Oncologists said that citing the new rules of PMJAY, many states are stopping hundreds of experienced, fellowship-trained oncologists of the private sector from treating patients of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).
Doctors said that they are being stopped not because they have less training or experience, but because they do not have super-specialty degrees like DM, MCh or DrNB recognized by NMC.
In a news published in The Times of India, doctors affected by this move said that till a few decades ago, the only way to get into oncology was through fellowship. No formal courses existed then. Even today, it is considered very prestigious for PG doctors to pursue a 2-3 year fellowship in cancer hospitals for practical training in head and neck surgery, gynecology-oncology, blood-oncology or pediatric cancer surgery.
He said that many of those who are now being declared ineligible due to the new rules have gone on to become department heads, medical directors, teachers and senior surgeons. He has been treating cancer patients for decades. Dr. Hemish Kania of Surat, who has collected data of more than 300 such affected doctors across the states, said that some of the doctors who are now being stopped have even taught oncology to DM or DrNB students.
Shortage of doctors is increasing due to this rule
This change in eligibility rules is shocking not only because of the increasing burden of cancer in India, but also because of the shortage of cancer specialist doctors. In India, there is approximately one medical oncologist for every million people and only around 4,000 oncosurgeons. In such a situation, excluding 300 trained specialist doctors from PMJAY related treatment may reduce access to treatment, especially in small towns where access to private insurance is low, and this can become a big problem for those poor patients who avail the benefits of government medical insurance.
Are Fellowships Worthless?
Dr Kishan (name changed), a 42-year-old general surgeon from UP, said he had completed a three-year fellowship in head and neck cancer at Tata Memorial Hospital, Parel. In 2021, he returned to his tier-II city with the hope of filling the gap in cancer care, but there were only six oncosurgeons in the city, four of whom were fellowship-trained. However, he found that he was barred from operating on PMJAY cancer patients. He said, if four out of six private sector cancer surgeons are excluded, then PMJAY patients have to stand in long queues.
Another doctor said that he is safe because he works in a government hospital. He said, 'In government hospitals, there is likely to be at least one member of the team who is recognized under PMJAY, but if I step into the private sector, the situation may be different.'
Some doctors said that their names have been removed from the HEM 2.0 portal. This portal is used by the National Health Authority (NHA) to manage PMJAY. Doctors said that hospitals are terminating their contracts because these specialists can no longer generate claims under PMJAY.
Why is this problem happening?
Doctors said that the current problem has arisen due to several issues, especially the way the NHA and NMC rules are interpreted by state health officials. The roots of this problem can be traced back to 2018, when the then Medical Council of India (MCI) started efforts to increase the number of oncology teachers.
Dr KS Sharma, former academic dean of Tata Memorial Centre, said that between 2002 and 2010, there were very few DM and MCh seats in medical and surgical oncology. In 2011, when he joined the Board of Governors of the then MCI, he came up with a plan to address the faculty shortage by expanding fellowship programs in prestigious cancer hospitals. He said, 'These fellowships were not recognized by MCI, but they had their own importance and credibility.'
Then MCI implemented the rule
MCI implemented a rule under which post-graduate doctors with MS or MD degree, who had obtained two years' experience as senior resident or fellow in a particular cancer hospital, could be considered as teachers until sufficient number of degreed oncologists were available in India. Thus, many trained fellows took up teaching positions in government cancer institutes, and over time, some of them moved to smaller towns to start their own independent practices.
But in 2020, the MCI was replaced by the NMC, which issued guidelines mandating that oncologists have recognized degrees. There was no mention of fellowship in these guidelines.
Now the issue has arisen again
NHA CEO Dr. Sunil Kumar Burnwal said that NHA empanels hospitals, not doctors, and the qualification of doctors is decided by NMC. Efforts to contact NMC Chairman Dr. Abhijat Seth failed, but doctors who met him said that he had asked them to contact NHA.
Meanwhile, the state authorities have asked the doctors to seek written clarification from NHA and NMC on this matter, since no such clarification has been issued, the impasse continues.
Meanwhile, many medical associations including the Indian Medical Association have raised this issue with NMC and NHA. Doctors argue that this rule cannot be implemented retrospectively. The Indian Association of Surgical Oncology wants the scope of eligibility to be extended to oncologists who hold fellowships from premier institutions or have trained for at least two years in such centres.
