In our hurry to import overseas Indian medical practitioners, let us not make compromises on licensing and patient care.
In recent years, there has been much brouhaha over medical tourism and the use of telemedicine to get opinions from doctors far away. While these concepts are beneficial in certain specific situations, they can be dangerous if not applied prudently. Globalisation of medicine is not as straightforward as setting up a call centre in a country where the cost is lower or employing a software engineer in a developing country to make a product for the first world. Plus, patients as well as their doctors are less portable across the globe than say an iPad or its maker.
Aspects of patient care
The Indian government is in the process of enacting laws to allow doctors who hold the Overseas Citizens of India status to practise in India and even become faculty members in medical colleges. In a country where allopathic doctors are in short supply, even though this may seem like a good move, it is not necessarily so, unless adequate measures are put in place. Most countries allow doctors trained elsewhere to practise only after going through rigorous requirements including passing their licensing examination and training in their country.
These processes are absolutely necessary to make sure that the practitioner is aware of local diseases as well as social, cultural, and ethical aspects of patient care that are unique to the region.
Imagine an overseas citizen of India who could be born, raised and trained as a doctor in the United States going to rural India to work for a few months with little understanding or experience of treating infectious diseases like tuberculosis and malaria or inherited diseases like thalassaemia. All of these are much more prevalent in India and someone trained locally would be better qualified to treat them. Even for those who were born and trained in India, it would not be easy after practising abroad for years. This move by the Indian government is obviously to woo the large number of non-resident Indian doctors in the U.S. and the United Kingdom. It seems ill conceived if we are to believe recent media reports of the possibility of allowing them to work in district hospitals for short periods without registration and necessary clearance. India needs good general practitioners more than super specialists, who seem to be in abundance nowadays in the urban areas. It needs doctors for the poor and the rural population and not necessarily for corporate hospital patients who can afford such facilities. These are the circumstances where the “foreign” doctor is likely to be all at sea while trying to treat diseases which are not commonly encountered in the western world. This is also likely to be the scenario for faculty positions, which are most often in medical colleges affiliated with government hospitals. The Indian diaspora is pushing for new rules in the hope of satisfying the inner yearning to give something back to the homeland. This ambition of brief stints by a handful does not warrant a major policy change that may result in the creation of loopholes in the system or even adverse patient outcomes.
The western world is coming up with stricter requirements for doctors to maintain certification like ongoing periodic examinations, continuing medical education and documentation of satisfactory patient care in local conditions. To allow a doctor to practise in India without satisfying necessary prerequisites would be regressive. Instead, the government should look to alternative strategies like establishing programmes to train rural general practitioners or physician assistants to address the shortage of health-care providers.
(The author is a neurologist at Children's Hospital Los Angeles and faculty member at Keck School of Medicine of the University of Southern California.)
More than 5 decades ago I asked my father to use his influence to get me transferred from one medical school to another "for better training". My father declined.He asked me to bring his medicine book, " Savill's Text Book of Clinical Medicine " and then showed me excerpts from that book. " A physician learns more from one mistake than from a multitude of successfully treated cases. Medical student feels he does not learn. It is partly true and partly not. Learning is a continual process, etc. ". Incidentally as it turned out I learned better medicine by staying in the original medical college which since earned a big name.Had I got transferred to any medical school under the Madras State Government it would have been a disaster for me. I thank my father with his immense wisdom and Savill's Text Book of Medicine. A physician who standing at the foot end of the patient's bed orders around does not learn so much as the one who takes a syringe and irrigates a bleeding bladder said Pye.
** India needs more doctors. Our doctors(Indians) are the best that
needs to be brought back. They will soon get acclimatized to Indian
Conditions. Or atleast will bring stricter regulations, higher studies
for diseases and will work for costlier hospitals. Still acceptable
than nothing.
** Alongwith this, government should train Doctors specifically for
Rural-semi urban setup
** Govt should, in rural-semi urban areas, provide better hospital and
residential facilities.
I have worked in the UK for 2 years from 2009. It was not easy to get a license to
practise. I had to pass PLAB which, apart from assessing clinical competence also includes a language test. Even after passing PLAB I was only allowed to work in Approved Practise Setting (APS) hospitals. APS settings ensure that the overseas doctor is monitored and supervised for at least a year.
Even stricter rules for Registration and for staying registered have recently been announced in the UK. Called Revalidation, it will allow a doctor to hold a license to practise for just five years after which his competence will be thoroughly reassessed. I agree with Dr Desai that doctors in a particular geographical location should be thoroughly familiar with it's epidemiological and cultural aspects. Diseases like tuberculosis, kangri cancer, worm obstruction, biliary ascariasis and hydatid disease are very prevalent in my part of the country; very tough for the western qualified doctor to diagnose indeed!
Being a doctor trained in chennai and now living in US, I disagree that doctors living abroad forget pathology in india. Being entirely in the US does not mean that he/she is capable enough to treat anything seen commonly in US. Same applies in india. One only builds knowledge and experience as we grow and each person has a different caliber. That is the whole purpose that learned academies bring out policy statements/protocols to be followed. India is experiencing "transition chaos" as in other fields.Our academies should play more pro-active role and bring guidelines to place so that it is easy for doctors/institutions to have better success rates. Doctors should be made to meet continuing medical education requirements as in US.
A well written article with varied comments. it is not the seniors or the ones in practice who makes tons of money who may be afraid of importing n r i doctors on the one side because these n r i doctors can work only in corporate hospitals who are answerable to share holders and not the patients!!!even if these doctors from abroad come to India it would take long for getting acclimatised. of course as they do abroad these doctors have to undergo specialized training in Indian conditions and to live our type of living!!!can they work without those newest diagnostic gadgets i.e. like our doctors who ask us to put out our tongues,see the pulse and use the steth and just give medicines.
Most Nri doctors would have done mbbs from india. So there is absolutely no logic to even
conduct a test to return to practicing in India. What is needed is a strong Code of practice
which then ensures that any practicing doctor in India irrespective of RI or NRI, follows
standards of care.
I think he is simply hitting back the western world, since US does have stringemt requalifying requirements for foreign educated physicians to practice here. Quid pro quo!!
The author has hit the nail on its head. Here in London my wife had TB. At the beginning they took a long time even for diagnosis and start the medication. They were more aware of the lung TB but lacked expertise when it came to TB in lymph nodes. Though the type of TB was not communicable, they unnecessarily put her in secluded ward etc. that were precautions taken for lung TB. Then the treatment extended for a longer duration as the doctors didn't give the dosage of sufficient strength, and were going in a set step by step procedure that is more applicable to the lung TB and local patients. Finally my wife had to come to India and get treated by the family doctor and everything was solved in 6 to 8 months. Imagine such a doctor from London coming to India and start practicing straight away, which can put lives in danger for no fault of the doctor or the patient. Better they write local exams and re-qualify here.
Let us leave issues concerning the use of foreign trained doctors in
India. We have issues concerning the safety of doctors and patients in
India. Sanitation and Hygiene is at the lowest levels in rural India.
Running water, uninterrupted power, and good housing are luxuries in
some parts of the country.
I live abroad & know this - our education, orientation, & adherence to
law are hindrances to practice medicine, law etc in India. We are
trained with a certain mindset - for example, needles are used only in
rare cases, with children. That would be in conflict when parents
believe that only doctors who administer injections are "good doctors",
& I say this from real experience in rural India.
The government seems to be in disarray- it is unable to organize,
discipline and motivate doctors, lawyers and airline pilots - it just
wants to open these sectors to foreigners, without any regard to
cultural sensitivities or practicality. Why this craze for everything
"Foreign"?
I m a PG Scholar of PSM (PREVENTIVE AND SOCIAL MEDICINE) UNANI,
National Institute of Unani Medicine, Bangalore.
A we know the AYUSH doctors are in lakhs in INDIA, and AYUSH doctors
are well aware about the local diseases then it is better to appoint
them in rural arease where doctors are needed. AYUSH doctors are doing
internship for 6 months from government Allopathic hospital, which is
mandatory.
Imagine an overseas citizen of India who could be born, raised and
trained as a doctor in the United States going to rural India to work
for a few months with little understanding or experience of treating
infectious diseases like tuberculosis and malaria or inherited
diseases like thalassaemia. All of these are much more prevalent in
India and someone trained locally would be better qualified to treat
them. Even for those who were born and trained in India, it would not
be easy after practising abroad for year.
so,I request Indian Government should look in this way.
Though I agree to a certain degree with the author, I do not think his argument is correct. Having qualified in India and working in a western country, I know very well that the safeguards are stricter and enforceable in western countries. The eligibility practice test is mainly because of the various non uniform curriculum and the irregularities by which one can qualify as a doctor in some of the countries.
A practicing doctor in this country, usually a specialist, is unlikely to go to a rural area and treat patients in a primary health centre as quoted as an example. They will be practicing in their specialities. One has to undergo 4-5 years of training after a PG degree and get accredited to be called a consultant. Further more they have to prove that they are continuing with education and are up to date with the evolving technology. In India getting a postgraduate degree is sufficient to call himself a consultant! I do not know of any doctor who was stuck off for irregularities.
The author is only reinstating American point of view. The healthcare costs in US have spiralled like skyscrapers. Many NRI Doctors have come back to India and have been successful. The Indian government must welcome foreign trained Indian doctors with open arms.
I disagree with the above article. Doctors actually adapt quite quickly
because their training allows them to assimilate and learn when faced
with new situations. I practice in Canada, and protectionism is now rampant around the world. As a doctor who is licensed and has practiced
on four different continent over the last 30 years, I can certainly say
that NRI doctors who decide to practice in India will be a great asset,
particularly in teaching hospitals.
I would even suggest that PIOs be allowed to practice.
Let's take this a step further and look at the allopathic system of medicine with honesty. Today it is just an extension of the pharmaceutical industry. The USA, arguably the nation with the maximum amount of know-how in this area has the highest per capita drug consumption! This means their people are not healthy and their diseases are NOT being cured by their doctors! Why should we import anybody from that system?
Hindu should not publish letters to the editor under the header Op-ed.
This article has got a small input about the overseas doctor's need to
know local conditions. Would have been a 100 word letter
The author states that a doctor who has lived and trained in the US or UK attempting to treat TB,Thalassaemia or malaria would not understand the local practices. It is true but there are some international guiding principles and irrespective of where you are from, nothing much can be done if the local setting does not permit it. Moreover most of the doctors who come to India are anyway the juniors and they find it a very educative and informative. The senior consultants who have been in the game for long know what not to do and get into a controversy.
I agree. Although there is a need for this give and take between the physicians from both the countries - in private and academic settings. I can conceive many exchange opportunities to eventually enhance the quality of patient care and safety.
Jay Desai is trying desperately to maintain "protectionism" for Indian allopathic medicine. For decades, his arguments have been used to prevent overseas doctors from practising in India. The results are there for all to see. Shoddy and third rate medical care for the poor and in rural areas while the wealthy and powerful either get treated at corporate hospitals in metros or go abroad directly. Most specialist doctors in metros have qualified overseas anyway. If our Indian medical education is so wonderful, what is there to fear from the entry of overseas qualified doctors? It is absurd to suggest that American doctors cannot treat malaria or Australian doctors cannot treat snake bites. In fact there are more specific anti snake venoms developed in Australia that we can only dream about here. The government must be commended for taking a long overdue step in spite of opponents like Desai. If implemented rightly, it will certainly change the quality of medical care in rural areas.
OUT OF TOUCH
I Totally Disagree with Dr.Desai who seems to be out of touch with current reality, India needs more Doctors, that too to treat the middle and lower income population. nowadays we are seeing reverse migration as Doctors are relocating to India, which is of very good benefit to the patients. NRI Doctors are an asset to the Medical Faculty in India. They bring with them very good communication skills and will always put patients first. They will be play an proactive role in modernising medical education.an NRI Dr. will be willing to learn and improve his practice and will be more open to criticisms. To say a Doctor who undergoes regular scrutiny of his knowledge and skills in the western world not fit enough to practice is absurd.
Are there any regular checks or scrutiny or examinations done for Doctors practising in India???
I am shocked to read this article. The article is claimed to be written by a doctor in the US. I have checked the Keck School of Medicine website, Children's hospital of Los Angeles website and the California Medical Board website and no one by this name exists. I hope 'The Hindu' will continue to maintain a high standards.
While I agree with some points you make , I disagree with the notion that only those doctors who were born and brought up in India will have the correct knowledge of treating local diseases. In fact many government junior Doctors are on strike now a days (one state after the other) and one of their demands is to reduce compulsory time to serve in rural areas (No none has interest to do public service). How then will these doctors with ("I am born in India") tag help? After all knowledge is knowledge, it is gained by thorough experience
and over years of practice.
Are you saying that a worlds top Doctor form say NY city simply will not know how to treat an disease in Indian village? Also putting red tape and not allowing foreigners to come back will ensure India never has doctors of good quality and will also ensure that the young junior doctors will have no competition. I do not see how this will improve the situation
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