Sunday, October 26, 2008

Oh Doctor!




According to the Medical Council of India, the allopathic doctor to patient ratio is 1:1634 (actually is still higher as not all registered physicians practice medicine). The doctor patient ratio actually also varies from case to case; it depends on various factors type of ailment, type of specialization, etc. The doctor patient ratio comes down significantly if one takes into account the other systems of medicines (i.e., Unani, ayurvedic and homeopathic) to 1:870. This doctor to patient ratio does not take into account the relatively more number of doctors in the urban areas, which essentially means the availability of doctors are even less than this pathetically high number in the rural areas.

Globally, the ratio depends on which part of the globe you are. Most of the sub-Saharan African countries have a high number and very low in countries like USA or UK. Cuba has the lowest ratio.

This number definitely needs to improve, more so since we Indians are multiplying at a much faster rate than the medical colleges are churning doctors. According to the MCI website the maximum annual intake for the first year course of MBBS is 31,298 in 289 colleges across the length and breadth of the country. India has a population of roughly 1.3 billion with a growth rate of 1.606% which means the doctor to patient ratio will worsen with time.

This gloomy scenario can be changed, albeit it has to be a continuous process and will take time. The first step obviously would be to increase the number of colleges offering the medical courses. But alas, the governments of India is not taking sufficient steps towards it (be in NDA or UPA).

India boasts of world class engineering colleges i.e., the Indian Institute of Technology. India has 7 IITs that are producing world class engineers and 8 more are coming up, but no such luck for medical colleges. India does not have any such medical colleges in the lines of IITs or IIMs. Although common sense says health should be of higher priority than engineering, the Indian think tank perhaps thinks otherwise. So the first step according to me should be setting up of more AIIMS in the lines of the IITs and IIMs.

There are many doctors (holding MBBS degree) who pass out from government colleges (hence subsidized fees) and take up professions other than medicine, i.e., IAS/IFS. This practice should be discouraged by having a bond at the beginning of the course (MBBS) of compulsory medical practice (for a minimum of 5 years or more) or payment of full course fee (the subsidy amount).

In USA, there is a concept of physician assistant. Physician assistants’ practice medicine under the supervision of physicians and surgeons and in rural areas independently. PAs are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and x-rays, and make diagnoses. They also treat minor injuries, by suturing, splinting, and casting. Physician assistant education programs usually last at least 2 years and is full time. Then there are the nurse practitioners who are nothing but registered nurse who has completed masters in nursing and training in the diagnosis and management of medical conditions.

The concept of PA is somewhat similar to what we have in engineering, certificate (ITI) or diploma engineers. If a system similar to PA is encouraged, the number of practitioners can increase in a short period of time and many an Indians would be saved from the hands of quacks who are flourishing in the country side (even the national capital of Delhi has a thriving number of quacks, especially in the areas of Shahpur jat, Madangir, Tughlaquabad).

These steps could help in bringing the doctor patient ratio to saner levels and thus ensure that Indians do not die as they are today without treatment.

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