The real challenge lies not just in producing more doctors but in placing the right specialists in the right locations to provide quality care. Currently, 30% of MBBS doctors miss out on clinical PG training, leaving gaps in fields like pediatrics, obstetrics, surgery, and anesthesia. Moreover, non-clinical PG seats often remain vacant, as they are not chosen by MBBS doctors as they don't directly contribute to patient care.

With a significant number of doctors unable to pursue clinical postgraduate training, the health care system is burdened with an inadequate specialist workforce. Rural and underserved areas are particularly affected, where timely interventions are crucial for improving health outcomes. For example, the lack of obstetricians in remote regions contributes to high neonatal and maternal mortality rates.

To bridge this gap, we must shift from focusing on just medical education to enhancing skill based medical training. By introducing National Medical Commission (NMC)-approved short but focused one-year problem-oriented courses in specialised areas like obstetric care (excluding gynaecology), pediatric outpatient care, diabetes management, chronic lung diseases, and non-invasive cardiology, we can equip these doctors to address community-specific health issues. We can also introduce courses that focus only on developing doctors who are very capable of providing just in-patient care. This will reduce unnecessary hospital admissions and help provide good care for the few patients who do need to get admitted. These doctors could be granted restricted licenses to practice in designated geographic areas, delivering timely, high-quality care. For instance, obstetric-trained doctors in rural areas could significantly lower neonatal and maternal mortality rates by providing timely interventions and early referrals. The fact that there is demand for such courses is validated by the fact MBBS students enroll in various online courses that are as short as even two weeks long and are not supervised, regulated, or authorised by any Indian regulatory body governed by the Indian government. These are offered by many private vendors with very little practical training and are quite expensive as well.

The current practice of requiring MBBS doctors to pursue post-graduate training in non-clinical specialties like anatomy, physiology, and biochemistry is unnecessary. In countries like the United States (US), these subjects are handled by BSc and MSc graduates who serve as faculty in medical colleges. If the NMC reconsiders this policy, it will eliminate the need to lower National Eligibility cum Entrance Test-PG cut-off scores to fill vacant non-clinical seats and would free up MBBS doctors to focus on patient care. This will help us utilise our entire pool of MBBS doctors for patient care and speed up the process of improving health care in remote areas.

To enhance clinical training, high-quality centres with rigorous oversight are essential. Collaboration with the private sector for faculty and infrastructure can address this need. The NMC should move away from relying solely on bed numbers for accreditation and instead focus on patient outcomes and the quality of faculty. Additionally, the government must enforce the restricted licences, ensuring these doctors serve only within their assigned regions or locations with proper supervision.

Telemedicine and digital learning platforms can play a crucial role in bridging the training gap. By leveraging technology, doctors in remote areas can access specialised knowledge and receive guidance from experienced mentors. This approach not only enhances their skills but also improves patient outcomes.

Addressing this issue requires all stakeholders to set aside preconceived notions and work toward the common goal of improving healthcare access and outcomes. By adopting innovative solutions and leveraging private sector resources, we can not only increase the number of doctors but also ensure they reach the communities that need them most. The PG seat crisis for MBBS doctors is a multi-faceted challenge that demands strategic reforms. By focusing on skill-based training, rethinking non-clinical specialties, and strengthening clinical education through collaboration and technology, we can create a robust health care system that caters to the diverse needs of our population. Only through such holistic measures can we bridge the gap between the increasing number of MBBS graduates and the limited availability of PG seats, ultimately enhancing health care delivery across the country.

This article is authored by Dr Arvind Balakrishna Kasaragod, director, Medical Services, Cloudnine Group of Hospitals, Bengaluru.