Monday, September 2, 2013

Steps sought to solve acute dearth of specialist doctors

Citing an urgent need to tackle the acute dearth of specialised doctors owing to inadequate PG seats, a campaign called ‘Save doctors who save your lives’ will be launched by medical practitioners across the state soon, as part of a nation wide campaign. The campaign says that an increase in the number of specialised doctors is the need of the hour as an MBBS doctor cannot treat non-communicable diseases (NCD) including those contributing to Maternal Mortality Rate (MMR).
“Treating NCDs is a gargantuan task and is going to be the major challenge in the days to come. To name a few, the top ten causes of death in India include cardiac diseases, diarrhoeal disease, chronic respiratory diseases and stroke. Nine out of those ten require specialist doctors. Unfortunately, we do not have enough specialised doctors due to inadequate number of PG seats in medical institutions”, said Dr Prem Kumar Nair, medical director, Amrita Institute of Medical Sciences, who heads the campaign in Kerala.
He pointed out that it is ironic that there exist a huge disparity in the seats allotted for PG and UG in a country which has the largest number of medical institutions.
“The mandatory rural posting also affects them as they end up spending 13 years only for studying. If this trend persists the risk will increase as there will be a dearth of specialists when a senior specialist doctors or surgeons retire”, he said. Dr Prem Kumar said that the government can solve the issue by adding more number of PG seats in the hospitals.
“For instance, the number of students under each professor or associate professor has to be increased. If they are currently handling one, it has to be increased to five”, he said.  Approximately 15 to 20 per cent of pregnancies end up requiring Caesarian section and if not managed well, the repercussion will be a high MMR. Caesarian sections need a radiologist to perform ultrasound scan to predict complications during childbirth, an anaesthesiologist to anaesthetize the pregnant woman, a gynaecologist to conduct the operation and a paediatrician to resuscitate the baby. A doctor with MBBS degree can attend to a normal delivery but a doctor with post graduation degree can reduce Infant Mortality Rate and MMR.
Dr Prem also said that owing to the dearth of specialists in rural areas, the infant mortality rate and MMR are high.
Besides, by increasing the number of post graduation seats, ‘brain drain’ will also come down drastically. “Many are opting for foreign countries as they could not secure PG seats. Increasing PG seats will be the right solution in this regard”, he added.

Sunday, September 1, 2013

Medical students gather in Mumbai pleading health ministry to equalize UG and PG seats

Medical students gather in Mumbai pleading health ministry to equalize UG and PG seats
MUMBAI: Over 300 medical students gathered at Indian Medical Association House (IMA) last week to once again plead to the Union Health Ministry to equalize Under Graduation (UG) and Post Graduation (PG) medical seats. The movement by the medical students called 'Save the Doctor' also took place in other cities like Bangalore, Jaipur, Hyderabad, Mysore, Guwahati and Hisar, on the same day. Dressed in their regular lab coats along with a black ribbon, the students made their hand impression on a large piece of canvas as a symbolic gesture to articulate the lack of specialist doctors in the country. The students also wrote their message "Save the Doctors" on the floor lit each alphabet was lit with candles.

Commenting about the movement, Dr. Naresh Trehan, CMD, Medanta said "I am quite concerned about the present state of affairs for the medical students in our country. We are all aware that the number of students graduating and the number of PG seats available are not equal. Students are struggling to get a PG seat today. We should take measures to change the system as soon as possible, as we need more specialists in the country." He also added, "If one notices, many a times, getting an appointment from a specialist, be it a gynecologist, orthopedic, etc is increasingly becoming an issue. The reason is because to serve the healthcare needs of a billion plus people, the number of specialists available is simple not enough. We have written to the ministry and authorities and we have received favorable response and we are hopeful there will soon be solutions."

The top ten causes of death in India include diseases of the heart, diarrheal disease, chronic respiratory diseases and strokes, to name a few. Nine out of the ten require specialist doctors to treat them. Today, India lacks specialist doctors due to inadequate number of PG seats in medical institutions. Though the country has the largest number of medical institutions, the disparity in the number of seats allotted for PG and UG students along with the mandatory rural posting are affecting young doctors, as they end up spending 13 years merely studying. This also means that the future of our healthcare system is at a huge risk if the current scenario continues. As senior specialist doctors/ surgeons retire in the future, there will be a dearth of specialist doctors and surgeons in India. Pursuing a Post Graduation in any stream of medicine is essential for a doctor to become a specialist such as Gynecologist, Neurologist, Surgeon, Radiologist etc.

Dr. Narendra Saini, Secretary General, IMA, said, "The young doctors of India are losing their productive years in studying to get a PG seat. There is a dearth of specialists in the country and limited PG seats will gravely affect the number of specialist doctors, available in the coming years. He further added, "'Save the Doctor' movement is a step to resolve the problem and we need the support of the nation."

There are 47,600 UG seats which is likely to reach 50,000 shortly due to the progressive steps taken by the MCI. Whereas, there are only 12,000 PG seats in clinical disciplines! In comparison, in a developed country such as the USA, there are 19,000 UG seats and 32,000 PG and fellowship seats. With a pass rate of 80% to 90%, nearly 40,000 doctors graduate every year and compete for the 12,000 clinical seats with their batch mates and over a lakh seniors. In the last PG entrance exam under NEET, over 90,000 doctors appeared for the test to claim one of the 12,000 seats. Adding to this, the one year compulsory rural posting as a pre-requisite to apply for PG course has worsened the situation.

Central Zone Executive of 'Save the Doctor' movement, Dr. Suranjana Basak, said, "The gathering we had today across India is just our humble appeal to make our voice heard. We want the leaders to take action and save the future."

Lakhs of young pregnant women who die during delivery is a testimony to show how lack of PG seats is taking away precious lives due to dearth in gynecologists. There are 28 million babies born every year in India, which means at least 28 million deliveries need to be handled annually. ""To perform this number the country requires that many gynecologists. Unfortunately we have only 40,000 practicing gynecologists and most of them are practicing mainly in cities. Our government is spending lakhs of rupees to reduce Maternity Mortality Rate without great success. What people and policy makers fail to realize is that it's not due to lack of money that young pregnant women are dying, but because the country does not have enough qualified gynecologists and pediatricians to take care of the mother and baby"", voiced Dr. Devi Prasad Shetty, Treasurer, AHPI.


Rural stint conditional for MD-

Diploma certificate

A plethora of problems plagues medical care in rural areas of the state; not least on the list is a lack of doctors. Most doctors who sign up for work in state-run hospitals invariably quit, frustrated by poor working conditions and facilities.
The government, though, is taking iron-clad action. Earlier this week, it sacked 43 doctors who refused to show up for work, as reported by Mirror on Saturday.

Now, the Directorate of Medical Education and Research (DMER) had made it mandatory for Doctor of Medicine-Diploma (MD-Diploma) students to complete a one-year stint in rural areas before pursuing higher education.

Until now, students were allowed to serve out their bond — pledging that they would work in rural areas for a year — after completing higher studies. 

But a circular issued by the DMER on August 6, puts an end to this practice. About 230 students would be affected, more so as the order comes after several students had appeared for entrance exams to higher education courses.

“Earlier, thanks to a court order which stated that no one could stop students from pursuing their education, students used to return later and serve out their one-year bond,”  said Dr Santosh Wakchaure, president, Maharashtra Association of Resident Doctors.
“Now, diploma students cannot secure admission for higher education unless they complete their one-year stint in a rural area. The DMER issued this order after social activist, Pournima Upadhay, filed a PIL against the lack of doctors in rural areas.”

Dr Pravin Shingare, director of DMER, claimed that the decision also stemmed from the fact that many students did not turn up to execute their bond. “Previously, they would sign an affidavit stating that they would return to serve out their bond after completing their education.” 

But most students did not come back which is one of the reasons for this circular. We have also started imposing a penalty on them.”

MD-Diploma students are livid, claiming that instead of  the DMER going after the few black sheep, it is punishing them all. Moreover, they say, it points to a failure on the part of the government to enforce the affidavit.

“The government took the affidavit lightly,” said a student from BJ Medical College. “Why don’t they punish the students who signed the affidavit, but did not show up for work? We are willing to serve out the bond, but we want to finish our education first in one go.”

Students fear that they would lose touch if they were to break their studies for a year. "How can one study for a competitive exam while working in a rural area?” wondered the student. 

“Most of us have appeared for Diplomate of National Board (DNB) exams and are awaiting our results. We now have to go for counselling, but DMER is not releasing our certificates. Had they told us earlier, we would have sat for the exams in the first place.”

Another student from BJMC said, "This circular has been issued only in Maharashtra. Instead of asking us to serve in rural areas, the government should instead appoint those who have completed their MBBS. 

This would not only serve the government’s purpose, but it would help rural folk too as a patient who requires a super-specialist would have access to one. Now they are simply referred to a district hospital. Why don’t they properly utilise the skills of these super-specialists?"