Promoting family medicine vital for universal healthcare
A family/general physician is an integral part of the health system. In India, having a family physician used to be the norm. He/she provided medical services to the family and was also often regarded as a trusted guide in family matters. In Western countries, the family physician continues to be considered important for healthcare. The system of having general physicians is the backbone of the UK’s National Health Service, which provides quality healthcare to local residents.
In India, medical graduates used to function as family physicians in cities while in villages, a registered medical practitioner (RMP) played that role. With significant advancement in medical knowledge, having only an MBBS degree is no longer considered enough for providing optimum care as a family physician. Accordingly, patients now usually approach specialists even for trivial problems.
The specialists, being highly focused on a particular discipline, are not able to handle associated ailments. As such, they either fail to comprehend the problem in totality (and that could prove to be quite serious at times) or tend to refer the patient to another specialist, thus increasing the expenditure on treatment.
We need well-qualified, highly skilled general/family practitioners to cater to the immediate, primary and even some secondary healthcare needs. The family physician is supposed to possess knowledge of various disciplines of medicine to provide comprehensive healthcare to the individual and the family across all ages and diseases. He may refer and coordinate with the specialist concerned, if needed.
With a view to providing optimum healthcare, adequate manpower and infrastructural facilities are needed. Over the years, both the government and the Medical Council of India (MCI) — now, the National Medical Commission (NMC) — have taken steps to ensure more medical colleges. Their number has gone up to more than 700, with the intake capacity for the MBBS seats being nearly one lakh. The number of postgraduate seats has also increased to nearly 70,000.
Though the number of seats in various specialities has increased, virtually no efforts have been made to increase the seats in MD (family medicine). The family/general physician cadre is crucial in providing effective universal care without needlessly burdening the specialists with routine ailments. In addition, the family physician can integrate for specialised care with experts, if required.
The need for a postgraduation degree in family medicine was realised long ago by the MCI and the National Board of Examinations (NBE), but, unfortunately, the matter was not pursued. It was only in 2011 that the MCI allowed the medical colleges to start an MD course in family medicine. The NBE had approved this course in some hospitals prior to that. In 2011-12, the MCI Board thought over this issue and prepared the precise curriculum and minimum standards required in family medicine.
The development was communicated to the government. It was considered that faculty from the medicine department could serve as coordinators, and the faculty from other relevant disciplines could also be included to teach MD (family medicine) residents rather than having a separate dedicated department in the beginning. It was even suggested that a special training programme/curriculum could be considered for MBBS doctors who were in regular service for over five years by reducing the training period to two years or so. That would have not only enhanced their prestige in society but also allowed them to learn new skills to effectively function as family/general physicians.
The NMC may now have a relook at the curriculum and the minimum standard required to be an effective family medicine physician. Importantly, the regulators must also ensure that the family medicine postgraduate degree does not make the candidate eligible to pursue the DM (doctorate of medicine) course. Otherwise, it might become a back-entry route for those who do not qualify for the MD (medicine) course. The MD (medicine) curriculum is entirely different from that of family medicine and, thus, they would not fulfil the eligibility criteria required for the DM course.
It is encouraging that the government has taken various steps to initiate and popularise the family medicine discipline. All newly established AIIMS institutions have been asked to start a PG course in family medicine.
Similarly, the NMC should take steps to encourage the medical colleges to initiate this course. The NMC Act specifically mentions that the Postgraduate Board should take steps to promote and facilitate MD in family medicine. The government has also modified the Indian Public Health Standards and added job opportunities for postgraduates in family medicine at community health centres (CHCs) and district hospitals. This was a much-needed step to encourage the graduates in opting for the family medicine discipline.
Some more steps are needed to make the course attractive in the interest of universal healthcare. A separate family physician cadre in primary health centres/CHCs and district hospitals is needed. They may be allowed to also practise beyond the regular time to fulfil the immediate needs of the family on payment of practising fees. There is a need to involve family physicians in private practice in some way for integrating them with universal healthcare delivery. Family physicians, in coordination with the specialists, will offer specialist care, if required, and provide follow-up care to avoid unnecessary visits to hospitals.
Both AIIMS and the NMC need to address the question of quality training so that our professionals can compete with the best in the world and also help in fulfilling global needs.
