Mumbai: Around 15 lakh cancer cases are detected in India every year, adding a patient load equal to the population of a city such as Nashik. Yet several states are excluding hundreds of experienced, fellowship-trained oncologists in the private sector from treating Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) patients.
Their exclusion is not due to inadequate training or lack of experience but because they do not hold NMC-recognised super-speciality degrees such as DM, MCh or DrNB.
Doctors affected by the move told TOI that this ignores the reality that, until a few decades ago, fellowships were the only route into oncology; formal courses did not exist. Even now, it’s considered prestigious for postgraduate doctors to bag two- or three-year fellowships at cancer hospitals for hands-on training in head and neck surgery, gynae-oncology, haemato-oncology or paediatric oncology surgery.
Many of those now rendered ineligible have gone on to become department heads, medical directors, teachers and senior surgeons, each treating cancer patients over decades. Surat-based Dr Hemish Kania, who compiled data showing over 300 such doctors affected across states, said some of those now barred have even taught oncology to DM or DrNB students.
The shift in eligibility criteria is striking not only because of India’s high cancer burden, but also because of its shortage of cancer specialists. India has roughly one medical oncologist per one million and only about 4,000 oncosurgeons. Excluding 300 trained specialists from PMJAY-linked care could reduce access to treatment, especially in smaller cities where private insurance penetration is low, and substantially so for many poor patients who avail themselves of govt medical insurance.
Dr Ravi (name changed), a 42-year-old general surgeon from UP, completed a three-year head and neck cancer fellowship at Tata Memorial Hospital, Parel. In 2021, he returned to his tier-II hometown expecting to fill a gap in cancer care: the city had only six oncosurgeons, four of them fellowship-trained. He, however, finds himself barred from operating on PMJAY cancer patients.
“If four of six private-sector cancer surgeons are excluded, PMJAY patients are forced into longer queues,” he said.
In Patna, 40-year-old Dr Arun (name changed) said he is “safe” because he works in a govt hospital. “In govt hospitals, at least one member in the team is likely to have recognition under PMJAY. But it may be different if I step into the private sector,” he said.
Some doctors said their names have been removed from the HEM 2.0 portal used by the National Health Authority (NHA) to manage PMJAY. Doctors said hospitals are ending contracts because these specialists can no longer generate PMJAY claims.
Genesis of the problem
Multiple issues have led to the current problem, especially the interpretation of NHA and NMC rules by state health authorities. The genesis of the problem can be traced to before 2018, when efforts by the erstwhile Medical Council of India (MCI) to increase the number of oncology teachers began.
Dr K S Sharma, ex-academic dean of Tata Memorial Centre, recalled that between 2002 and 2010 there were very few DM and MCh seats in medical and surgical oncology. In 2011, after he joined the erstwhile MCI’s board of governors, he framed a plan to fix the shortage of teachers by expanding fellowship programmes at reputed cancer hospitals. “These fellowships were not recognised by MCI but had sanctity,” he said.
MCI introduced a rule that MS or MD postgraduate doctors with two years’ experience in a dedicated cancer hospital as senior residents/fellows could be regarded as teachers until India had enough degree-holding oncologists. Many trained fellows thus took up teaching posts in public cancer institutes, and over time some moved to smaller cities to build independent practices.
But in 2020, MCI was replaced by NMC, which issued guidelines requiring oncologists to hold recognised degrees. Fellowships were not mentioned.
When contacted, NHA CEO Dr Sunil Kumar Barnwal said NHA empanels hospitals, not doctors, and that doctor qualifications are decided by NMC. Efforts to contact NMC chairman Dr Abhijat Sheth failed, but doctors who met him said he had asked them to approach NHA.
State authorities, meanwhile, have asked doctors to obtain written clarification from NHA and NMC in this regard. As no such clarification has been issued, the deadlock continues.
Meanwhile, medical associations, including the Indian Medical Association, have taken up the issue with NMC and NHA. Doctors argue that the rule cannot be applied retrospectively. The Indian Association of Surgical Oncology wants eligibility to be extended to oncologists from premier institutions with fellowships or at least two years of training in such centres.
