Family Medicine in India
Family Medicine in India!
Is Family Medicine new to India?
Family Practice/ General Practice is the oldest form medical practice in India. Even today it is the main modality of health care delivery involving large numbers of medical professionals. In India about 70 to 80 percent of health care is delivered by private sector, family physicians form the largest group of health care providers coming into first contact with the patients.
Scientific training and skill development of this group of practitioners has a major impact on health care delivery system. However there has been a general reluctance in accepting ”family medicine” as a separate academic specialty.
The licensing procedure in India allows doctors to practice medicine immediately after completion of graduate qualification i.e. MBBS. Also there is a large gap in the ratio of graduate (MBBS) and post graduate(MD/MS) training positions. As a result majority of MBBS students do not get opportunity for further career enhancement, leading to large number of them aspiring to migrate abroad.
It has been long realized that India is short of skilled primary care physicians. The development of health facilitates in India have largely remained specialty and subspecialty based. Islands of clinical excellence have developed, which do not serve the large sections of the populations.
MBBS training has failed to evolve and able to cater community needs directly due to long pending medical education reforms. Due to rapid advancement of medical science during in last few decades, plain MBBS level general practice is not able to cater to the primary health care needs of urban, semi urban and rural & remote populations. As a result there has been a gradual decline in the prestige of general practice.
Development of “Academic Family Medicine” in India
Family Medicine has been recognized as a separate specialty by Medical Council of India since 1983 by amendment in first schedule of MCI act. DNB (Diplomate of National Board) -Family Medicine is a recognized post graduate qualification since 1983. Since than, family medicine has evolved as structured three year residency based training program.
This training program is largely based and delivered through NBE (National Board of Examination – a body of ministry of health & family welfare, India www.natboard.edu.in ) accreditated health institution.
It was 2002. when Government of India formally accepted the importance of “Family Medicine” in the “National Health Policy 2002” and committed for urgent upliftment of this specialty. Recently the number NBE accredited institutions providing family medicine residency training has risen sharply. At present there are about 700 DNB post graduate training posts available annually at 200* NBE accredited health institutions in India. *(2008)
Future of Family Medicine in India:
The success of several ambitious projects of government of India like ”National Rural Health Mission” largely depend on revival of “Family Medicine” in India. Also for the high end, private, hi – tech health facilities to survive, growth of family medicine is essential. No tertiary care system can develop without an efficient primary care delivery system. With limited paying capacity and out of pocket spending for health, high end tertiary care facilities depend on growth of health insurance in India. For health insurance sector to survive, the development of family medicine is critical.
Medical Education Reforms and Family Medicine in India
The concept of Family Medicine offers an unique solution to the ongoing medical education reforms in India. Within the existing infrastructure and shortage of faculty for sub specialties, thousands of post graduate family medicine seats can be created by initiating MD – Family Medicine. Three to four year duration of these family medicine PG seats can be distributed over training at medical college hospital, district hospitals and primary health centers/ urban community health centers and GP practice sites. This approach will efficiently address the acute shortage of physicians in rural and underserved populations. Also the availability of opportunities will effectively counter migration of qualified doctors to overseas. Presently we have seen several doctors wasting 5-7 years for entrance of post graduate medical seats only to get diploma in specialties which have limited value to the individual doctors and the community.
Rural posting has always been offered as punishment for young doctors. Never it has been packedged as career enhancement and academic acomplishment. There is need to build up an environment where a person opting for rural practice has an opportunity to become “professor of rural medicine.”
