‘Bridge’ widens allopathy-Ayush rift

The National Medical Commission Bill that the Centre introduced late last year has a number of radical suggestions, including dismantling the Medical Council of India and bringing in an exit examination for medical graduates among others. 

For a country that faces a crippling shortage of qualified medical practitioners, a proposal to increase the numbers by as much as 70 per cent is nothing short of a miracle. However, the Centre’s proposal to permit doctors from the alternative systems of medicine to practise allopathy and prescribe medicines has triggered a heated debate, including questions about long-term solution to address shortage of doctors.

In short, the new bill tries to address the shortage of doctors by bringing in a bridge course, and also by integrating the educational modules and programmes of the various systems for “medical pluralism”. This led to instant and vociferous protests from the allopathy doctors, who staged protests across the country, including in Chennai, while the rest – the Indian systems of medicine (Ayurveda, Yoga, Unani, Siddha, Naturopathy) and Homeopathy, collectively called ‘Ayush’ – have enthusiastically come forward to back the proposal.

The key difference, said Dr JA Jayalal, state president of Indian Medical Association (IMA), is that allopathy is an evidence-based system while the rest are rooted in tradition. A short-term bridge course that focuses on the theoretical aspect would not be sufficient to follow this whole different system, he said. “While we are not against the Indian systems, we are surprised by this move. Understanding the research that has gone into each medicine is not possible in a six-month span,” Dr Jayalal added.

Though the proponents of the idea point out that this would reduce quackery, doctors like Jayalal believe that it would only lead to a rise.

Then there is the proposed exit examination. At present, after studying for four years, MBBS students have to practise under supervision for one year before they can qualify as doctors. Now, the NMC bill has brought in a proposal to introduce a licentiate (exit) examination to qualify them as certified medical practitioners. “On the other hand, Ayush doctors will be allowed to practice allopathic medicine after completing just the bridge course,” Dr Jayalal pointed out the contradiction.

Stating that the patients’ interest has not been taken into account, Dr G R Ravindranath, general secretary, Doctors’ Association for Social Equality, said, “The integration of the systems will dilute the quality of modern scientific medicine and result in an increase in confusion, not only among doctors, but also among patients.”

Doctors from the Indian systems and homeopathy are not amused by the furore, and point out the alarming shortage of doctors, especially in the rural parts of the country. “Taking into account the country as a whole, the number of doctors in India is way lesser than World Health Organisation’s (WHO) minimum standards. It is therefore important not to look at it as an issue between separate systems of medicine, but as a public health issue,” said Dr B Muthukumar, national spokesperson for India Siddha Medical Graduates Association.

Facing such a gap in demand and supply, doctors of alternative systems prescribing allopathic medicine would help provide healthcare to large populations in rural India, who are struggling without enough experts and facilities, added Dr Raghav Shankar, a doctor who practises acupuncture in the city.

A majority of these doctors are unanimous in seeking an integration of Ayush doctors into the fold of modern medicine citing public interest. There are also a few among the experts who are not enthused about prescribing allopathy medicines, but are interested more in about formal access to modern medical technology like scan, radiology and anaesthesia.

There are about a million allopathy doctors in India right now, but that absolute figure will not convey the whole picture. There indeed is a shortage of doctors –only one doctor available for 1,674 persons, as against 1: 1,000 prescribed by the WHO. On the other hand, however, around 52,000 medical graduates pass out of the 467 medical colleges in the country every year.

The trouble, hence, is the skewed numbers when it comes to availability of doctors in rural parts. According to the Rural Health Statistics 2014-15 of the Ministry of Health and Family Welfare, there is a huge shortfall of doctors and specialists in the rural healthcare system with a total shortfall of 81.2 per cent specialists at the Community Health Centres (CHCs).

This is where the nearly seven lakh Ayush practitioners are being roped in to help, which has not convinced the allopathy practitioners. “We cannot have allopathic doctors for urban areas and Ayush doctors for rural parts. That is not how the system should work,” added Dr Jayalal.

The question then is: is there a solution to the disinclination of young MBBS graduates to serve in rural areas? The prestigious Christian Medical College and Hospital (CMC), Vellore, is a case in point. One of the most sought after medical colleges, the CMC has the mandatory rural service for a specific period as a condition while admitting students.

“Besides the entrance exam, we also have a three-day interview during which we try to gauge the ability and potential of students to work in mission hospitals and rural areas,” said Dr Biju George, vice principal of research at CMC. Having seen the reality of rural healthcare, he added that Ayush doctors prescribing Western medicine will not solve the problem of shortage.

WHO prescribes one doctor per 1,000 persons

In India, it is 1: 1,674 now

Allopathy doctors: 10 lakh

Ayush practitioners: 7 lakh

Small and medium sized hospitals – 6,000

Corporate and multi-speciality hospitals – 600

PHCs – 2,300

Medical Colleges in TN – 36

Number of doctors in TN – 90,000

Around 5,000 MBBS students graduate from the medical colleges in TN every year 

Allopathy doctors are not willing to work in rural and tribal areas. Immediately after MBBS, they concentrate on PG preparation for many years. Studies have shown that Ayush doctors have helped provide medical care in remote areas, as MBBS doctors prefer urban postings.

A 2014 study by New Delhi-based Public Health Foundation of India had highlighted that in as many as 32 per cent of PHCs in remote and tribal areas, it is the alternative medicine practitioners who provide clinical care.