supply of health professionals must be planned according to the health needs of the emerging population, advances in medical and digital technologies and the aging of the population. Curricula should be designed to prepare the student for complex health systems and integrated, patient-centered, values-based care. Standards must be consistent with changing learning methods and tools. Quality should be ensured through high standards in entrance and exit examinations, licensing and license renewal methods. The planned National Register of Health Professionals will help plan the supply of graduates and medical graduates. In addition, the growing gap between supply and demand around the world is a strong argument in favor of saving the labor of health workers.