Medical system needs tier-II staff: experts

KNOW YOUR INSTITUTE/ Indian Institute of Social Welfare and Business Management

Most of the cases which come to the hospitals do not actually require the attention of a specialised doctor and can easily be treated by a physician-assistant or a community medical practitioner (CMP), and they can greatly enhance the productivity of specialist by relieving them of routine jobs, feel medical educators and clinical administrators.

Physician's assistants in USA are allowed to perform anatomical dissection, and a surgeon often comes in right at the end to perform the final act of repairing and/or grafting, said Bernard Francis O'Connor, president of De Sales University, Pennsylvania, at a seminar on 'Globalisation of public health and the role of medical education' at the Indian Institute of Social Welfare and Business Management (IISWBM) here.

At primary, secondary and tertiary level healthcare centres, there is such a rush that it adversely influences the time a physician can spare for patient care, so the virtually-defunct programme for CMP can be revived, said Satadal Saha, managing director of Westbank Hospital in Howrah.

Ashoke Dutta, director of IISWBM, said research had established that when a doctor was assisted by a skilled, knowledgeable assistant, productivity almost doubled.

"The need is to create a cadre of professionals who by specialised training and skill upgrading can help to relieve doctors," said Dutta.

A suitable regulatory authority was needed to establish accountability and implement controls so that the CMP or physician assistant worked well, said Indian medical professionals.

Poor consumer awareness could erode the social acceptability of such assistants, while Medical Council of India rules and archaic laws based on the British system could lead to legal problems, warned Sajal Dutta, president of Association of Hospitals of Eastern India.

West Bengal had at present only seven medical colleges, each with a minimum of 25 acres of land as required under existing regulations.

A medical college or training institute in reality needed only 10 acres so relaxation of the existing laws could lead to expansion of the colleges, Dutta said.

The United States had a three-tier system with specialist doctors and surgeons at the top of the pyramid, with physician assistants who could have very well qualified for any medical school but opted out of stressful lives of doctors at the second level, followed by nurse practitioners and nurses, said O'Connor.