Pvt hospitals seek financial aid from govt to train more specialists

Hospitals across India want financial support to train and pay specialist doctors as the government pushes for more such health professionals to help overcome a shortfall of such personnel, especially in small towns and rural areas.

There are currently about 10,000 Diplomate of National Board (DNB) seats in India, which are equivalent to post-graduate degrees in medicine (MS and MD). The Centre wants to increase this number to 20,000.

The Association of National Board Accredited Institutions, a network of hospitals offering DNB degrees, recently wrote to Dr V K Paul, member (health) at Niti Aayog, saying the government should subsidise the stipend that hospitals need to pay DNB residents.

“This, as you are aware, is the main cause for hospitals limiting the number of seats and will go a long way in smaller hospitals also starting new courses and increasing the number of students and subsequently specialists,” ANBAI founder-member Alexander Thomas said in the letter, referring to the financial burden of hospitals.

Thomas, who also heads the Association of Healthcare Providers of India, a network of large private hospitals, told Moneycontrol that Paul had earlier proposed this aid from the government.

Meanwhile the ANBAI also urged the Centre to create a national medical library to help lower training costs. At present, hospitals conducting DNB courses spend Rs 1-2 crore on journals and books for the academic programme.

Private hospitals
The DNB seats for both broad specialty and super specialty courses in hospitals are in addition to about 40,000 PG seats offered by medical colleges governed by the National Medical Commission.

A majority of the DNB seats, almost 90 percent – regulated by the National Board of Examinations in Medical Sciences under the Union health ministry – are in large private hospitals, while some are offered by district hospitals run by the government.

The NBEMS administers DNB broad specialty courses in 29 disciplines of modern medicine. The courses are three years for post-MBBS students. It also offers super specialty courses in 27 disciplines of modern medicine including cardiac anaesthesia, medical genetics and surgical oncology.

According to senior management executives in private hospitals who did not want to be identified, hospitals spend Rs 3-5 lakh per year on training every DNB resident and recover about Rs 1.25 lakh through annual fees.

This was after infrastructure and resource norms were relaxed for hospitals in order to increase the number of DNB seats, which were once considered inferior to PG medicine degrees offered by medical colleges but are now almost at par.

“In addition, hospitals are also required to pay a hefty stipend to every DNB resident and in states like Delhi, the students are paid Rs 80-90,000 per month,” said an executive associated with a hospital chain in the national capital.

Another executive said hospitals are already pressed due to the expenditure incurred on training residents and the growing salary burden paid to consultants.

“DNB residents are the backbone in many hospitals but the truth is also that financially it is not possible for us to raise the seats considering the stress on our resources under the present norms,” the executive said. “While a private medical college earns Rs 25-50 lakh per year from a PG student, DNB seats bring almost zero financial incentive to hospitals. So why should hospitals be interested in raising the seats?”

Crunch of specialists
Officials in the health ministry, on the other hand, insisted that the drive for additional DNB seats is part of a government initiative to increase the number of specialists in the country.

“We are also asking medical colleges to raise the number of PG seats wherever possible and a couple of years back, even 100-bed hospitals were permitted by the NBEMS to start 2-year PG diploma courses provided they met specified norms,” said an official in the medical education division of the ministry.

Government data shows the number of PG degree and PG diploma seats in the country has risen by about 78 percent over the past five years.

However, the number of specialists outside tier-1 cities is dismal. According to the Rural Health Statistics 2020-21 released by the government in May, there were 4,405 specialists in rural community health centres, the lowest level of public hospitals where specialists are posted, against a requirement of 21,924, an 80 percent shortfall.

Veterans such as Ayanabh DebGupta, cofounder and joint managing director of Kolkata-based Medica Hospitals, said DNB courses are an effective way to tackle the dearth of clinical human resources in both public and private hospitals.

“In concurrence with MD courses, DNB, too, has a centralised entry exam, a three-year tenure period, academic, clinical and research exposure, and an exit exam,” he said. “With the implementation of DNB courses, round-the-clock faculty is available to provide healthcare services. It provides services for three years in post-degree courses and two years in post-diploma courses.”

DNB is a cost-effective way of dealing with the human resource crunch and to achieve universal health coverage without an added financial burden, said DebGupta who is also a member of the health services committee at the Federation of Indian Chambers of Commerce and Industry.

“Therefore, the prospective reform for increasing the DNB seats from the current number is certainly an appreciable step,” he said. Moneycontrol