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Review: What is the number of MBBS students who may be available for COVID-19 duties?

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The Government of India decided to augment the availability of medical professionals by permitting the deployment of medical interns for COVID-19 management duties and final year MBBS students for extending teleconsultation services and monitoring of mild COVID-19 cases. Many other states have also initiated similar measures. Here is a review of the numbers.

India is currently experiencing a devastating second wave of COVID-19 pandemic since April 2021 with a record number of infections and deaths being reported every day. As a result, the healthcare infrastructure across the country is overwhelmed and has resulted in a shortage of beds, oxygen, ventilators, and drugs. Recently, a review of the growing need for human resources to respond to the COVID-19 pandemic in the country was carried out. One of the decisions taken by the Government of India is to augment the availability of medical professionals by permitting the deployment of medical interns for COVID-19 Management duties and final year MBBS students for extending teleconsultation services and monitoring of mild COVID-19 cases. In this story, we look at the numbers available to understand the impact of this decision. 

India has more than 12.89 Lakh registered doctors 

Data provided by the Ministry of Health and Family Welfare (MoHFW) in the Rajya Sabha on 09 March 2021, indicates that there are 12.89 lakh registered allopathic doctors in India as of 31 December 2020.  The Ministry further stated, supposing that the availability is 80%, there will be approximately 10.31 lakh doctors in India who may be available for active service. As per the recommendations of the World Health Organisation (WHO), the ideal doctor population ratio for a country is 1:1000. As per the Ministry’s response, there are 5.65 lakh AYUSH doctors available in the country, including which India’s doctor–population ratio in the country is 1:845, meeting the WHO norms. 

India will require an additional 3 lakh allopathic doctors to meet the WHO’s ideal ratio of doctor to population

Going by the number of allopathic doctors registered in the country, India is far away from the ideal ratio prescribed by WHO. According to the 15th Finance Commission’s special report in the backdrop of COVID-19, in 2018, there were 11.54 lakh registered allopathic medical doctors in India giving a doctor to population ratio in India is 1:1,511 against the WHO norm of 1:1,000. Assuming that the population of India is 1.35 billion, the allopathic doctor population ratio now stands at 1:1309, implying there is one doctor for every 1309 people in the country (assuming 80% availability of doctors). India would need an additional 2.5 to 3 lakh doctors in service to meet the WHO norms. It is not just the number of doctors, even the distribution of these doctors is skewed with substantial differences between urban/rural and between states. 

Five states account for 1 in 2 doctors registered in medical councils across India

Of the total number of doctors registered in various state medical councils, five states- Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, and Uttar Pradesh account for more than 51% of the doctors. The data also indicates that 52,666 doctors have registered with the Medical Council of India and not any state. 

For easier interpretation, India has 8 to 9 doctors per 10,000 population. The population of each state and India has been taken from the 2011 Census. The actual population would have increased now as per projections. The state-wise distribution of doctors per ten thousand population shows that Goa has the highest, 22 doctors per ten thousand people, followed by Sikkim with 20 doctors. Kerala & Karnataka 17 doctors each while Tamil Nadu has 16 doctors per ten thousand people. Eleven states/UTs including Andhra Pradesh (that includes Telangana) Punjab, Maharashtra, Delhi, and Jammu & Kashmir have at least 10 doctors per ten thousand population, which is one doctor per thousand people. 

Madhya Pradesh, Tripura, Himachal Pradesh, Bihar, Uttar Pradesh, Chhattisgarh, Haryana, Jharkhand, Mizoram, and Nagaland have less than five doctors per ten thousand population. 

Government has called for roping in MBBS final students and interns for COVID-19 duties

Recently, the Government of India announced that NEET exams have been postponed by over four months and that the services of final year MBBS students can be utilized for providing services like teleconsultation and monitoring of mild COVID-19 cases after due orientation by faculty. Further, medical interns could be deployed on COVID-19 management duties under the supervision of their faculty, as part of their internship. With respect to final year PG Students (broad as well as super-specialties), their services as residents may continue to be utilized until fresh batches of PG Students join. Along with them, even BSc/GNM qualified nurses could be roped in full-time for COVID nursing duties under the supervision of senior doctors and nurses. By roping in the graduates, the government aims to boost the availability of qualified medical professionals to fight the pandemic, reduce the workload on existing doctors engaged in COVID-19 duty, and provide a boost to efforts of triaging. 

Around 54,000 medical professionals will be available for COVID-19 duty if medical interns join

Students who enrolled themselves for MBBS in 2014-2015 may be currently available for an internship as they would be in their final year. Based on the intake for under-graduate MBBS in medical colleges across India in 2014-15, India will have an additional 54,000 odd medical professionals engaged in COVID management duties, if all these interns choose to join. However, the distribution across states is varied. For instance, student intake in Karnataka and Andhra Pradesh for MBBS was around 6,900 students each in 2014-15, while Maharashtra had close to 6,200 seats. Meanwhile, Madhya Pradesh had an intake of only 1850, Bihar and Punjab around 1300, and Delhi with 1000 seats. How many of these final year students choose to join COVID-19 duties remains to be seen. 

States such as AP, Karnataka, and Tamil Nadu, which already have a better doctor population ratio than the national average, also have a greater number of medical colleges and students, who may be roped in. At the same time, states like Bihar, Odisha, and Chhattisgarh which already lag in terms of doctor-population ratio have fewer MBBS final year students who may be available for COVID duties. Hence, the initiative of encouraging final year students to take up COVID duties is laudable, it may not help all the states to the same extent. The skew in numbers also highlights the need for equitable distribution of medical colleges. 

Priority in government recruitments will be given for those involved in COVID-19 duty

The central government also announced that the medical students/professionals who will be engaged in COVID-19 related duties will be vaccinated and that all the health professionals engaged would be covered under the Insurance Scheme of Government for health workers engaged in fighting COVID-19. Furthermore, those professionals who sign up for at least 100 days of COVID-19 duty will be given the Prime Minister’s Distinguished Covid National Service Samman from the Government of India on successful completion of duty. Also, they would be given priority in forthcoming regular Government recruitments after they complete a minimum of 100 days of COVID duty.

Some states have already started roping in medical students amidst the second wave

Karnataka recently announced that 17797 medical students including interns, PG, final year students will be deployed for COVID-19 duty. It was also added that the services of the nursing department which has 45,470 students, and services of students pursuing dental (2538), Ayush (9654), and pharmacy (9936) courses will also be sought. Himachal Pradesh government announced an incentive of Rs 10,000 per month for fourth and fifth-year MBBS students, contractual doctors, and junior/senior residents. Telangana government is inviting applications from qualified MBBS graduates (about 50,000) for appointments on a temporary basis, according to the CMO’s Twitter handle. Similar to the Centre’s announcement, the candidates will be given priority in future recruitments. Jammu & Kashmir has decided to re-employ retired doctors aged below 70 years and deploy final year MBBS students for a monthly incentive of Rs.5000 to deal with the shortage of medical staff till the end of the year.  

Every available resource has to be used to overcome the crisis

It is a known fact that healthcare workers are at the forefront of the world’s battle against the pandemic. The availability of an adequate number of healthcare workers to treat patients at this critical juncture must be ensured to avoid resource burn. The steps initiated by the central government & various state governments to augment resources are welcome. However, how many of these translate into the availability of additional human resources remains to be seen. 

Featured Image: MBBS students available for COVID-19 duties

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