Dr. Robert Bad McClure’s Maharashtra Medical Council registration number is “1” on the National Medical Commission (NMC) site when you search for medical registry of India. [1], He died in 1991 in Canada at the age of 90. He is part of a “stock” of 13.01 lakh (1.301 million) doctors listed in the Indian Medical Registry, mentioned in the Lok Sabha in December 2021. [3], Dr. Ramchandra Shivaji Poredi is the first entry (No. 100) in the Bombay Medical Council’s (now defunct) list in the same registry. They were registered in 1913. He is also not alive.
Both doctors are an arbitrarily part of the 20% who are believed to have died, retired, stopped practicing, never practiced or migrated. This gives us an arbitrary number (80%) of 10.41 lakh doctors currently practicing in India, a doctor:patient (D:P) ratio of 0.74:1000 for a population of 1.40 billion (140 crore) as of December 2021 . The WHO recommendation is a minimum D:P ratio of 1:1000. Qatar has the highest D:P ratio in the world of 7.7:1000, Cuba has 6.7:1000, Spain has 4.9:1000, Switzerland has 4.0:1000, Australia has 3.2:1000, China has 1.5:1000 and Bangladesh has 0.3. :1000.
In reality though, we have no clue. No one really knows how many doctors are actually practicing in India, ie are part of the “living/practicing” list of doctors. Once a doctor has registered himself with their respective State Medical Councils, we do not have any tracking mechanism. We only use gross, inaccurate estimates.
Several papers in the last two decades have shown that the situation is very bad. The most recent is that of Anoop Karan of the Indian Institute of Public Health and his colleagues. [4] Which compares National Health Workforce Account (NHWA) numbers (taken from Indian Medical Registry) with 2018 census and National Sample Survey Office (NSSO) numbers. The article states that the number of doctors living and practicing “qualified” is likely to be 675,000 (0.5:1,000), an availability of only 53% of those registered (the other 148,000 are “doctors”, but ineligible). and there are potential quacks).
You can go back and say that the situation will improve significantly in the future. After all, we have the highest number of medical colleges in the world (595 as of January 2022) with 89395 students enrolled last year. [5], If 80% of these students complete their MBBS, and 75% of them stay in India to practice, we will add at least 53000 doctors per year.
But the population is also growing at the rate of 0.92% (1.3 crore) every year and will reach 1.52 billion or 152 crore in 2032. Suppose we add 500 additional doctors a year (which means opening at least 5-10 new medical colleges a year) then we will add 6.1 lakh practicing doctors by 2032. If we assume that 20% of the current stock of 6.75 lakh has fallen further, we will get a total of 11.6 lakh doctors in 2032, which will bring us. Ratio of 0.76/1000, which is still not enough, given the fact that the population is also getting older and will get older in the next 10 years, even more doctors and health workers will be needed.
And we are not even considering the new WHO norms of 44 healthcare workers (doctors, nurses, technologists) per 10,000 population (4.4/1000). [6], It is the same story with nurses (just twice the number of doctors) and technologists.
The chart below summarizes these doctor numbers.
We can add 5 lakh AYUSH doctors to the mix and say it improves our doctor:patient ratio, but we don’t really know how AYUSH doctors actually practice in India.
Maybe your eyes are blind to all this data. If you read Rukmini S’s new book, “Whole Numbers and Half-Truths”, you will realize that this problem with data is a typical “Indian” problem. For some reason, our DNA is wired to live off the data. Given that most national policies are based on data, which is often not enough, you can imagine the problems this “data divergence” causes. Let’s take tuberculosis for example. India is the tuberculosis capital of the world and should be the world leader in tuberculosis research… but no path-breaking study has emerged from our country, be it basic science or epidemiology or treatment… for information and updates. countries such as South Korea, South Africa and sometimes also Uganda and Mozambique.
So you can turn around and ask, “But how does this affect me?” Perhaps you have enough money and resources to find the best doctors in the best clinics and hospitals in this country. So, what difference do these doctor numbers make?
Carlo Rovelli, echoing Nagarjuna’s philosophy, writes in one of his books, “I” is a wave in a network of networks. None of us is an island and everything and everyone is interdependent. Living in India increases your chances of getting tuberculosis, dengue, malaria, typhoid, amoebiasis, etc. whether you live on the 34th floor of a building facing the Arabian Sea or whether you live in slums. Dharavi, the only difference is that if you are rich, your risk is less and you have better treatment facilities than a poor person. And yet, it’s not so straightforward. Ranchi’s richest person still won’t get immediate treatment for acute stroke as a middle-class man in Mumbai, as Ranchi lacks an acute stroke care unit, while Mumbai has at least three. Ranchi’s shortcomings are due to lack of adequate, trained manpower and infrastructure, which no amount of personal money can overcome…and so on and so forth.
In our atmasvasth In our quest to live longer, healthier lives, there’s a lot we can do to improve ourselves. health span and lifespan, But we are still dependent on the overall health infrastructure of the region and the country in which we live. On one hand, we are one of the few countries with a Bluetooth based COVID-19 app that works, we have a digital COVID-19 vaccination. The certificate is valid worldwide and we recently launched a National Health ID, which will hopefully revolutionize patient care in the coming decades. And yet, we have no clue how many doctors (and nurses and technologists), who are the backbone of treatment delivery in India, actually work and practice in the country.
How difficult can it be to get the data? All the health ministry has to do is take a bunch of smart kids, give them access to income tax data (find doctors who list professional medical income and cross-check with the registry list), those above age Knock-off everyone. 85, Liaise with Medical Boards of US, UK, Canada, Australia and similar countries where Indian doctors migrate and find out how many first generation Indians are practicing there and cross reference them with registry list Do… it can be done. We may still have some gaps, but we will have a better idea of the manpower situation.
Echoing the views of Rukmini in her book…Accurate data is the foundation on which good policies are made. Our soulful quest to live longer, healthier lives is dependent on our nation’s ability to provide optimal healthcare, which in turn depends on healthcare workers, particularly doctors and nurses. To begin with, we need to know how many people are actually practicing in India.
Footnote:
1. https://www.nmc.org.in/information-desk/indian-medical-register/
2. https://www.maharashtramedicalcouncil.in/frmRmpList.aspx
3. http://164.100.24.220/loksabhaquestions/qhindi/177/AU2299.pdf
4. Karan A. et al. We Resource Health. 2021 Mar 22; 19(1): 39
5. https://www.nmc.org.in/information-desk/for-students-to-study-in-india/list-of-college-teaching-mbbs/
5. https://www.nmc.org.in/information-desk/for-students-to-study-in-india/list-of-college-teaching-mbbs
6. https://apps.who.int/iris/handle/10665/334226
Disclaimer
The views expressed above are those of the author.
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