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Need for structured training programmes for GPs and employing them fruitfully

The plight of a fresh pass out MBBS graduate is worth spending some time over if we wish to continue to attract the best and the brightest in the society to a career in medicine. I am not oblivious to the fate of other graduates in the country but as a doctor, I feel I should focus on the doctors and the patients.

Dr Kamal Mahawar
Dr Kamal Mahawar

A large number of them will work as the so-called General Practitioner (GP). The title of the job does not do justice to the immense importance it has for the profession and the patients. In any medical establishment, these are the doctors running the show. They possess a special skill set that for example I, working in a specialised bariatric unit, do not. They are astute clinicians who have the ability to recognise a self-limiting medical symptom from the one that will evolve into a serious condition. They have the clinical wisdom to differentiate a number of ill-defined symptoms and presentations that patients can present with (particularly in suburban India).

Yet, there is no structured training in India for the majority of doctors who will eventually become a General Practitioner. They are left to fend for themselves. Typically, they will work in underpaid jobs in various government and private establishments until one fine day they feel able to take a plunge into the market and open their own clinic.

One is forced to think if we can come up with a better system. Can we not create a 3-4 year training course involving academically minded GPs in each district in the country? Students will learn the grass-root medicine and for this training, they may even be prepared to go out into the smaller towns and villages. By encouraging young doctors to move out of big cities, it will also partially rectify the manpower imbalance when our cities have too many doctors competing with each other and towns and villages too few.

Of course, we will need to incentivise GPs to train and there is no doubt we will have to pay these medical graduates wages that fit a doctor. Otherwise, this will never work. And when they are finally fully trained as GPs, the government should think of employing the majority of them in a radically overhauled and properly funded Primary Health Care System where they are paid wages that a postgraduate doctor deserves and others with similar standing get. These are no small doctors. They are highly specialised doctors motivated enough to work in places most highly educated Indians don’t even want to live. They have to be paid more than what faculty in medical colleges earn if we wish to retain them in our Primary Health Centres (PHCs) and the facilities of the PHCs need upgrading to the level where they can be called clinics.

Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.

One Comment

  1. Vasumathi Sriganesh Vasumathi Sriganesh Saturday, August 27, 2016

    Dear Dr Mahawar

    I completely agree with what you have written. It is indeed a pity that every doctor today feels that he / she has to do a PG degree, when – as you mention that they can do great work if their MBBS training prepares them a bit more. There are a couple of excellent rural health initiatives (SEARCH – Gadchiroli, JSS Ganiyari – to name a couple), but we need lots more. We also have the Academy of Family Physicians of India – AFPI which is trying to revive Family Medicine as an important need in the country.

    I just wanted to mention that as a former medical librarian, I run a Not for profit initiative which trains anyone interested, in the art and science of proper literature searching and management of references. Our non profit – QMed Knowledge Foundation, specially focuses on medical students. We believe that the sooner they learn these skills, they will learn about the need for searching for evidence from the right sources and use the best evidence. I hope that if some of them choose to be GPs / Family Physicians, they will use the skills they learn, to be better physicians.


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