This article is written by Diksha Tripathi and Shrishti Shrivas of Narsee Monjee Institute of Management Studies
Introduction
The Department of Indian System of Medicine was renamed as AYUSH in 2003, and the Ministry of AYUSH was formed as a distinct ministry in 2014. Since 2005, many Union governments have attempted to integrate AYUSH into the mainstream and include physicians educated in these five specialties into India’s medical workforce.[1]AYUSH stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy. There are 6,86319 AYUSH practitioners in the country out of which 4,46,051 are ASU doctors.[2]
If the National Medical Commission’s (NMC) proposal is approved by the government, AYUSH physicians would no longer be permitted to provide allopathic drugs. According to the NMC suggestion, an individual certified in multiple systems of medicine can choose which one to practice. Once licensed to perform contemporary healthcare under the NMC Act, the individual is not permitted to practice any other system of medicine concurrently. The idea is part of the proposed Registered Medical Practitioner (Professional Conduct) Regulation 2022, which was posted for public input a few periods ago by the NMC’s Ethics and Medical Registration Board.
The initiative contradicts the government’s need for a more integrated medical system. Several states, including Madhya Pradesh, Rajasthan, Bihar, Maharashtra, Uttar Pradesh, and Tamil Nadu, have authorized AYUSH practitioners to open primary and community health centers where they can prescribe and distribute allopathic medications.[3]
The idea of integration of the medical practice is we believe a pandora box full of surprises. Having said that we would like to draw attention towards the current medical conditions prevailing in India. According to WHO report there should be a ratio of 1:1000 doctors in the world that means for every 1000 people 1 doctor should be available. But India had, 20.6 healthcare professionals for every 10,000 people, which less than half of the 44.5 per 10,000 that the World Health Organization recommends. As per the information provided by National Medical Commission (NMC), there are 13,08,009 allopathic doctors registered with the state medical councils and the National Medical Commission (NMC) as on June, 2022.[4]
Complexities and Implications of Implementing Integrated Medical Practice
The ratio of doctors and population is quite concerning. With the addition of integrated medical practice, the burden on doctors will increase significantly. They will have to study multiple related fields to practice effectively, and there will be an urgent need for a comprehensive curriculum, along with experienced professors to teach them.
Doctors take an oath to treat patients, and in integrated practice, they will have to treat all kinds of patients they encounter. The need for specialization will also be compromised in such conditions, as a doctor should not be called an expert unless they have specialized in that particular branch. Integrating AYUSH doctors into practice will require specialization in allopathy and other fields.
There is also an increasing concern regarding the quality and safety concerns regarding the adequate training of the AYUSH PRACTIONER in the modern medical practice. Inadequate training can lead to misdiagnosis, incorrect treatment and compromised safety of patient. As previously mentioned, there is a lack of a standardized curriculum for integrated practices. This absence of a regulatory framework might compromise safety.[5]
As we have talked about the need for the regulatory framework already, lets delve deeper into that problem. We believe not only there will be licensing and accreditation problem but also a greater problem in deciding the scope of practice for the AYUSH Doctors. This would completely overtake the old regulatory regime because now, there will be need for new licensing authority for providing license to AYUSH Doctors indulged in the integrated modern practice.
Another problem that would be encountered is that there would be professional discrepancies and that is, not all doctors are treated equally. For eg. a surgeon is treated with much more respect that an emergency doctor. Like a society is divided into class, in the same manner there is a class system in doctors also exist and if there is no parity in the opinions of doctors then how can they even do integrated practice. There is bound to happen collaborations issues and professional frictions.
One of the important concern is lack of public trust is the biggest problem. People sometimes find it difficult to even trust a doctor with a particular degree and we are expecting them have trust in doctor that have done integrated medical practice is too much to ask for[6].
Advantages and Opportunities of Integrating AYUSH Practices in Healthcare
Let’s talk about the BOONS of the having such integrated medical practice in AYUSH Doctors
Firstly, traditional medicine practitioners assist improve the public health system’s doctor-patient ratio by providing healthcare in underprivileged parts of India.
The Rural Health Statistics 2021–22 report indicates that while there is a general labor deficit in the public health sector, it is particularly severe in tribal regions, where there is a 13.7% gap in primary healthcare centers (PHCs) and sub centers. An estimated 600 million Indians, many of whom live in rural areas, lack access to reasonably priced, high-quality healthcare. In addition, a 2017 mid-term appraisal of the National AYUSH Mission states that India confronts a severe lack of qualified health professionals, including physicians, nurses, and allied healthcare workers.
In accordance with the 2017 National Health Policy, the government suggested integrating AYUSH services within primary healthcare. Since 2017–18, Ayurvedic practitioners have been permitted to practice allopathic medicine following a six-month training program. In 2019, Unani practitioners were added to the list of qualified professions, but with more training hours. Currently, there are around 755,780 AYUSH physicians in India. According to Minister of State for Health and Family Welfare Bharati Pawar’s testimony before the Rajya Sabha in 2022, adding these raises India’s doctor-patient ratio to 1.83 physicians per 1,000 people, beyond the WHO guideline of one doctor per 1,000 people.
Secondly, the integration would lead the enhanced healthcare accessibility. It will cater to the shortages of the doctors that we usually face. AYUSH doctors can help to decrease the shortages of the medical practitioners especially in the rural and underdeveloped areas. Not only this but also there will be an overall enhanced treatment of the patient as well as this treatment would combine the preventive and holistic approach[7].
Most importantly,the doctors will be overall skilled and will be able to observe and serve the thetreatment to the patient correctly without any delay. Also, many people have stronger belief in the traditional medicines and with this integration there be balance approach to both the modern medicine and the AYUSH medicine thereby leading to the integration of both.
Well, this was all about the holistic and comprehensive approach but we have another advantage of the integration of the medical practice of AYUSH doctors and that is cost efficiency. As there will be decreased burden on the doctors and also one doctor for a patient will be sufficient thereby ruling out the possibility for the other doctor which will ultimately lead to the reduction in the fees that the patient had to pay[8].
Having said about the pros and cons of the Integration of the medical practice of AYUSH Doctors. Now let’s discuss acrucial case laws related to such request that have been filed in the court of India.
Mukhtiar Chand & Others V State Of Punjab & Others
- Introduction:
This case is a historic case where the doctors were not allowed to do practice modern allopathy medicine in the Punjab. The doctors argued that this hinder their ability to provide comprehensive treatment especially where there were scarcity of doctors.
- Issues:
Whether Ayush practioner are legally permitted to practice the allopathic medicine under certsin circumstances?
And what would be the necessary qualifications and training required for AYUSH Practioners for practicing modern practice?
- Judgement:
The Supreme Court emphasize that without the proper qualifications mentioned under the Indian Medical Council Act 1956, the AYUSH Doctors cannot practice the modern medical practice. The court further went on to focus on the requirements of the need for the sufficient registration and licensing under the various State Medical Councils for being authorized to practice the modern allopathic medicine. The judgement also highlighted the lack of regulatory framework to regulate the working of the doctors and to ensure that safe and effective medical care is being provided to the patients[9].
Conclusion
The present case highlighted the complex difficulties involved in integrating the traditional and modern medical practices in India.
Among the 179 WHO members, India has a system of Traditional, Complementary, and Integrative Medicine (TCIM). The inaugural WHO Traditional Medicine Global Summit took place in Gandhinagar, India, in August 2023. It featured debates on bolstering the body of evidence supporting traditional and indigenous medicine as well as the training and licensing of its practitioners, and it was attended by policy officials from 88 different nations. We must not forget that everything comes with a cost so we need to overcome the challenges by skillful actions to bring a gamechanger revolution in medical arena.
- Details of the Authors
- Authors: Diksha Tripathi and Shrishti Shrivas law students of Narsee Monjee Institute of Management Studies
[1]Iqbal, N. and Salve, P. (2023) Ayush doctors fill in public healthcare gaps by providingallopathic medicines, Indiaspend. Available at: https://www.indiaspend.com/health/ayush-doctors-fill-in-public-healthcare-gaps-by-providing-allopathic-medicines-876766(Accessed: 21 June 2024).
[2]Indian Medical Association. Available at: https://www.ima-india.org/ima/archive-page-details.php?pid=245 (Accessed: 23 June 2024).
[3]K, P. NMC prescribes new rules for Ayush doctors, The New Indian Express. Available at: https://www.newindianexpress.com/nation/2022/May/30/nmc-prescribes-new-rules-for-ayush-doctors-2459600.html#:~:text=The%20proposal%20runs%20counter%20to,prescribe%20and%20dispense%20allopathic%20drugs. (Accessed: 22 June 2024).
[4]Business newsThe Economic Times. Available at: https://m.economictimes.com/news/india/doctor-population-ratio-in-country-stands-at-1834-mansukh-mandaviya-tells-lok-sabha/amp_articleshow/107561323.cms (Accessed: 21 June 2024).
sabha/articleshow/107561323.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
[5]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033720/ , J Ayurveda Integr Med. 2018 Apr-Jun; 9(2): 143–150. Published online 2018 May 29. doi: 10.1016/j.jaim.2018.05.001, Shailaja Chandraa,∗ and Kishor Patwardhanb
[6]https://www.sciencedirect.com/science/article/abs/pii/S2095496418300165 by Shubha Singhal, Vandana Roy
[7]Allopathy practice by Ayush doctors may be allowed in State (2021) The Hindu. Available at: https://www.thehindu.com/news/national/karnataka/allopathy-practice-by-ayush-doctors-may-be-allowed-in-state/article5031581.ece (Accessed: 24 June 2024).
[8]Policy challenges amidst modern medicine and Ayush: What is the solution?orfonline.org. Available at: https://www.orfonline.org/expert-speak/policy-challenges-amidst-modern-medicine-ayush-what-solution (Accessed: 22 June 2024).
[9]https://www.the-laws.com/Encyclopedia/browse/Case?caseId=008991110100&title=mukhtiar-chand-vs-state-of-punjabMukhtiar Chand vs. State of Punjab. Available at: https://www.thelaws.com/Encyclopedia/browse/Case?caseId=008991110100&title=mukhtiar-chand-vs-state-of-punjab (Accessed: 25 June 2024).