Where has the Indian Family Doctor gone?
Like most families in Mumbai, we are migrants. My parents moved here almost 45 years ago and still think home is elsewhere in India. And among the many homely things they pine for, they pine for their family doctor. This Doctor Uncle was a friend to the family and knew all its members, as ready to comfort in times of need as to pull you up for not being careful with your health. He is a mythical character in my life. Many generations of Indians have grown up with this idea of the Doctor Uncle, as is evident from his appearance in Bollywood movies. His absence is a common woe in cities.
Dr. Rana Mehta, Executive Director at PricewaterhouseCoopers (PwC) India, estimates there are about 200,000 Family Doctor clinics in India. That works out to roughly 0.16 GPs per 1,000 people. In stark contrast, Canada has 10 GPs per 1,000.
So is this just a natural decline? Have their numbers dwindled because they’re simply no longer needed? Do they really offer something different from a visit to the specialist or multi-specialty hospital?
We think they do, or at least did. By virtue of practicing in the same area for years and caring for the same families across generations, the GP is well aware of the general health of the community and is emotionally invested in their well-being. Since he is exposed to the full range of ailments prevalent in a community at any one time, he is best placed to play a key role beyond just making people better; he can also educate them about prevention.
With urbanisation in India is ongoing, along with the consequent expansion of large and specialty hospitals, generalists have become increasingly scarce, and home visits a thing of the past. India does not offer a degree in family medicine after graduation. Of close to 8,000 seats that are reserved for a 3-year post-graduatecourse offered by the Ministry of Health and Family Welfare in India, only five to six percent of seats are allotted to family medicine.
Doctors themselves seem to prefer specialisation as well. Dr Shantanu Chattopadhyay, founder of NationWide, a primary healthcare services provider, says, “If you go to a medical college today, probably only three in a class of 100 would like to be general physicians.” India produces nearly 42,000 specialist MBBS doctors every year. But of these, only 8,000 to 10,000 take up general medical practice as a profession. The complaint against these MBBS doctorsis that they are merely ‘disease-curers’ and not ‘community healthcare managers’. Many feel these healthcare professionals are less personally involved and their patient interactions more transactional, and less rooted in trust.
Clinic chains like Healthspring are attempting to fill this gap. They provide a network of clinics across India and offer annual plans for individuals and families. Services include medical testing and family physician services along with access to specialists. The offerings are holistic and extend to nutritionists and dieticians. Healthspring promises services which have been timed to be convenient for working couples. They position themselves as wellness consultants.
While these offerings are definitely making healthcare more personalised, they are still a far-cry from being personal. After all, Doctor Uncle did not offer you packages for your health, he just offered concern and guidance. Even as the modern medical community offers better service and accountability, the space for a more genuine emotional investment in the health of a community seems unfilled in new urban India.
Health through the Culture Lens is a weekly series exploring important cultural currents in health and pharma
- Article by Sneha Chaturvedi