POLICY
Mind the Training Gap The Medical Council of India (MCI) is slowly taking positive steps towards educating a new emergency physician workforce. by dr. subroto das
A
decade and a half since the advent of Academic Emergency Medicine in India, the struggle to institutionalize EM in the country has gathered a never seen before momentum. This has been due, in part, to organizations like the Society for Emergency Medicine, India (SEMI), continually emphasizing emergency medicine before the Medical Council of India (MCI), the nation’s nodal agency responsible for accreditation of all Medical Courses in India. It started in 1988 when the MCI instituted a course by the name of Accident & Emergency Medicine as the 24th specialty for post-graduate eduction. The specialty was then abolished in 2000 because, according to MCI, because it overlapped with other branches of medicine. Soon after, private universities began to feel the need for this course of study and added it back into the curriculum. These private programs had the support of foreign institutes, including some partnerships which still continue to this day. In 2009, MCI awoke to the emergency medicine needs of a country of more than a billion and granted permission to start post-graduate training in two of India’s premier medical Colleges. At this point, emergency medicine became the 30th specialty recognized by MCI in India. It was a joyous moment for more than a 1000 practising emergency physicians, most of them qualified through collaborative programs between Indian Institutes and UK or US-based academic organisations. Into this new decade, MCI has taken further steps, now expanding the accreditation to six medical colleges and also recognizing the UK-based MEM degrees, courses which are available in the country through Indian affiliates like the Apollo Hospital Group, arguably India’s biggest chain of tertiary care hospitals. MCI has also set guidelines for faculty development in EM and minimum qualifications for
8
January 2012 // Emergency Physicians International
teaching faculty. While these are positive steps, they are not enough. There are 300 public medical colleges and a growing number of private institutions, all capable of conferring the emergency medicine degree. The need is undeniable. The Ministry of Health and Family Welfare and the MCI both state that the doctor to population ratio is 1:1722. Though 600,000 physicians are registered to practice, the actual number is far less due to emigration and retirements. In actuality, there are only about 50 to 60 doctors for every 100,000 people, and only about 1000 total practice emergency medicine. According to SEMI President Dr. V. P. Chandrasekharan, for India’s population of 1.2 billion, at least 10,000 emergency physicians are needed. This kind of increase in the physician workforce would take time. If today MCI were to permit two EM seats per medical college, 628 graduates would graduate every academic year (after an initial three years). That means that to attain a goal of 12,000 emergency physicians it will take 19 years (assuming that population growth rate is zero, which is impossible). Many experts in the country feel that the situation can be addressed differently: There were and still are many emergency training courses available in India. As there were no guidelines when these courses were started, training periods vary. Fellowships and degrees are still being awarded by private and foreign universities. According to Dr Chandrasekharan, the A&E training is similar to any other discipline offered by MCI. Moreover, MD A&E courses were formed in a structured manner similar to MCI recognized courses and the syllabus and curriculum set by board of studies of respective universities. These courses need to be evaluated, streamlined if necessary, and recognised by MCI to increase the number of qualified EPs. Moreover, with at least 45 publicly-funded medical colleges in readiness to have EM courses, their recognition need to be fast-tracked. Many experts, led by SEMI, also feel that MCI needs to reexamine its faculty development criteria. As it stands, the Council has ignored the existing EPs who have been trained in this specialty. The MCI notifications clearly state that MDs in general medicine, pulmonology, anesthesiology and MS (post-graduate) in general surgery/orthopedics with two years work experience in emergency medicine can be a faculty. While the 1st generation of EM teachers in the United States in the 1960s emerged from these various specialties, India needs to expedite this process and quickly raise the quality of EM training. Only then will the country be able to deliver high quality emergency care to each of its citizens. In all fairness to MCI, despite the pulls and pushes, it has taken steps to champion EM in India. Whoever, takes the credit for pushing MCI, the fact remains that the council has taken EM in right earnest, calling for frequent meetings with stakeholders, the most recent being in September 2011, to discuss expansion of EM courses and involve the private sector to speed up the development.