India is facing a debilitating shortage of health specialists, including in basic disciplines such as surgery, gynaecology and paediatrics, statistics compiled by the National Health Mission show.
Rural community health centres face over 82 per cent shortage in surgeons, physicians and peadiatricians — 82.5%, 82.6% and 82.2% respectively — and have only 23.4 per cent of the obstetricians and gynaecologists they require.
The story in urban centres is no better, with around 2 lakh surgeons, less than 50,000 paediatricians, 70,000 obstetrics/gynaecology doctors and around 1 lakh physicians catering to the 121 crore population of the country.
“Overall there is a shortfall of 81 per cent in specialists at the CHCs,” a report by the NHM says. The total number of specialist doctors in the centres has actually declined from 5,805 in 2013 to 4,091 in 2014, with the highest decreases in Uttar Pradesh (1,256) and West Bengal (947).
There are no consolidated registries of specialists available, with the Medical Council of India’s decision making it mandatory for practising doctors to re-register every five years still too recent. However, associations of specialists admit that while there is an obvious urban-rural divide, the country is overall woefully short of qualified practitioners in even the “bread and butter” specialities.
“There are around 30,000 doctors registered with the Federation of Obstetrics and Gynaecological Societies of India (FOGSI), another 4,000-5,000 doing PG who are not registered yet and maybe another 35,000 odd out of the FOGSI fold. So there may be around 70,000 practising obstetrics/gynaecology doctors. There is a norm of one per 1,000 population but a ballpark shows India is about 40 per cent short. One also needs to understand that not all specialists trained in the field do both kinds of work, some stick to only obstetrics and some do only gynaecology,” Dr Prakash Trivedi, president of the FOGSI, said.
The total number of obstetrics/gynaecology seats in the country is approximately 1,000, he added.
As per the standard norm of one paediatrician for every 10,000 population, India should have 1.21 lakh practising paediatricians. The Indian Academy of Paediatrics (IAP), the second largest association of paediatricians in the world after the US association, has around 23,000 members. “There is a shortage of paediatricians all across the country, though the situation is better in bigger cities and also in the middle-tier ones. We have 23,000 members, there may be another 20,000 or 25,000 practising paediatricians who are not our members. That is way short of meeting the one paediatrician per 10,000 people mark. Paediatricians are overworked, seeing 50-70 patients a day and the government’s insistence on stricter medical college norms is not making things any better,” said Dr Praveen Mehta, secretary of the IAP.
Around 1,500 new paediatricians graduate from medical colleges every year but many are believed to leave for foreign shores.
Same is the case with the approximately 1,000-odd qualified physicians — holders of at least a PG degree in medicine — who leave medical colleges each year.
According to Dr Rajesh Upadhyay, president of the Association of Physicians of India, there are around 50,000 qualified PG physicians registered with the Indian Medical Association. There may be an equal number outside that fold. “There may be around one lakh qualified physicians working in India — not taking into account the many MBBS doctors who are currently working across the country as family physicians. India needs at least double that number. The shortage of physicians is acute but rules for medical colleges are an added deterrent. There is a huge shortage of faculty, where will new doctors come from if there is nobody to train them?” Upadhyay said.
The math gets more complex for surgeons — given the fact that everyone from an onco-surgeon to an orthopaedic surgeon fits the bill. That is also why the figure of 2 lakh estimated practising surgeons in India does not really give the real picture of either their shortage or the regional bias in their distribution, said Dr Santosh John Abraham, president of the Association of Surgeons of India.
“There is a huge deficiency of surgeons across the country. We do train a lot of surgeons but there is a significant outflow. There is naturally a rural-urban divide because any trained person would want to stay in a centre that has facilities. I would say, taking all kinds of surgeons together, there would be around 2 lakh practising in the country.
But this is not a discipline where a standard population-specialist ratio from a European country can simply be superimposed on the Indian scene,” Abraham added.