Continuous Upskilling of Primary Care Doctors Critical for Real Success of Ayushman Bharat
Shortage of doctors is a major contributor to the ailing healthcare system in India. While we are aware that India has a shortage of allopathic doctors, with only one doctor per 1,597, the ratio of specialists to generalists is even less favourable, if compared to developed countries. The total yearly input for MBBS is 60,600 whereas for MD/MS/diplomas it is 30,253 and for super-specialities such as DM cardiology or MCH cardiothoracic surgery, the yearly input is only 2,771. With the introduction of the central government’s Ayushman Bharat insurance scheme, the burden on the healthcare scheme is only expected to rise. With the covering 50 crore households or 500 million people, healthcare not just needs to become more accessible but more efficient in diagnosing and treating patients with a strong primary care system in place.
The way forward
In India, people who have access to healthcare reach super-specialists for treatment of basic ailments which can be addressed even by a good primary care doctor. This put unnecessary load on the already scares specialists' resources. The primary care system should be strengthened such that they are capable of doing the initial assessment, diagnosis and basic management and appropriate referral if need be. A thorough assessment and investigation at the primary care or secondary care can lead to a significant saving of resources at the territory level. Even specialists agree that nearly 80 per cent of all patients can be managed by primary care physicians if supported by sound practice guidelines and referral systems.
The key to strengthening the primary care system includes continuously re-educate and upgrade the skills of its existing doctors with the latest guidelines and investigation and management protocols. The hurdle from patients’ side is lack of trust in primary care doctors which comes from a perceived lack of adequate capabilities in the primary care providers to tackle chronic health conditions. CME helps to improve the competence and skills of the primary care provider and thus plays a key role in building the patient’s trust in the primary care system.
Continuing Medical Education (CME) for doctors
The first question that may come to our mind is why qualified and trained doctors need further medical education or training. This is because their medical training is likely to get outdated over a period of time. The Indian medical associations have long emphasized on the need for doctors to get continuing medical education to keep them aware of the latest developments in the field of drugs, equipment and medical practices.
In the recent past, several cases have been reported where doctors were still recommending single or double anti-retroviral for HIV/AIDS patients instead of triple combinations which are standard. This knowledge gap arises when excessively busy doctors fail to keep abreast of the latest developments in the fields. This is particularly relevant for doctors operating in smaller towns or rural areas who find it difficult to step out of their remote areas on a regular basis to stay connected with the medical fraternity outside. This knowledge gap or lack of Continuing Medical Education can prove to be a major hazard for the healthcare system.
Taking a cue from the west
Putting adequate emphasis on Continuing Medical Education has worked wonders in improving the health of the rural population in western countries. Rural physicians in the United States have benefited from the establishment of Regional Health Education Centres to train physicians about ever-changing health trends, treatment protocols and technology. Also, many advanced nations including the U.S, Australia and Canada have made CME a requirement for the registration of health professionals.
Role of medical associations in CME
The Medical Council of India has been working to promote Continuing Medical Education since 1985. Various medical associations such as API, FOGSI, CSI, IAP, ISG, etc have been using their influence and reach to push doctors to do CME to update their medical knowledge for the larger societal benefit.
Various medical councils have followed the western model of enacting punitive measures such as not renewing licenses of doctors who do not adhere to CME requirements. The practice has been adopted by various medicals councils such as Maharashtra, Karnataka, Andhra Pradesh, etc by making CME credit hours’ compulsory for renewing licenses.
Cooperation from state governments
Given health is a state subject, the role of the state governments in advancing the cause of re-skilling health professionals becomes all the more important keeping in view poor rural infrastructure and inadequate proficiency in the primary health system. It is up to the government to adopt a carrot and stick approach to motivate doctors to sign up to CME. A nationwide law to make CME mandatory can benefit a great deal in this regard. The government doctors can also be given points in their promotion criteria for upgrading their skills continuously through these CMEs.
Utilising Digital CME
With the advancement in Information and communication technologies, getting CME has become a far easier task for the doctors. A doctor sitting in a Primary Health Centre at a remote place in India can easily access the latest medical tutorials using his smartphone or desktop all without leaving his workplace and wasting time on travel. He can access videos and lectures by top experts from across the country on various specialities based on his interest. This system will prove to be a boon for doctors associated with rural healthcare setup as they are the first point of contact for the community.
