Is qualification of a specialist necessary?

It would trigger unnecessary litigations

Dr Ketan Parikh

In April 2002, the Medical Council of India (MCI) published a fresh set of guidelines for the medical practitioners, one of which (7.20) states that "A physician shall not claim to be a specialist unless he has a special qualification in that branch."

Whereas, the intent behind the framing the new guideline must have been noble but the manner in which it has been passed, gives an impression that the MCI was in desperate urgency to prove its existence and re-enforce its credibility rather than help the society procure better health-care.

On the face of it, this guideline seems to be rather rational, but it completely ignores the aspect of experience and knowledge and gives priority only to qualification.It also fails to define the word qualification. Do qualifications mean self-styled, home-made diploma? It also ignores the fact that medicine is an ever-expanding branch of science and ‘specialisations’ evolve when men of distinction, concentrate on a particular area of interest over several years.

Many senior specialists have got recognised as specialists in their respective fields due to their experience in that field over several years. Onco-surgery, endocrinology, neonatology are some such branches where university level qualifications were non-existent till a few years ago. Most genuine specialists in these fields have earned their recognition after either concentrating on these branches of interest for several years or being trained under such a specialist in India or abroad (once again most such qualifications are not recognised by MCI).

In fact, many of the university teachers of such specialities do not have qualifications but are internationally recognised authorities in their respective fields. It creates an ironical scenario that the student who gets a qualification is allowed to claim to be a specialist whereas the teacher who has trained him is forbidden to claim the same. Similarly, some of the still newer specialities like andrology, laparoscopy and infertility still do not have any qualified consultants but are widely accepted specialities.

Even in the litigation-conscious country like the US, a specialist is recognised by the training he has received and qualifications are not mandatory in many states. The failure to define the word qualifications is likely to lead to mushrooming of many self-styled schools of speciality where "qualifications" would be available for a price rather than merit.

The need was to identify speciality accreditation agencies which would identify specialists on the basis of their experience, national standing or qualifications and then to incorporate these names in an appropriate ’speciality register’ to be maintained by the MCI or the state councils. The guideline in its present form needs to be scrapped lest it should trigger off unnecessary litigations against the genuine specialists or permit the self-styled specialists under a garb of fake qualifications.

(Dr Parikh is a consultant paediatrician at the Jaslok hospital and the immediate past president of Association of Medical Consultants)

--

Let the common man not be duped

Dr S M Sapatnekar

There is a vast difference when the poem "Daffodil" is reviewed by a student of tenth standard, a postgraduate and a research scholar. So will differ a surgery conducted by a specialist and his assistant who has learnt the art by watching the master. A qualification displayed on the nameboard or letterheads is a clear representation to the people that the doctor possesses special skills and expertise. That should be permitted only if the doctor has udergone formal training, that is, endorsed by a Statutory University. Otherwise, it is an unsubstantiated claim that the common man may succumb to.

The common man, why even the educated, can be swayed by an endless list of qualifications that a doctor claims. Also, the guidelines would be fair to the genuine qualified specialist. So either possess a qualification or else do not display what you do not have! Let us remember the parable of Aesop where a fox was masquerading as a lion. We know the consequence.

I agree that there can be an argument about experience being as important as qualification as innumerable doctors who are practising a particular specialty because of their years of experience in that specialty. This issue can be put to rest by providing further criteria to judge the experience. The State Medical Council (SMC) will have to prescribe further guidelines in the spirit of what has been directed by the Medical Council of India (MCI). If professors are teaching a specialty just because of their experience in a Medical College, the management will be held responsible for it.

Appointments of professors are made based on the eligibility criteria of qualifications (a master’s degree in the subject) and experience (10 years teaching experience of which at least five years in the capacity of Associate professor). The experience of a doctor is valid if accrued in a recognised Medical College. Those experienced but unqualified doctors and teachers who give a false or unfounded representation to the people about their expertise without possessing it have to get formally qualified now.

If a complaint is lodged, the SMC shall cognicise it. About following the US way of giving equal importance to experience and qualification, I would say that let us not look at the US as the ultimate solution for everything. We should also remember that regulatory authorities in the US enforce Law mercilessly. They do not have a "let it be" attitude.

One acquires medical qualifications in Modern Medicine in India only after proving equal expertise in theory as well as practice of Medicine. The MCI has provided explicit guidelines for the appointment of teaching staff at Medical Colleges. These are binding provisions. MCI does make exceptions if there are sufficient grounds. But then, such exceptions are (a) based on merits of the case (b) specific to context (c) as a conscious and considered decision of its executives and (d) rarely. I feel we must believe in the official channel - MCI and SMCs- who have the legal authority and the experience. If there is any limitation in the rules or the law, the issue will be cognicised by the Government and acted upon. Beat piracy. Say no to it.

(Dr Sapatnekar is administrator, Maharashta Medical Council and the director of Haffkine Institute for Training Research and Testing)