A large-scale physician and chemist census across India’s top 120 cities and towns by Mumbai-based market research and consultancy firm IMS Health has found that non-M.B.B.S doctors i.e. doctors who don’t hold a degree in medicine accounted for 16 per cent of the total doctor universe that practices allopathy or modern medicine.
These doctors are qualified in alternative systems of medicine such as Ayurveda and Homeopathy but 40 per cent or more of their prescriptions are made up of allopathic drugs such as antiobiotics and painkillers. The census covered over 3,73,000 doctors across the country.
The findings highlight, once again, the need for proactive policy-making to effectively harness and regulate this workforce to shore up the quality and availability of healthcare delivery in under-served areas.
The influx of non-MBBS doctors into allopathy has occurred even as state governments ruminate over the right approach towards them. For instance, just this month the Maharashtra government said it would allow such doctors to practice allopathy only after they cleared a year-long government-approved course in pharmacology. The course material is still being given the finishing touches.
Yet, in the state’s capital Mumbai, non-MBBS general physicians constituted about 22.2 per cent of IMS Health’s census universe . In Pune, that number was higher at 31.1 per cent and in Nashik even more so at 33.6 per cent.
The key reason for this proliferation is doctor unavailability. The proportion of non-MBBS doctors in the overall doctor universe is the lowest in metros such as Mumbai and Delhi and increases in the smaller towns and cities. This is no doubt a result of lower doctor-patient ratios as one moves away from major cities and towns.
IMS Health found that while 76 cities had a doctor-patient ratio that was higher than the global median of 1.2 doctors per 1000 population a good number of them also had dismally poor ratios (such as Mallapuram in Kerala at 0.1 per 1000). The top 9 cities accounted for 52 per cent of the doctor universe. That and the rising demand for modern medicine has made it to lucrative for alternative medicine practitioners to practice allopathy.
“The key challenge before the government is how to utilise these non-MBBS doctors and formalise the system,” said Amit Backliwal, managing director, south Asia, IMS Health.
Blow hot, blow cold
How, indeed. An important and influential group i.e. the allopaths, has opposed any attempt at providing legitimacy to these non-MBBS doctors. This month, in response to the state government’s announcement, the Maharashtra Medical Council (MMC) reportedly issued a resolution to the state medical education department that it did not support the move. “There is large-scale confusion about the sanctity of medical courses now and the resolution was to address the chaos,” one MMC official was quoted as saying in the news report. Last year, the Indian Medical Association had threatened to sue.
And last month, allopaths also opposed a similar suggestion by the Union Ministry of Health and Family Welfare to address the shortage of allopaths in government-owned primary healthcare centres.
The government’s flagship rural health programme the National Rural Health Mission (NRHM) allowed non-MBBS doctors to assist the main doctors who would be qualified in allopathy at its primary healthcare centres (PHCs). But owing to the shortage of the latter, in some districts these assistants have reportedly ended up being the main doctors at PHCs.
States such as Maharashtra meanwhile appear to be blowing hot and cold. While it has obviously winked at the practice, letting it get to the point where “regularisation” seems the most obvious solution, at other times it has tried to wield the whip. For instance, last year the state government attempted to prevent chemists from filling prescriptions of non-MBBS doctors. It had to backtrack after chemists threatened to go on strike.
For their part, non-MBBS doctors say that allopathy forms part of what they learn at university and that prescribing modern medicine is important during emergencies. Besides, with the shortage of doctors, they believe, the government doesn’t really have much of a choice.
Given its controversial nature, there have also been a number of lawsuits in different courts all over the country on this subject and each party has used judgements favouring it to further it’s cause.
Time to respond
In the meantime, on the ground data such as what IMS Health has presented shows that the demand-supply mismatch has overriden all other considerations.
Since the doctor-patient ratio is unlikely to change in a hurry, it is definitely time to not only leverage this workforce but also to equip it to deal with a dynamic discipline that is currently also experiencing never-before safety concerns.
It is time that the Centre and states came up with a coordinated response. Non-MBBS doctors predominantly practice as general physicians. They are the first port of call for patients making them the gatekeepers into the wider healthcare delivery system. A solution that does not stop at brushing up their theory but also ensures their continuous medical education and measures outcomes is the need of the hour.
Pic sourced from photostream of Simon Lieschke on Flickr