NEWS

Doctors with MD/DNB (Family Medicine) to be appointed at CHCs, sub-district hospitals

Monday, May 6, 2013

New Delhi: The union health ministry has asked all the state health departments to make MD/DNB (Family Medicine) a desirable qualification for posting doctors at community health centres (CHCs) and sub-district hospitals.

The ministry has also directed state health departments to encourage medical colleges in their state to start a course in MD (Family Medicine) with approval of MCI and DNB (Family Medicine) in large government hospitals.

“There is a need for an integrated generalist approach to diagnosis and treatment and the family physicians are best positioned to deliver this integrated approach to diagnosis, treatment and complete healthcare management of an individual and family,” according to Keshav Desiraju, secretary, union ministry of health and family welfare.

“A single postgraduate in Family Medicine can meet the requirement of a surgeon, obstetrician and gynaecologist, physician and a paediatrician in a CHC, besides taking care of public health needs of the community,” Desiraju said in a letter sent on May 1 to principal secretaries of medical education / health and family welfare of all states and union territories.

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19 Comments »

Comment by Dr Hemant D Shewade
2013-05-07 09:32:35

MD community medicine was started with the same concept of posting them at CHC; where they can play role of a family physician and public health specialist. As of now the job opportunities post MD are restricted to the Public Health component of Community Medicine.

Community Medicine = Family Medicine + Public Health/PSM

There is a large pool of community medicine specialists in India. Appropriate job opportunities in the health care delivery system (at least for the fresh MD doctors) will also streamline the community medicine MD training in the medical colleges in India. Practice of Community Medicine will get streamlined.

Rather than utilizing this large pool of MD post graduates, why is this trend of starting a new speciality?

Starting anything new from the scratch is never advisable. The existing infrastructure must be utilized efficiently.

 
Comment by Dr Hemant D Shewade
2013-05-07 09:38:56

Community Medicine departments, under them, already have the infrastructure (RHTC and UHTC). Post graduates are getting trained in the RHTC / UHTC regarding managing health centres and providing health care.

Community Medicine = Family Medicine + Public Health/PSM

 
Comment by Lalji Verma
2013-05-07 10:28:31

Another illogical fiat from the government! Healthcare delivery system in the rural areas suffers from non availability of graduate MBBS doctors then how will post graduates would like to be posted to CHCs? There is a need to have national debate on how to buttress technical manpower at the PHCs and CHCs. Course in rural medicine with three years curriculum would have been suitable but was negated by the Parliamentary Committee. It is unfortunate that we are not ready to change the mind set without which nothing can be achieved.

 
Comment by Prof.Alexander John
2013-05-07 12:10:36

Can’t help wishing that ministries/decision makers would take the advice of technical experts prior to embarking on important changes to a system which is already crawling.
I agree with Dr.Hemant that Community Medicine has not received the recognition it deserves. Unless Public Health improves the health of the citizens of our country is not going to improve.Unless Primary care is given importance the medical services in our country is not going to be effective.
Encouraging the concept of Family physician and Family Medicine is good but it should not be an emotional reaction of some recent conference. The problem is that there isn’t enough Preventive medicine in the Family Medicine syllabus and one needs a lot of that in fulfilling the job responsibilities of the CHC medical officer.
I also have to disagree at this stage with Vermaji. I don’t think rural health can make do with less qualified doctors than elsewhere. Somehow we have to get doctors to like/ not dislike working in rural areas for atleast a few years.

 
Comment by Jay
2013-05-07 13:50:51

Excellent step taken…

please proceed.. MD/DNB Family Medicine is need for the society…

Great step taken.

 
Comment by Dr Hemant D Shewade
2013-05-07 14:12:17

MD family Medicine will undergo the same fate as MD community medicine.Why did community medicine not acheive its true potential? The answer is that systems were not put in place for their placement post specialization.

Community Medicine specialists have moved on to lucrative public health related job opportunities. Similarly, MD family medicine will join other lucrative private job opportunities.

There are large number of community medicine specialists. It would be more prudent to open job opportunities for them at CHC level.

We need to put systems in place, not new courses!!!

(Community Medicine = Family Medicine + Public Health/PSM)

Regards,
Dr Hemant D Shewade
Asst Professor, Community Medicine,
IGMCRI Puducherry.

 
Comment by Santosh
2013-05-07 16:16:22

Let us not be confused about Community medicine and Family medicine at this stage. Community Medicine specialists use their epidemiological skills to arrive at Community Diagnosis, formulate health policies / health programmes , implement them and monitor their functioning and impact generated over the targeted health problems identified in the community. Family physicians are multi competent physicians ,specialists of common ailments ,able to offer first contact care, comprehensive care and continuity of care to individuals irrespective of their age or sex.
While the Community medicine specialists focus over communities/populations with interventions that have a broader impact, Family physicians have to narrow down to the acute and chronic needs of individuals and families. A family physician being part of a community cannot ignore the needs of the community, however much of their training would be towards acquiring clinical skills and communication skills to address wide variety of simple and complex illnesses /family and social issues that are common in the communities they serve.

The recent Family Medicine conference was a landmark event in the history of modern India that not brought together a large number of young budding as well as experienced doctors , with a resolve to see a paradigm shift in the country’s primary health care scenario. There were a series of meaningful deliberations by the national and international faculty, and sharing of the success models of family medicine based care in India as well as other developing/developed countries.
The story of Prem Jyothi Community Hospital ,Sahibganj,a venture by a dedicated couple(Dr Isaac and Dr Vijula) both trained in family medicine proved that even at the current level of family medicine training in India they could do wonders and change the health scene of a large underserved community of a remote area of our country. We have many such devoted young doctors graduating from the medical schools who require a platform for adequate training to meet the needs of the country arising out of rising costs and largely inaccessible specialist care and complexities of ailments in a greying society, and family medicine being a counter culture movement is the right answer and the need of the hour.
In conclusion, I would say that Community Medicine and Family medicine must complement one another rather than trying to substitute one another. And this new development from the government side should not be seen as an emotional reaction, rather a far sighted key intervention that was much awaited.

Dr SL Thomas, DPH, DNB(family medicine)
drliontom@yahoo.com

 
Comment by Dr. Sumeet Singh
2013-05-07 17:23:03

Fully agree with Prof.Alexander John

Policy makers today are just following the lobbying being done now a days at various forums to raise the MD Family Medicine without judging the requirements of Health Care delivery system in India with a long term perspective and where will you put these physicians into system after a decade when you will have specialists from every branch. The scenario which Community Medicine is facing although the MCI and University curriculum of which has full potential of exposure in almost all of the branches but is not being followed.Even with the better management of existing resources we can achieve much better.

Scope of Community Medicine people has been limited to Epidemiologist work only at many places. States are not involving in planning phase, Nor in the District action Plan Preparation, ideally one Community Medicine person should be there at Block CHC level for assessment of needs and preparation of action plan, then to monitor them and able to do local staff mobilization from PHC to achieve their desired results. Many Specialists SMO are working as program officers are being working as District program Officers WHY? when you are to short of specialists A BIG WHY

Rightly said Encouraging the concept of Family physician and Family Medicine is good but it should not be an emotional reaction of some recent conference.

It will be also wastage of manpower which you are short of if you cant Sincerely offer them honourable work after completion of these courses. Even MCI coming on with some new MASTERS IN MEDICINE courses in vision 2015, will there be no clash of interests .

 
Comment by Jay
2013-05-07 17:56:05

India is not the first country to launch this subject..

there are lots of students who are taking DNB Family Medicine as a post graduate course
after MBBS after Clearing CET exam Conducted by National Board of Examinations
and are getting admissions via centralised counselling purely based on merit..
Also MD Family Medicine has started in govt. medical college Calicut.
More over AIIMS Jodhpur, Raipur, Bhubaneshwar ,Bhopal are developing the Department of Family Medicne

Such a good development will give future Post Graduate Residents of Family Medicine
to excel in the fields of DNB / MD Family Medicine and work for the society..

 
Comment by Colonel(Dr) Mohan Kubendra
2013-05-07 23:22:20

This is absolutely rubbish…. although Community Medicine was designed to include family practice, it is a pity that they have remained public health babus and at the most epedemiologists. They have never actually involved in clinical practice which is the essence of Family Medicine and the need of the nation.
In fact the equation is like this
Family Medicine= Clinical Medicine+Community Medicine+Public Health
It is for the authorities and the community to decide as to what is more appropriate for for providing comprehensive primary health care to the community

Having said that I am a great admirer of what Pubic health specialist have contributed.
But the time has come to have a big change and that change is the promotion of Family Medicine as a specialty focused on primary care and Family Practice both in rural and Urban areas.

The recent Family Medicine conference was a landmark event in the history of modern India that not only brought together a large number of young budding as well as experienced doctors , with a resolve to see a paradigm shift in the country’s primary health care scenario.
I agree with Dr Santosh that Community Medicine and Family medicine must complement one another rather than trying to substitute one another with Family Medicine taking the lead and Community Medicine should be an integral part.

 
Comment by Dr Hemant D Shewade
2013-05-08 14:49:04

What’s there in a name?
If eventually the same work (community oriented work) has to be done, why to have a separate speciality?

I agree that a good number community medicine specialists are not practising family medicine. The reason being, their job opportunities post MD is/was restricted to public health related work. If appropriate job opportunities are created Im sure, the existing MD training will get streamlined. The same will happen with Family Medicine.
There are many examples of colleges where they practice and train in community medicine, in the true sense. Its high time that the existing systems under community medicine are used in a better manner.

When the systemic problem (no long term plan for job opportunities in the health system) remains the same, how family medicine (old wine in new bottle) will change things?
Im not against family medicine. I was trained in it during my PG as a part of my community medicine training at PGI and one of the four theory papers was on family medicine.

Scope of community medicine is wider. Scope of both should be clearly defined.

(Community Medicine = Family Medicine + Public health / PSM; where
Public Health = Epidemiology + Health Promotion + health management)

Cheers!!!
Dr Hemant D Shewade
IGMCRI Puducherry

 
Comment by Colonel(Dr) Mohan Kubendra
2013-05-08 23:25:38

I once again reiterate the same work cannot by Community Medicine specialists.Both are community oriented but one is preventive practice(which is a noble way) and the other one is both Preventive and curative.
They fall acutely short of Family Medicine specialists in clinical skills and knowledge they possess purely because of the way this course is structured
I agree that the scope of Community Medicine is wider but the existing curriculum and the way it is being practiced,it can not substitute Family Medicine but can only comlement
- Colonel(Dr) Mohan Kubendra

 
Comment by Dr. sunita
2013-05-15 15:18:01

There is no problem in discussing things but the results of any debate cannot be fruitful if it is biased.

The introduction of family medicine should not be based on some assumptions or lobbying. I don’t think that any one is against family medicine. Skilled family physicians are very much needed to provide primary care. But the genuine issues which have been raised by Dr. Hemant and many is that, do the future family physicians will be ready to serve the underserved? We should learn from the past. We should honestly search for the factors why community medicine has failed to achieve its very objective of producing competent community physicians?
It is always a better idea to strengthen existing system rather than introducing new one. Is there any doubt about it? Family medicine is one of core subjects taught to the community medicine trainee. Then why we failed to produce skilled primary care physicians? Why they end up becoming public health babus not the physicians? We are likely to end up a new cadre of trained physicians with no defined role in the existing health care delivery system. Ultimately they are likely to go after private lucrative clinical jobs.

 
Comment by Dr Raman Kumar
2013-05-29 12:19:18

Family medicine is not a new speciality. Rather it is the practicing speciality of the majority of medical doctor in India namely general practitioners, family physicians, medical officers, GDMOs. Most of them do not have opportunity of residency training though. Internationally family medicine has developed from the historical tradition of general practice. Nowhere in the world it has branched out from community medicine/SPM/ Public Health.
For more information on family medicine please visit the websites of WONCA (World Organization of Family Doctors I am sure most have not heard of it http://www.globalfamilydoctor.com) Royal College of General Practice UK (NHS depends on it) American Academy of Family Physicians, College of Family Physicians of Canada. In spite people claiming here expertise in family medicine I am sure, most of them have not seen any textbook of family medicine or ever referred to a family medicine journal. I am equally sure that the MD community medicine doctors would not like to address themselves as family physicians.
In India family medicine is not branching out from community medicine. Fortunately none of the professors of community medicine ever thought family medicine concept worthy of any interest. It is the DNBs in family medicine who are raising the flag. India is the only country in the world which does not have a single professor in family medicine. Which is indeed very good thing to happen. The younger doctors have the opportunity to script its future direction.
Family medicine is not about starting MD family medicine at 360 medical colleges. MD family medicine is about conducting training at district hospital, CHC and PHC apart from training at tertiary care teaching hospitals. It is about medical doctors working at DH/CHC/PHC becoming professors of family medicine and primary care. It is not about solving public health problems on computers sitting in AC chambers.
I find opposition of family medicine by community medicine doctors very strange and amusing. Community medicine should not get threatened by emergence of family medicine. It is understandable if the clinical specialists like internist, physicians, pediatricians, surgeons, obstetricians, and anesthetists feel insecure because of family medicine. Family medicine will instantly become popular once it is available at large scale.
Emergence of family medicine is not going to impact community medicine in anyway. Community medicine/SPM will continue to exist as medicalized form of public health in India. If your feel community medicine failed in India you should retrospect and ask your teachers why it happened. The past and present faculty of community medicine have benefited from scarcity of faculty at medical colleges. Its only attraction is considered to be a secure option for getting faculty position.
The comments here reflect the fact that the present generation community medicine faculty also does not have guts to revolt against the misdeed of their seniors. Continuing of scarcity is in the interest of past and present faculty as it comes with a good retirement package (You get paid lakhs to appear in MCI inspection as rarely found/ permanently absent professor).
Keep developing formulas in your computer (community medicine = family medicine + public health and its permutations and combinations). This is neither going to secure your future, not improve status of the health of the people of our country! Squatting over space, doing nothing and not allowing others to do anything is not going to help anymore.

 
Comment by udayakumar
2014-02-06 02:17:56

Hello sir,
   I have completed my MBBS and intern on 2013..and I have scored 7000 rank in dnb entrance exam..am very much interested in medicine..with my rank I can get family medicine.. But my friends giving me negative view on the scope of fam med..and convincing me to spend another year for speciality course.. But as for myself am interested in fam med..now totally confused sir.
Kindly suggest me.. Wats the scope in private sector and gov setup. How is d pay compared to speciality fields? Is dnb fam med is approved and sufficient enough to go abroad..?
Sorry sir,as my questions may sound direct..but am really confused,coz I made my mind n now people around me giving diff opinions.

Waiting for your reply eagerly sir
UDAYAKUMAR

 
Comment by Dr Jacob JohnMS,M.Ch
2014-02-07 11:54:16

Community Medicine PG is conducted as a non clinical subject for all practical purposes except may be in CMC,Vellore. They are never trained to be a multicompetent primary care practitioner. There shouldnot be any confusion regarding this.Both are different. With the Govt planning for UHC in the 12th plan, Family medicine drs will be needed in large numbers.

 
Comment by Dr Bijayraj R
2014-02-07 13:23:43

Dear Dr Udaya Kumar,

Lets assume you have eyes and can see. Would you ask a blind man to lead you along a dimly lit path? That happens when one seeks advice from people who know nothing/ are pre-judiced about something.
Good that you are thinking independently, different from the mundane flow.

This message board is full of various seniors comments- who travelled along (or are well versed with) the family medicine (and Community medicine) route. Many commentators in this thread, such as Dr Raman Kumar, Dr Mohan Kubendra, Dr Jacob John etc. are eminent teachers, leaders and advocates of this speciality. All are successful, and most importantly, HAPPY in their own way.

There is enough material here to help you make an informed decision.

Wish you all the best
Dr Bijayraj R
In-charge, DNB FM training,
Malabar Institute of Medical Sciences,
Calicut, Kerala.

 
Comment by Kishore Chaudhry
2014-02-14 08:47:51

@UDAYAKUMAR
Few comments in this discussions have corectly pointed out the concept of Family Medicine, (say Dr. Santosh on 2013-05-07). It is important to understand that Family Medicine/ Family Practice and General Practice and Family Practice are the same. What would get intended by MD/ DNB in Family Medicine, would be the enhanced training and expertise on the subject than MBBS. The inadequacies of fresh MBBS doctors in India has been recognized and pointed out at certain fora. MBBS doctors gain more expertise on various aspects/ specialties of medicine through experience and CME. MD/ DNB would achieve that goal in a shorter period of time hopefully under a conducive environment. The hope in the sentence is due to the fact that Family Medicine cannot be taught by one specialty, although it may need to be coordinated by one department at least to begin with (say Community and Family Medicine Departments in the new AIIMS with staff largely drawn from Community Medicine. It could have been Medicine/ Surgery/ Pedatrics/ Obs & Gynae). It has been pointed out earlier in the thread that Family Medicine is not the same as Community Medicne/ PSM, although initially it may have been expected to be similar (mix of both clinical and public health). Given the huge level of National Health Programs in India, the importance of Community Medicine/ PSM/ Public Health is unquestionable and would continue.

Before I address Dr. Udayakumar’s specific questions, I would like to point out that Family Medicine experts would not be only for underserved or only for rural areas. They are likely to play an important role in private practice also, even among elite and urban areas. Success of such clinics in countries like USA is a big example, where the government further wants to promote Family Medicine. An infrastructure for Family Medicine at University of Michigan at Ann Arbor, USA (one of the top medical institutions of USA), is an example.

The answer to Dr. Udayakumar questions would lie in what he wants to do in future. It has to be realized that system of learning medicine is different in different countries. The first level of qualification as doctors in countries like USA, Canada, is MD (not MBBS) which is earned after 12 years high school + 4 years undergraduate + 4 years MD + 3 years of residency, a total of 23 years of study and training. Compare it with 12+4.5+1 = 17.5 years in India. One may argue that 4 years of undergraduate do not pertain to medicine. Not correct, as many aspects of physiology. biochemistry are mainly taught at this stage, which get passing or little details during MD (many school keep it at self reading levels).

Since Family Medicine would focus on common diseases/ problems of the country, the focus in curriculum necessarily should be and is different in different countries. If Dr. Udayakumar is looking for a better job abroad, I would suggest that he should not venture into Family Medicine because it would not provide additional recognition in USA/ Canada/ Australia, etc., and countries like Middle East/ Africa may not know how to deal with it and at the maximum may treat him at par with MBBS with experience.

Private sector in India has not yet seen MD/ DNB Family Medicine. While general MBBS largely practices outdoor, MD/ DNB Family Medicine can also take indoor duties. The specialty is new in India and the first few batches would need to prove their worth and expertise before private sector would look forward to their entry.

Government is promoting Family Medicine, which is a good step. However, the battle would be won once Departments of Family Medicine start in Medical Colleges and the concept of screening OPDs and long term follow up of common chronic dseases gains concept. Road ahead is not rosy but is definitely inportant. These new specialists on entering government sector (say at CHCs/PHCs) need to remember that patients in community (not to be confused with rural areas alone) even with public health approach do require careful examination and early detection of diseases which at present might be getting missed waiting for specialists. This step would also reduce the quantum requirement for organ/ diseases specialists in the India, keeping in mind that these organ/ disease specialists would still be insufficient to perform specialized tasks for patients referred by MD/DNB Family Medicine. The Family Mdicine people should perform common interventions and not specialized interventions leaving that for area specialists. Future would see a lot of debate on role of Family Medicine vs MBBS vs current specialists. The debate would be similar to Inrenal Medicine/ General Medicine vs other medical specialities. I am sure evetually India would find an optimum mix/ roles.

It is natural to get varied opinions as happens with any new specialty. I hope the above helps Dr. Udayakumar to take a decision for his future which largely depends on his perceived future role/ activities.

I am glad to know that the conference on Family Medicine was success and liked by many. Unfortunately, the conference was scheduled after I left Inda and thus could not participate in it. My best wishes for the specialty of Family Medicine in India.

Kishore Chaudhry, MD (PSM), DNB (Family Medicine)
Ex-Dean, AIIMS Bhopal; and Prof. & Head, Dept of Community & Family Medicine, AIIMS Bhopal; and
Ex-Scientist, ICMR, New Delhi

 
Comment by Dr Bijayraj R
2014-02-14 09:53:17

@ Dr Udayakumar,
See the link for a rough idea about present scope of FM in private centers:
http://www.jfmpc.com/article.asp?issn=2249-4863;year=2013;volume=2;issue=4;spage=323;epage=325;aulast=Bijayraj

The scope is, in fact, much wider than the article suggests. It doesn’t delve into individual private practice/ Govt positions etc.

 
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