Family Medicine in India
Is Family Medicine new to India?
Family Practice/ General Practice has been the main modality of health care delivery in India. However there has been a general reluctance among specialists in accepting "family medicine" as a separate academic specialty.
The licensing procedure in India allows doctors to practice medicine immediately after completion of graduate qualification i.e. MBBS. There is a large gap in the ratio of graduate(MBBS) and post graduate(MD/MS) training positions. As a result majority of MBBS students do not get opportunity for further career enhancement, leading to large number of them aspiring to migrating to UK, USA and other countries. It has been long realized that India is short of skilled primary care physicians. The development of health facilitates in have largely remained specialty and subspecialty based. Islands of clinical excellence have developed which do not serve the large sections of the populations. MBBS training has failed to evolve and able to cater community needs directly due to long pending medical education reforms. Due to rapid advancement of medical science during in last few decades, the MBBS level general practice is not able to cater to the primary health care needs of Urban, semi urban and rural & remote populations. As a result there has been a gradual decline in the prestige of general practice.
Development of Academic Family Medicine in India
Family Medicine has been recognized as a separate specialty by Medical Council of India since 1983 by ammendment in first schedule of MCI act. DNB (Diplomate of National Board) -Family Medicine has been a recognized post graduate qualification since 1983. Since than family medicine has evolved as structured three year residency based training program.
This training program is largely based and delivered through NBE ( National Board of Examination - a body of ministry of health & family welfare, Govt of India( www.natboard.nic.in ) accredited hospitals. It was 2002 when Government of India specially accepted the importance of the specialty of "Family Medicine" in the "National Health Policy 2002" and committed for urgent upliftment of this medical specialty. Since than the number NBE accredited institutions providing family medicine residency training has risen sharply. At present there are 670 DNB post graduate training posts available annually at 292 NBE accredited health institutions in India.
Future of Family Medicine in India:
The success of several ambitious government projects of government of India like "National Rural Health Mission" largely depend of revival of "Family Medicine" in India. Also for the high end, private, hi tech health facilities to survive, growth of family medicine is essential. No tertiary care system can survive develop without an efficient primary care delivery system. With limited paying capacity and out of pocket spending for health high end tertiary care facilitates depend on growth of Health insurance in India. For health insurance sector to survive, the development of family medicine is vital.
Medical Education Reforms and Family Medicine in India
Family Medicine offers unique opportunity to current medical education reform in India. With existing infrastructure and shortage of faculty for sub specialties, thousands of post graduate family medicine seats can be created by initiating MD - Family Medicine. Three to four year duration of these family medicine PG seats can be distributed between training at Medical College tertiary level hospital, District Hospitals and Primary Health Centers/ Urban Community health canters. This approach will efficiently address acute shortage of physicians in rural and underserved populations.