India’s 13 lakh doctors (10 lakh practising) translate to a ratio of 1 active MBBS doctor for every 1,343 people. According to the World Health Organization, India faces a shortage of 15.4 lakh doctors, particularly specialists, with just 0.3 specialists per 1,000 population.
An immediate solution to address this, would be to use existing hospitals to produce specialists through DNB (Diplomate of the National Board). Over 1,000 large facilities in the country are accredited to the National Board of Examinations in Medical Sciences (NBEMS) and contribute around 12,000 DNB/DrNB/FNB specialist seats. But there is tremendous potential to leverage the network of mid-sized hospitals to upgrade the academic framework and bridge the gap for specialists.
The subsidy gap in DNB must be financed. Private hospitals spend ₹10-15 lakhs per DNB student annually. There is a huge subsidy for DNB students. Compared to a private medical college specialist course costing ₹25-30 lakhs per year for MD/MS degree, it costs between ₹50,000 to ₹2.5 lakh annually for DNB students. Clearly, the financing cost of the programme can be paid off after graduation by DNB students through education loans.
Along with closing the subsidy gap, there is also a need to create visibility around the value of DNB vs MD/MS to address a perception gap among patients and students. There could be a common certificate for MD/MS and DNB, and MBBS students may be counseled to join DNB programmes.
Processes must be standardised. A common teachers’ accreditation cell for NMC and NBE is essential to standardise and improve the quality of faculty. There should be a fixed schedule for admissions and exams with no changes barring emergencies. Raising the faculty’s retirement age can create an adequate talent pool of teachers. Qualified professionals from outside India can be considered for NBE appointments.
More seats needed
Seats need to be increased in the most in-demand specialties to meet the demand for more specialists. More applications can be encouraged towards specialties that are mutually beneficial for all stakeholders.
It also is critical to re-start accreditation to Standalone Diagnostic Labs and Radiology Centers for DNB training in courses like Pathology which was earlier provided by NBEMS. There are three lakh labs in India with only about 7,000 odd specialists. Hence, there is a dire need to produce more specialists.
These measures can help create 5,000-10,000 additional DNB seats annually without compromising quality, and thereby, reduce the shortage of specialists.
(The doctor is Chairman, Manipal Health Enterprise. Views are personal.)