|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 474
The leadership crisis of medical profession in India: Ongoing impact on the health system
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||23-Jul-2015|
Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sood R. The leadership crisis of medical profession in India: Ongoing impact on the health system. J Family Med Prim Care 2015;4:474
|How to cite this URL:|
Sood R. The leadership crisis of medical profession in India: Ongoing impact on the health system. J Family Med Prim Care [serial online] 2015 [cited 2018 Oct 19];4:474. Available from: http://www.jfmpc.com/text.asp?2015/4/3/474/161366
This is in reference to the editorial published in the last issue of the JFMPC. 
Quite often, the public expectations are blamed for the increasing culture of medical specialization developing over the last many years. However, I think this is true only for a relatively small proportion of patients and public. In general, people want a good doctor, not necessarily always a super-specialist (actually sub-specialist). It is not unusual today to see many patients in medicine out patient department (OPD), after they have been to a number of sub-specialists without their actual problem being solved. By this time, they usually know they "do not have" a heart disease or a disease of a particular organ, but what is responsible for their suffering is not deciphered (many a times it could all be psychosomatic). They keep shuttling from one OPD to another, not only increasing the cost of care, the load on hospitals, and individual doctors but also suffering the discomfort and loss of time and wages.
Attending to patients admitted through medical emergency in a tertiary care center, I can easily say that a good proportion of them might not have reached the existing state had they been dealt with appropriately at primary and secondary health care levels, again emphasizing the need for improving the quality of undergraduate and postgraduate training at a national level and increasing the breadth of their training. Just increasing the numbers is not solving the problem, either in terms of quality of health care or breadth of coverage. As pointed out by the author, a large pool of graduates is just sitting and preparing for PG entrance exams, thus creating an artificial shortage.
There is no doubt that a well-trained graduate with the necessary breadth of knowledge and skills (a family physician) should form the backbone of the primary health care system. Though an initiative to develop a curriculum for an MD in family medicine has been taken by Medical Council of India, not many medical colleges have shown interest in introducing this course. Important is for policy makers and health care systems to value broad based physicians, create more career opportunities for them, and build appropriate reward systems for more doctors to choose primary care specialties. We have been having a dearth of good applicants for senior residency in internal medicine as almost all of them after their MD start appearing for DM entrance exam. Hence, it becomes like a hurdle race clearing one entrance exam after the other before they enter fully into the health care system. I have come across many young doctors who though say they enjoy broad based specialty like internal medicine and find it more exciting, but enter into sub-specialty because of market pressures and our health care systems geared toward specialty-driven hospitals.
I compliment the author for voicing these concerns. Though there is a need of having adequate tertiary health care institutions through the country, it is the focus on improving primary and secondary level health care that would not only play an important role in improving the health of the people but also decrease the unnecessary load on these tertiary care centers. A good proportion of undergraduate and postgraduate training should happen at ambulatory settings in the community and in secondary level hospitals so that they are better geared up to meet the health needs of society. Through their curricula, students need to experience that quality primary and secondary level care can be as satisfying and rewarding as much as practicing in a narrow field in Hi-Tech environment.
| References|| |
Kumar R. The leadership crisis of medical profession in India: Ongoing impact on the health system. J Family Med Prim Care 2015;4:159-61.