Where Are the Family Physicians? Indian Survey Flags critical shortage

New Delhi: A recent national survey discussed for the first time the landscape of family medicine in India, especially highlighting the gap between the required number of family physicians and the lack of facilities to provide training to them.

While the Planning Commission for the 12th plan (2012-2017) estimated the need for 15,000 new family physicians per year by 2030, the recent survey titled "The landscape of family medicine in India- A cross-sectional survey study" revealed that the country does not have the required infrastructure of training to reach that goal.

This survey was conducted across 28 States and Union Territories, and it collected responses from a total of 272 family physicians. Released before the National Doctors' Day 2025, themed "Behind the Mask: Caring for Caregivers", the survey aimed to understand the implementation of Family Medicine in India to date and the potential ways in which Family Medicine may contribute to a stronger primary healthcare system.

The key findings from the survey are as follows-

Most Family Physicians from three Southern States:

In the survey, it was discovered that most Family Medicine training programs exist in three southern states- Tamil Nadu, Karnataka, and Kerala and inherently, most family physician respondents who participated in the survey were found to be working in these three states.

As per the survey, these states were the first to introduce Family Medicine training. "However, with the introduction of blended-type programs, States and institutions that are leaders in FM training support the training of family physicians across several other states. This is highlighted when almost all our respondents who completed a distance or blended type program were trained by a single institution in Tamil Nadu, CMC Vellore. However, only one-fifth of blended program learners completed their hands-on learning in Tamil Nadu. Most learners completed their hands-on training in 24 other States in India, so we see a pan-India spread where family physicians work," mentioned the survey.

Also Read: Doctors call for inclusion of 'training as family physicians' in MBBS course

Lack of recognised training programmes:

The survey found that either the Family Physicians received recognised Full-time residency training via DNB or MD in Family Medicine or they were trained via a non-recognised Part-time route. More than one-third of the family physicians who responded in the survey were trained via the second option.

This revealed the lack of required infrastructure to train willing candidates in Family Medicine. While the survey acknowledged that the DNB full-time training programs are the backbone of the recognised programs that recruit and train medical school graduates, such training programs and even MD programs are limited to date, and they have only a few training spots.

According to the survey, only thirty-nine accredited private institutes out of 276 offered the DNB-FM program as of 2023, and only 110 DNB-FM training spots were available nationally. 

Regarding the MD-FM graduates, the survey revealed that none of the responses were from MD-FM graduates. In this context, the survey highlighted how few graduates are from MD-FM programs. The first MD-FM program started in 2012 at the Government Medical College in Calicut, Kerala. It was only allocated two seats per year; between 2015 and 2020, it graduated at most ten family physicians. As of 2023, only seven government medical colleges out of 286 offer the MD-FM program

"The current number of DNB-FM and MD-FM programs alone will not be able to produce enough graduating family physicians. It is estimated that just over 1% of all accredited postgraduate training seats in India are in FM," highlighted the survey.

Family Physicians Across India: 

According to the data collected in the survey, 48.3% of the respondents in the survey are working in the primary care sector. It further revealed that 56.3 % of the respondents work in the emergency department, 68.9% in the in-patient care, 62% in Palliative care, 66.2% make home visists and 15.5% offer telemedicine facility.

Overall, the data highlighted the wide-ranging responsibilities managed by family physicians. From outpatient consultations to minor surgeries and childbirth, the role of family physicians in the primary care was highlighted in the survey.

Lack of Work Opportunities in the Public Sector: 

Two-thirds of the respondents who participated in the survey were found to be working in the private sector alone. However, the survey highlighted that this was not necessarily due to choice "but instead because of the lack of opportunity for family physicians to find positions within the government sector."

In the government sector, PHC is delivered through a network of subcenters, primary and community health centers, pointed out the survey, adding that "Currently, CHCs are meant to be staffed by four medical specialists (internal medicine, pediatrician, general surgeon, and obstetrician and gynecologist) supported by paramedical providers. However, finding specialists to work in these centres is an immense challenge; over half of the specialist positions in CHCs are vacant, resulting in many being closed."

"Introducing family physicians’ roles in government CHCs may be one way of addressing these gaps. Our research has shown that family physicians with postgraduate training have a broad set of skills, including surgical skills, overlapping and potentially encompassing the skills of the currently allocated four medical specialists," it further mentioned.

Family Physicians in Rural Areas: 

The survey highlighted that the CHC specialist positions remain vacant because, traditionally, there is an urban preference. 13.3 doctors per 10,000 are in urban areas whereas 3.9 doctors work per 10,000 iun rural areas.

Referring to this, the survey highlighted that "This skew in urbanization is even more significant for physicians with postgraduate specialization training."

Among the respondents who participated in the survey, two-fifth indicated they worked in either a town, semi-urban area, village, or rural centre. "Our finding suggests that FM training may encourage working in smaller communities irrespective of the type of training. Scaling up postgraduate FM training could support a shift towards community-based practice with family physician specialists, which has not been seen with other medical specialists who tend to be concentrated in urban settings," mentioned the survey.

Need for more Family Physicians: 

Pointing out the need for more Family Physicians to promote skilled providers in the primary care sector, the survey mentioned that 85% of medical school graduates do not get any postgraduate training in any field.

Suggesting that the Government may consider increasing the number of Family Medicine Postgraduate training seats in India, the survey opined, "Increasing the proportion of postgraduate seats in FM promotes having skilled providers in the primary care sector. This recommendation does not suggest that India should train more doctors but rather that a larger proportion of graduating doctors would benefit from having postgraduate training in FM."

"Our sample found that the proportion of family physicians working in rural areas is higher than all physicians in India, which is an important finding given the significant gaps in human resources in rural and remote regions of India. Family physicians self-report delivering a broad range of patient services and largely remain in the primary care sector. These findings support expanding postgraduate training in family medicine to improve primary care," the survey concluded.

Medical Dialogues team had reached out to Dr. Raman Kumar, Founding President of Academy of Family Physicians of India (AEPI) for his opinions on what the survey revealed. 

When asked about the reason for such a gap between the training for Family Physicians and the required number of such specialists across India, Dr. Kumar, told Medical Dialogues, "It is not included in the MBBS course, it is not included as one of the subjects."

"Family Medicine is not taught at MBBS level. Although it is available at postgraduate level, at the MBBS training, there is no subject, examination, training, or internship in Family Medicine. That is one of the primary root causes," he added.

Pointing out that three southern states have maximum number of family physicians, he mentioned, "They have efficient health systems and they also have large number of medical education institutions, which proportionately is larger than the northern side of India. Whatever happens, it has more impact in South. Even 3/4th of the medical colleges are located in the southern states of India. Same is reflected in the training of Family Physicians. Also, probably, their public health systems are efficient. People are more aware of the need of family physicians."

When asked about the role of DNB courses to fulfill the requirement of family physicians, Dr. Kumar said, "Normally, teaching hospitals would not have a Department of Family Medicine for family physicians. So, that is a challenge. But still, under government policies, it has started in many district hospitals. Many States have started it and even private hospitals can start it. So, that is an easier way to start postgraduate training. But MD level- that is a problem because in National Medical Commission-controlled medical colleges there is no department of family medicine. So, unless there is a department, they cannot apply for a postgraduate department."

As opposed to this, he pointed out that "DNB is a main source of training of Postgraduate Family Medicine in India, because there are few colleges in India- around 8 or 10- which are offering MD Family Medicine."

Pointing out that "Family Physicians are community-based", Dr. Kumar mentioned how during the pandemic time, patients were told to be managed at home. "That is the reason it became more obvious that we need more family physicians."

While highlighting that India has the largest medical education system in the world, Dr. Kumar opined that without any department of Family Medicine for the Family Physicians at the undergraduate level, the need for Family Physicians cannot be met.

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