Medical Colleges must Implement District Residency Programme in broad specialty areas: Dr VK Paul on tackling Shortage of specialists

Lucknow: Emphasising the need for more specialist doctors, NITI Aayog member Dr. Vinod Kumar Paul recently suggested that the medical colleges in Uttar Pradesh should implement a PG District Residency Programme (DRP) in broad-spectrum specialty areas to provide better hospital care.

Dr. Paul expressed such opinions while attending the 3rd Foundation Day ceremony of Dr. Ram Manohar Lohia Institute of Medical Sciences (RMLIMS).

Referring to the total number of PG medical seats, he pointed out that 68,000 PG medical seats in India are insufficient to meet the population needs in a country like India.

He further highlighted that compared to the developed nations in the West, India has five times fewer broad specialty seats. Commenting on the matter, Dr. Paul told HT, "We have a deficit of doctors. India has one doctor per 1000 population or 1.3 doctor if we add Ayush practitioners, whereas developed nations have three doctors for same population volume. The need is even greater for specialists."

Dr. Paul opined that the DNB courses and the District Residency Programme (DRP) should be used to increase the number of specialists in India. Under DRP, one fourth of the candidates get posted with the district hospitals for better learning and service to patients.

Medical Dialogues had earlier reported that NMC proposed introducing the District Residency Programme in 2021 with the aim of "strengthening of services of the District Health System." NMC had mentioned about the programme at the District Hospitals in the Draft Regulations on Postgraduate Medical Education Regulations 2021.

Also Read: Rank Service PG Medicos Separately for District Residency Programme, Post them Based on Seniority: Doctors tell TN Govt

It was proposed that all the PG medical students pursuing their MD/MS in broad specialities should undergo a compulsory residential rotation of three months in District Hospitals/ District Health Systems as a part of the course curriculum. The Commission had clarified that such rotation would take place in the 3rd or 4th or 5th semester of the Postgraduate programme.

However, DRP could not be properly implemented due to COVID-19 pandemic and later NMC PG Board made it mandatory for all the Postgraduate broad speciality students admitted in the 2021 batch onwards. Earlier this year, NMC addressed the doubts and confusions regarding the program's implementation and wrote to the Principal Secretary/ Secretary of Medical Education of all the States/UTs, the Directors of all the State/UT DMEs, and the Heads of all the medical institutes.

Recently, releasing the Draft Postgraduate Medical Education Regulations (PGMER), the PG Medical Education Board of NMC once again addressed the issue of the District Residency Programme and clarified that satisfactory completion of the DRP shall be an essential condition for the post-graduate candidates to be allowed to appear in the final examinations.

As per the latest media report by the Times of India, referring to the DRP, Dr. Paul added, "If the scheme is properly implemented, each district will have 5-10 PG residents who will offer a wide range of medical specialties at the district level, reducing reliance on tertiary care. Medical colleges will also be able to boost their seat capacity by one-fourth."

The DRP was introduced in Uttar Pradesh earlier this year and 768 candidates from various medical colleges participated in the programme. They were posted with district hospitals for three months. Dr. Paul said that once the first batch completed the posting, the second batch joined theirs.

He further assured the MBBS students not to worry about securing a PG medical seat as the number of PG medical seats has increased and the process to add more seats was underway. Hindustan Times adds that Dr. Paul pointed out that proper implementation of DPR would ensure that each district hospital had 5 to 10 PG students.

"There are over 68,000 PG medical seats in the country and if one-fourth are in hospitals it will help improve the service to patients and also increase the number of candidates as colleges can take additional students," said Paul.

"The PG seats have gone up from 32,000 to over 63,000 in the country and UG medical seats are up from 52,000 to 1.8 lakh. The challenge is to increase the number of specialists in the country," he further added.

The advantages of the DRP system were also acknowledged by the Medical Superintendent of RMLIMS, Prof Vikram Singh. He added, "The long-term strategy for enhancing healthcare at the district level is to train district-level doctors rather than exporting expertise."

Meanwhile, the Director General of Indian Council of Medical Research and Secretary to the Government of India, department of Health Research Dr Rajiv Bahl mentioned, "Research should not be limited to only a few institutes. All institutes must take part in it. This year ICMR gave 600 grants to 203 different institutes and not many were known as institutes of national importance."

In its Draft PGMER, NMC clarified that the main objectives of the District Residency Programme (DRP) would be: a. to expose the post-graduate student to District Health System/ District Hospital and involve them in health care services being provided by District Health System /District Hospital for learning while serving; b. to acquaint them with the planning, implementation, monitoring and assessment of outcomes of the National Health programmes at the district level; and c. to orient them to promotive, preventive, curative and rehabilitative services being provided by various categories of healthcare professionals under the umbrella of National Health Mission. In doing so, the post-graduate medical students would also be contributing towards strengthening of services of the District Health System as specialty resident doctors working as members of the district teams.

Also Read: Satisfactory completion of District Residency Programme essential to appear in final PG exam: NMC Draft PGMER