Ayurvedic doctors and sanction for surgeries
Dr Anant Bhan
Is allowing Ayurvedic doctors to perform surgery legally and medically tenable? What are the issues around allowing non-allopathic surgeons to receive training for various procedures?
The story so far: On November 20, the Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry to regulate Indian systems of medicine, issued a gazette notification allowing postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures. The decision follows the amendment to the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016, to allow PG students of Ayurveda to practise general surgery.
Is allowing non-allopathic doctors to perform surgery legally and medically tenable?
The passing of the National Medical Commission Act in 2019 allowed for the formalisation of proposals to induct mid-level care providers — Community Health Providers — in primary healthcare in India, who would serve at health and wellness centres across the country, and focus on primary healthcare provision, with a limited range of medicines allowed for them to use for treatment of patients. This move had also attracted strong opposition from modern medicine practitioners, who branded this as a form of quackery through half-baked doctors. Several countries have been using mid-level care providers, such as nurse practitioners, to enhance the access to healthcare, though with strict safeguards around training, certification, and standards.
The current debate revolves around the Central Council of Indian Medicine issuing amendments to the Indian Medicine Central Council (Post Graduate Ayurvedic Education) Regulations, 2016, to allow postgraduates students in Ayurveda undergoing ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures. This was immediately opposed by many allopathic professionals, with the Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy. The AYUSH Ministry subsequently clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum, and the amendment merely added clarity and definitions to the 2016 regulations concerning post-graduate Ayurveda education.
Can short-term training equip them to conduct surgeries and will this dilute the medicine standards in India?
As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course. Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.
Will non-allopathic doctors who have undergone training be restricted to practise in rural areas having poor doctor-patient ratios?
As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas. They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.
With allopathic surgeons often unwilling to practise in rural areas, how can this problem be solved?
The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue. The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats, as well as, more recently, a plan to work on increasing the number of medical colleges and postgraduate seats. However, we would probably still continue to fall short of enough trained specialists in rural areas. We need to explore creative ways of addressing this gap by evidence-based approaches, such as task-sharing, supported by efficient and quality referral mechanisms. The advent of mid-level healthcare providers, such as Community Health Providers in many States, is also an opportunity to shift some elements of healthcare (preventive, promotive, and limited curative) to these providers, while ensuring clarity of role and career progression.
Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?
The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine. They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda. There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy. An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone. It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine. Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.
Can this lead to substandard care?
Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving. For invasive procedures, like surgery, the risk element can be high. Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training. There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.
Dr. Anant Bhan is a researcher in global health, bioethics and health policy