Doctors who don't practise but teach can be roped in: S Vaitheeswaran

S Vaitheeswaran talks about the possible ways to bridge the gap in skilled manpower in the sector

One of the first private pioneers in medical education in India, the Manipal group currently has roughly 3000 beds in its teaching hospitals and more recently with its acquisition of Columbia Asia, it has more than 3500 treating beds across 27 hospitals, taking the total bed capacity to just below 7000. In total, it has around 4000 doctors in its ecosystem.
 
Manipal Education and Medical Group CEO and board member of Manipal Global Education Services, S Vaitheeswaran spoke to Anjuli Bhargava on how the group is attempting to do its bit, possible ways for bridging the gap in skilled manpower in the sector both during COVID and post it and on what he’d like to see in medical education in India over a period of time. Excerpts from a detailed chat:

 
What can be done immediately to augment the supply of doctors and healthcare professionals?
 

There are almost 300 medical colleges in the country with teaching doctors who don’t practice but mainly teach. Many of them can be pulled in to treat or if nothing else to tele-consult and you may have an additional pool of almost 15,000-odd competent, medically qualified doctors who can allay people’s fears. A lot of people are asymptomatic or have mild symptoms that can be managed with some doctor guidance at home itself. We are currently exploring this for our own pool of teaching and treating doctors. If each of them can give even 2-3 hours a day on the phone, this can reduce the panic that has set in and ameliorate the situation.

 
Then, we have a fairly large pool of army doctors from AFMC, senior defence doctors and male and female nurses who may have retired recently but are able, competent, experienced and in good health themselves. I’d expect this to be almost 2500-4000 in number. They can be pulled in almost immediately across the country, many can give even 6-8 hours a day to attend to patients. But this needs the center and states to think on their feet, coordinate and set such protocols in place.
 
What have you as a group in this space done for this national emergency?

 
65-70% of our total bed capacity has been diverted to COVID care. Other elective care, routine surgeries or medical procedures are being delayed wherever reasonably possible. We have pulled in our teaching doctors as well. An average of 2500 RT PCR tests are being done everyday across facilities. Over 100 off-facility camps have been done in Bengaluru over the last few months. We are also involved with the vaccine rollout kiosks and are holding camps. In a few cities, we have activated home care units that are helping those who may need attention but not hospitalisation in the cities where we have hospitals, Manipal or Columbia Asia ones.  As we speak, we are trying to set up a formal tele-consulting system with our 4000-odd doctors advising patients for 2-4 hours a day including our teaching doctors. A large panel for tele-consulting that can allay most of the fears and anxieties of patients: am I deteriorating, can I manage this at home, mild medication for treating symptoms can be dealt with. This is city agnostic and can help reduce the panic too. We are pitching in a bigger way too with government efforts wherever asked. It is important that the government is not too prescriptive on this front as well. If a non-COVID patient requires treatment, the discretion must be left to the doctor not to some regulator sitting far away. Let’s not swing the pendulum entirely.

 
When we closed down the country, what we as a country perhaps failed to ramp up our home or outside hospital care facilities like they are now trying in Delhi instead of only focussing on large hospitals like AIIMs or Max. People would have had access in this wave to a reasonable level of care - a level below Remdesivir patients - outside the big hospitals and not just in the metros but even in smaller towns. I think we missed the boat.
 
The pandemic may have sharply highlighted the gap but why is there a shortage of doctors even in the normal course of things?

 
There is a shortage of doctors, nurses and technicians even in normal times. We have 1.3 to 1.5 doctors for every 1000 people. Medical seats available in India are around 80,000 where aspirants are 1.5 million.
 
Let me talk of the supply side. Setting up a medical school of 150 students requires you to have a 750 bed hospital (every seat needs 5 teaching hospital beds). If we don’t include land, the cost of setting up a 150-bed teaching facility would range between Rs 150-200 crore. Raising money to set up such facilities is not easy since in India higher education is a not for profit. Outside of India, in most countries, higher education is for profit. Then, the process is fairly elaborate too in terms of procedures, regulations to be complied with and can take years. Qualified teachers are not easy to find and faculty needs are prescribed by the authorities. Government prescribed requirements for specialisations and sub specialisations lead to onerous faculty numbers that are not always easy to meet.

 
Let me highlight the positives too. We have just set up a medical school in Jamshedpur with Tata’s - a private, private partnership, Manipal-Tata Medical College  - in exactly two years, which is unusual as normally the process would take 3-4 years typically but we had the full support of the Jharkhand government with quick approvals. 150 students have joined this year and at full capacity, the facility will produce 250 doctors a year. So there are some islands of good success stories. But one needs 50 such instances in the country for the next ten years at least to bridge the gap. In general let me say that the norms and regulations required need to be less prescriptive and more facilitative.

 
Based on your experience in other countries, what can India do to augment its supply of doctors and other healthcare staff in the more immediate future?
 
There has been talk of looking at non allopathic solutions but I will limit myself to allopathy. We run a 2000 student medical college in Antigua, Caribbean, 95% of them Americans. Medical education costs in the US can be prohibitive so the US allowed many islands in the Caribbean and parts of South America are catering to this need and many private groups have set up colleges that are accredited by the US medical council.

 
Becoming an MD in the US requires a student to meet many criteria but there is another category of professionals who fill in and who assist the senior physicians: precision assistants. These courses are strongly focussed on anatomy, biology and internal medicine. In two years’ time, they are certified physician assistants who work with doctors and they earn upwards of US $ 150,000 a year at a very young age. Applicants for PAs annually in the US are around 35,000 and around half the number qualify.
 
Even in India, we could look at something like this. Overall, it is a pity that the old family doctor practice is all but vanishing. Few people need specialised care. Mostly, people need care for basic levels of ailments. Everybody need not be a full MBBS or specialise in some discipline. Why not look at it below? Alternate forms of reduced medical education that can serve your needs. I think if you want to increase the supply chain, you need to widen the funnel, not restrict it.

 
In a crisis, let me cite an example of quick decision making that helped alleviate the shortage of manpower in the US. The US students spend 2.5 years in our college in Antigua and do their clinical rotations in the US in hospitals where our college has tie ups. Last year due to COVID, even the clinical rotations were done digitally and the US medical council supported this for all the medical colleges accredited with them in just one week.  So the students who were ready could be pulled in to help with the crisis. Such quick decision making helps alleviate shortages. I would reckon it would not happen so quickly in India.