The Indian Family Physician on his way to extinction?
Dr. Allan, happily welcomes Sunny, an otherwise chirpy 5 year old into his clinic. Sunny is feverish. “Measles”, says Dr. Allan confidently, having seen hundreds of cases in his clinical practice. Dr. Allan’s clinic is a landmark in a Mumbai suburb and has seen a steady flow of patients, morning and evening everyday for the last thirty years. Sunny is the third generation of the Bhatia family coming to Dr. Allan for medical treatment. Several general practitioners like Dr. Allan, custodians of family medical histories, have formed the primary healthcare foundation of India. They play an elementary role in the Indian healthcare system, not just addressing the patient load efficiently but also providing the affordable healing touch. Yet for all the value they bring, healthcare communication for physicians in India has historically been under-invested — leaving general practitioners without the tools, information, and brand support that specialists routinely receive.
Recent studies however indicate that there are far lesser numbers of medical graduates opting for general practice. Dr. Raghvendra M.S, Bangalore based Dean of Family Physicians of India says “the era of 10 x 10 clinics is gone”. Progressing medical research has so expanded the realms of medical care that it is increasingly being felt that no individual can provide the best possible medical care in general. Fueled by rising incomes and augmented awareness; patients are naturally gravitating to specialized centers. Today is an era of specialization. Tomorrow, may move to super-specialization.
From an India perspective is this a healthy shift? Brandcare’s report on “Understanding Healthcare Consumer Behavior: The Young and Urban” reflects such a shift where 41% of the respondents prefer visiting a specialist over a general practitioner. As per the Medical Council of India (MCI), the total number of doctors registered (allopathic) in the country is around eight lakhs Which means the doctor-population ratio is around 1:2000. When the first point of care is in such under supply can we afford a run for the specialist? Without a solid foundation of primary care the entire health system can become unstable and unbalanced. In the United Kingdom, for example; it is required that every individual must have a GP and a patient can be admitted to the hospital only on advice of the GP. Studies have revealed that an effective primary care system — with the family physician as its backbone — can bring down health costs drastically.
The answer to reinstate the vanishing family physician may lie in persuasion at different levels. The IMA needs to pursue the issue with the government in creating referral policies and family medicine specializations. More persuasion is required perhaps at the student level to revive the lost glory of the family physician. On an equal scale the consumer needs persuasion to go back to his Dr. Allan!
1. http://data.gov.in 
Rashmi Thosar, CEO
Brandcare Medical Advertising & Consultancy
FAQ
Is the role of the family physician declining in India?
It is, and the numbers tell a worrying story. Fewer medical graduates are choosing general practice, and patients are increasingly walking past the neighbourhood clinic to visit a specialist. The family physician who once knew three generations of the same family is slowly becoming a rare figure in urban India.
How should pharma brands adapt their HCP strategy for changing GP dynamics?
By recognising that the GP of today is not who they were a decade ago. Fewer in number, under greater pressure and serving a more aware patient population, today’s family physician needs communication that respects their time and adds genuine clinical value. Brands that still treat GPs as homogeneous mass are working with an outdated map.
What will it take to revive the family physician’s role in India?
Change needs to happen at multiple levels. Medical councils need to push for referral policies that give GPs a structured role in the healthcare journey. Students need to be shown that family medicine is a meaningful, respected career. And patients need to be reminded that their Dr. Allan knew things about them that no specialist ever would.
What happens to a healthcare system without a strong primary care foundation?
It gets expensive, fragmented and harder to navigate. When patients bypass the family physician and head straight to specialists or hospitals, costs rise sharply and continuity of care breaks down. Countries with strong primary care systems consistently show lower healthcare costs and better health outcomes. India’s rush toward specialisation comes with a real price tag.
Why are fewer doctors choosing general practice in India today?
Medicine has grown enormously in scope, and many graduates feel that specialisation offers better prospects, both financially and professionally. The idea that one doctor can handle all medicine feels outdated to a new generation of physicians. The 10-by-10 clinic, as one senior family doctor put it, belongs to a different era.
One Reply to “The Indian Family Physician on his way to extinction?”
According to India Knowledge@Wharton, the primary health care sector in India is around US$39 billion in total size and the industry is highly fragmented. It has been estimated that India has around 26,000 government-run primary health care centers and 615 district-level hospitals. We have around 200,000 privately-owned general physician clinics in the country. These facilities are meant to provide low-cost health care system to public. Also a first contact for a patient with an undiagnosed health concern. Brandcare’s report on “Understanding Healthcare Consumer Behavior: The Young and Urban” reveals that large % of today’s youth are visiting to specialists directly and even multi-specialty hospitals. One of the reason can be perceived poor quality of delivery at primary care physicians end. Because of this, primary care healthcare system will may remain underutilized and it can also boosts the overall healthcare costs of the country. Our healthcare system is going heavily skewed towards tertiary services and focus on primary care system is reducing. 25-30 years ago, first point of contact for all illnesses was Primary care. People trusted their physicians and was relying on primary care physicians for continuous management of their disease. But its not the same scenario now. Efforts should be taken to give required strength to primary care healthcare system.