India has 1.8 million registered medical graduates (modern and traditional medicine) to serve a population of 1.33 billion, which means India has already achieved the doctor-to-patient ratio recommended by the World Health Organization (WHO) 1: 1000. If we only consider modern doctors, India will likely reach the recommended ratio by 2024. The number may look promising; However, when we analyze these figures in depth, we realize that 80% of Indian doctors are concentrated in urban India, which is home to only 35% of the Indian population, and that the remaining 65% of the rural population are served by 20% of the population. doctors in total. The distribution parity of physicians in itself is a testament to the fact that the Indian health system is in need of radical decentralization.
A recent study pointed out that about 66% of rural doctors are charlatans with no formal medical qualifications, which further underscores the need to shift focus to rural health. Fake doctors often use the drugs irrationally to get the desired results, which often complicates even simple health issues. The COVID pandemic was testimony to the previous statement in which many people lost their lives because they continued to seek treatment from their local doctor, likely a charlatan, without even getting tested for COVID.
The pandemic has highlighted the need for a qualified family doctor who can be available to the family when the need arises, if not physically, at least for a tele-consultation. During the difficult times of the second wave of COVID, many people in rural India struggled to contact a qualified doctor. People who have lost their lives due to symptoms of COVID and have not been able to pass a test should be considered COVID deaths and their families should be eligible for relief programs provided by the state and central government .
Family physicians were an integral part of India’s health care delivery system. However, over time, unfavorable regulations brought this field to the brink of extinction. Interestingly, the entire MBBS program does not mention family medicine once. While the West embraced family medicine with both hands, India simply continued to ignore this important flow of health care. Most of the other specialist fields require enormous infrastructure, so they are limited to large cities. Family physicians were the link between families and other specialties. In the absence of family doctors, people end up contacting charlatans who have further deteriorated their health or have spent a lot of money traveling to big cities to see a specialist. In many cases, visits to a specialist could be avoided if the right treatment was provided at an early stage. The current situation places an additional burden on already overworked physicians and an unnecessary economic burden on patients.
The time has come to reinvent our health care delivery system and promote family medicine as a subject. This will contribute to the decentralization of health care delivery and patients would be able to see a qualified specialist in the peripheral areas.
The author is National President of the Academy of Family Physicians of India (AFPI).