Hospitalists versus generalists – the issues in medical care are the same everywhere!!

Without any dispute the US leads the world in the field of medical research and drug discovery. It is the dream of many young Indian medical graduates to move to the US or at least train there. And many in this country believe that the most advanced treatments are available in that country. While this may be definitely true, few have a real insight to the state of US healthcare as a whole, how deficient it is on so many fronts and how difficult it is to rationalize these deficiencies in the light of their  prosperity. In fact, as disparate as our economic and social circumstances are from theirs, it is ironic how alike our problems in the field of healthcare are.

This was brought home to me when I read with great interest the article titled “Why is there a primary care shortage ” by  John Schumann. He asks this question, in light of the current American scenario and the impending implementation of President Obama’s Affordable Care Act (ACA) which over the next 2 years will cover some 30 out of 50 million of those Americans that currently lack health insurance.  Although the cost of this program is one of the hot debates of the current US Presidential election campaign, Schumann laments that no one is  adequately addressing the one major question “Who will see all the new patients?”

The shortfall of doctors in US has been estimated at 30,000 in the next couple of years. New medical schools  have been opened and class sizes have been expanded. But all the new doctors are in hospitals and Schumann quotes Dr. Robert Wachter, chief of the division of hospital medicine at the University of California, San Francisco, “Hospital medicine is the fastest growing specialty in American medical history.”  Wachter is credited with coining the term “hospitalist” in 1996. But, what the medical profession, both here and in the US, does not want to acknowledge is that only ‘disease’ care is provided by the  hospitalist and generalists are required to provide ‘health’care.

The scenario in our country is so similar that and as polarised as it has become in the US. There is the constant boast that we have the best doctors and state of the art hospitals (all corporate), and that medical tourism is a ‘business’ growth sector. But, at the other end of the spectrum, public hospitals have been deteriorating in facilities and services, and are grossly inadequate for the growing population. Like a sleeping giant, there has been a slow (and sleepy) realization by the Government, that all is not well with this sector. So we are assured that a number of remedial steps are in the pipeline in the new 5 year plan, including ‘Universal health coverage’!!! Of these, I shall talk later. And as I read the article, I thought, no one here is addressing the same question ” who will see all the patients?”.

The jerky and certainly, not thought through, response here too, has been to increase the number of medical seats. And here too, all the new doctors that graduate populate the increasing number of corporate private so called ‘state-of-art’ ( or sometimes not so state- of-art) facilities. The increase in medical seats needs to be accompanied with well thought out and implemented plans to reorient medical education, and train generalists rather than hospitalists. Failing this, we will fall into the same trap that our more  prosperous American friends are falling into – we will continue to promote ‘disease treatment’  and not ‘care’ for health.

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