New Delhi: Private hospitals are pushing for relaxation in norms to allow select facilities with 200 beds to start postgraduate (PG) courses in medicine, arguing that the move will bring down the shortage of specialist doctors in the country, ThePrint has learnt.
The Association of Healthcare Providers of India (AHPI), in its recommendations to the Union ministry of health and family welfare and the Niti Aayog a week ago, has suggested opening at least four-five PG institutes to begin with.
The AHPI has a network of 19,000 private health facilities in India, many of them corporate hospitals. Nearly 1,200 of these hospitals have a capacity of more than 200 beds.
As of now, no private facilities are permitted to offer standalone PG courses, though there are several government institutions doing so.
“if we combine modern medicine and Ayush Ayush doctors, we are more than meeting the World Health Organisation norm of one doctor per 1,000 population. But when it comes to availability of specialists, we have a huge shortage,” reads the report, ‘Towards A Healthy India: AHPI’s Blueprint for Change’, seen by ThePrint.
India is known to have over 75 percent shortage of specialist doctors, it says, adding that a way to address this is to allow private health facilities with over 200 beds to start Doctor of Medicine (MD) and Master of Surgery (MS) courses.
It, the AHPI says, will be a cost-effective way to fill the gap of specialists.
AHPI director general Girdhar J. Gyani told ThePrint that large hospitals can easily build a small teaching block adjacent or in the vicinity of the existing facilities and can start enrolling students, if the government relaxes the stipulated norms for PG courses in medicine.
In his Independence day speech, Prime Minister Narendra Modi had said that the government aims to add 75,000 more medical seats over the next five years.
Gyani said that the focus should now be on adding more PG seats in medicine, instead of just MBBS seats. He added that while large private hospitals are allowed to offer seats for Diplomate of National Board (DNB) seats, which are considered equivalent to MS and MD, they are not very “viable” financially.
As per the government data, India now has 731 medical colleges offering 1,12,112 MBBS seats and 72,627 post graduate or post graduate equivalent seats in medicine. These include nearly 15,000 DNB seats, majority of which are offered by the private sector hospitals with bed capacity of 100 and above.
However, the crisis of specialists beyond Tier 1 and 2 cities and not all those with MBBS degrees able to secure PG admission remain major concerns.
Gyani said that some initial discussion on the proposal with senior Niti Aayog officials had already taken place last week.
“We have worked very hard to ensure the quality of training through the DNB course over the years and private hospitals should do more (in terms of offering more seats),” Dr V. K. Paul, member (health), Niti Aayog, told ThePrint.
“However there may be a preference to offer standalone PG courses by some hospitals and that may require regulation but why not?”
Also Read: Rural India has an 80% shortfall of specialist doctors. MP, Gujarat, Tamil Nadu worst off
‘Criteria too strict, need some relaxation’
Under the minimum standard requirement for PG institutions effective from 2024, according to the National Medical Commission (NMC), a hospital must have at least 220 beds to start a PG course in medicine.
The land required for such a teaching hospital must be at least 10 acres—down from 20 acres—which can be further relaxed in case of hilly or other difficult terrains.
In addition, the beds must be occupied by patients at least 80 percent of the time throughout the year. The hospital must also reserve at least 15 percent of its beds for the ICU.
Also, the faculty should not indulge in private practice during the teaching hours and the institution should have at least five active departments.
Gyani said the criterion such as land requirement of 10 acres to run a PG teaching institution should be done away with.
“There are a number of top-notch hospitals interested in starting PG courses, provided that the government is supportive. These facilities should not be denied this permission on grounds such as lack of certain plot size,” he said.
Some public health experts expressed scepticism at the proposal, saying it may lead to poor quality training and churning out doctors unfit for specialised care.
“I see it as a trap,” said Dr Antony K.R., a public health specialist and independent monitor of the Centre’s National Health Mission.
“The government must be very careful in awarding such permissions to private hospitals as specialisation in a medical or surgical branch that needs a certain amount of clinical caseload is necessary for hands-on experience in skills required for practice of that specialisation,” he pointed out.
Further, he said, a minimum number of dedicated teaching faculty members is required.
“Cutting corners on such requirements by the National Medical Commission may come across as a deliberate attempt to exploit the supply-gap of specialists in the country and the resultant deteriorating standards of care,” Antony said.
He also stressed that there is a motive to commercialise PG training at lucrative rates of fees and exploit the trainee students for clearing routine workload of hospitals at paltry stipends.
‘Need to look beyond DNB’
The Centre has been pushing private hospitals to offer more DNB seats, once considered inferior to PG seats. In 2020, it allowed even those with 100-beds, down from 200, to start the training.
As of now, a majority of the DNB seats, almost 90 percent–regulated by the National Board of Examinations in Medical Sciences (NBEMS) under the Union health ministry– are in large private hospitals, while some are offered by district hospitals run by the government.
The NBEMS administers DNB broad specialty courses in 29 disciplines of modern medicine. The courses are three years for post-MBBS students. It also offers super specialty courses in 27 disciplines of modern medicine, including cardiac anaesthesia, medical genetics, and surgical oncology.
However, sources in private hospitals concede that hospitals spend Rs 3-5 lakh per year on training every DNB resident and recover about Rs 1.25 lakh through annual fees.
“Hospitals are also required to pay a hefty stipend to every DNB resident and in states like Delhi, they are paid Rs 80,000-90,000 per month. The government has not been listening to our demand for giving financial aid for running DNB courses,” said a senior doctor associated with a corporate hospital chain.
He also said that hospitals are pressed due to the expenditure incurred on training residents and the growing salary burden paid to consultants. “So financially, DNB residents add more pressure on the resources.”
Private colleges are known to charge up to Rs 25 lakh- 50 lakh per year from a PG student.
“It’s a fact that most hospitals are not interested in raising DNB seats. This is a degree seen as inferior to PG seats and the model is not suitable financially,” Gyani, too, concurred.
The AHPI suggestion, meanwhile, has found some independent support albeit with some modifications.
Dr Thomas Chacko, a medical education expert who has been associated with the World Medical Education Federation founded by the WHO and World Medical association, said that hospitals interested in opening PG seats, could get attached to medical colleges and get recognised as a teaching hospital, like in the UK.
“This way the teaching hospitals’ teaching can get supervised or supplemented by qualified teachers from medical colleges. This will work well with private not-for-profit medical colleges—which find the cost of teaching beds difficult to support financially—to remain financially viable,” Chacko said.
DNB, too, should come under the NMC, Chacko said, pointing out that this arrangement will enable an increase in the number of PG seats-linked to the number of teaching beds.
“Besides, now we have new medical colleges opening in every district in the country. Increase in PG seats will result in all MBBS students getting a PG seat. Currently, the MBBS graduate has to wait 3-4 years to get high cut off scores due to the lesser number of PG seats compared to the number of MBBS passouts,” he said.
This, Chacko stressed, will also bring down the fees computed by the state fee fixation committees that fixes the fee structure in private medical colleges, as the cost of running will come down and the benefit will be passed on to the students.
(Edited by Tony Rai)